New plants herald spring. Green shoots push through wet earth and start their wavering climb toward the sun. As lean stalks become tall -- often quite suddenly -- some slant at ever more precarious angles, bending to catch the rays. If you stake the unsteady shoots, they'll usually survive. Withhold the props and they may tilt a little too far, fall over and break.
his is the way with some children, says Robert Hendren, DO. Give them a stake when they're just starting to topple, and many will eventually straighten out. But deny a child a stake during the crucial years of emotional and mental development, and he may never thrive.
So how do you "stake" a child? Prescription drugs, talk or behavior therapy, or most likely a combination of these, are what some children need to flourish and grow, says the professor of psychiatry and pediatrics at UMDNJ-Robert Wood Johnson Medical School.
The psychiatrist, who began his medical career wanting to practice "talk therapy," says the world of child mental health care has changed dramatically since the mid-1970s. "Because of our greater understanding of the biology of the brain, we have new medicines that can make a profound, immediate and more predictable difference," he says. "You might do psychotherapy for years before seeing this kind of change."
By the time a child comes in for treatment, Hendren explains, he may be failing in school, spending part of each day in the principal's office and have no friends. The parents may be desperately trying to save an unraveling marriage.
"If you change the child's behavior, you will transform the way in which his environment
responds back," says Hendren, who is also director of child and adolescent psychiatry at UMDNJ's University Behavioral HealthCare in Piscataway. "The family will relate differently because the child is benefiting from medication. We often deal with the biology first and see what problems are left. Then we can tackle those with nondrug therapy."
Sound reasonable and positive? Yes. But there is a downside to what some describe as "miracle drugs." As many as 70 to 80 percent of psychiatric -- as well as other -- medications given to children are prescribed "off label," meaning that the drugs are being prescribed for a different use than that for which they have been tested and approved by the FDA. In most cases, those under 18 have not been included in the medicine's rigorous testing. That leaves many unanswered questions, such as what dosages are safe and effective at different ages and stages of development, which drugs are the most beneficial for a particular condition, and what short- and long-term side effects the young person may experience.
Although many psychiatric drugs that are prescribed "off label" have been used on
significant numbers of children with no reports of ill effects, Hendren contends that "there are some kids whose symptoms are so bad that it may be worth the risk of using an unproven or inadequately tested drug." The children are monitored closely and taken off the drug if they have ill effects.