Maryland school mental health alliance*

Maryland School Mental Health Alliance*
Medication Management in Children and Adolescents
Information for Clinicians

Definition
Psychiatric medications are any medications used to treat a mental health disorder (for
example, ADHD, Depression). Medications under the prescription of a treating medical
professional and when taken as prescribed, along with the other non-medication
interventions, can be important elements in the successful treatment of psychiatric
disorders. Medications can help to control symptoms, make other kinds of treatment
more effective, and most importantly, may help to reduce the barriers to learning and
enhance school and life success.
Some facts to know
• Medications do not cure mental illness – They may not cure mental illness, but
in many cases, along with other non-medication interventions (therapy, parent and family support), they can help a person function despite some continuing mental pain and difficulty coping with problems. • Length of treatment depends on the individual and the disorder – Some may
only need to take medication for a set time period and then never need it again; others may have to take medication indefinitely. • Medications may not produce the same effect in everyone – Some people may
respond better to one medication than another, often times due to factors such as age, sex, body size, body chemistry, physical illnesses, diets and other treatments. Some may need larger doses versus smaller doses, some may have side effects, while some may have no side effects, and some may experience minimal symptom relief as opposed to having complete symptom relief. • Good reports from families and teachers – Families and teachers often report
that the combination of medication and therapy has allowed their child to better participate in school and function at home. • Only used when benefits outweigh the risks – Medications should be used only
when the anticipated benefits outweigh the risks. • It is not unusual for children/adolescents to require changes in dosages and/or
medications over time. It is important to regularly monitor the impact of medications. Why do we care?
• Although many individuals with mental health disorders can be very successful in life by utilizing non-medication interventions only (e.g., individual, group, or family therapy, parent and family support), medication management may also be a factor that may help in the treatment of a mental health disorder or it may help to make these other forms of treatments more effective. • Without proper identification and treatment, mental health disorders in childhood may have serious consequences, such as school failure, family stress, problems with relationships, problems developing social skills, substance abuse, delinquency, and risk for accidental injuries and death. • As with any intervention, a case-by-case decision-making process is necessary depending on the child’s diagnosis and individual needs, and the decision to medicate should be made solely by the child’s parents or caregivers and a medical professional experienced in diagnosing and treating childhood disorders.
The most increasingly recognized and treated mental health disorders in childhood and
adolescence are Attention-Deficit Hyperactivity Disorder (ADHD), Depression, and
Anxiety.
• The medications most commonly prescribed for ADHD are called stimulants.
These include methylphenidate (Ritalin, Metadate, Concerta), ampethamine (Adderall) and dextroamphetamine (Dexadrine, Dextrostat). Some non-stimulant medications such as bupropion (Wellbutrin) and atomoxetine (Strattera) are often used as alternative medications for ADHD for children who do not respond well to stimulants. • The medications most commonly prescribed for Depression are called
antidepressants. These include, but are not limited to: fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), imipramine (Tofranil), and buproprion (Wellbutrin). • The medications most commonly prescribed for Anxiety are called Anti-anxiety
medications. These include, but are not limited to: alprazolam (Xanax), lorazepam (Atrivan), diazepam (Valium), clonazepam (Klonopin), diphenhydramine (benadryl), hydroxizine (Vistaril), buspirone (BuSpar), and zolpidem (Ambien).
What can we do about it?
If you have a case and you are unsure if medication is indicated, consult with a
psychiatrist or other medical professional and consider if a referral would be appropriate.

What happens next:
o If you are referring a child to a medical professional outside of your setting then you should meet with the parent and the child to discuss why you are making the referral, including why you think the possibility of medication management should be considered. It is recommended that you encourage families to at least attend one appointment to consider their options. o If a medical professional who is able to prescribe medication is part of the team in your setting, you should meet with the family and the medical professional so that everyone involved in the case is aware and so that a collaborative decision can be made. o The parent and child should be educated on possible medications for the child, other treatments available, the risks and potential side effects (short-term and long-term), what the research shows regarding specific medications, how and when to take medication, and answer any other questions the parent and child may have. o If it is decided the child will try medication management, then the medical professional will need to know the child’s medical history, other medications being taken, and other background information, if he/she does not know it already. o The child will then begin a trial of taking the medication while being monitored closely by you, the parent, and the medical professional (and other caregivers if possible). • Some questions you may want to prompt parents to ask:
o What is the name of the medication, and what is it supposed to do? o How and when will my child take it, and when does he/she stop taking it? o What foods, drinks, or other medications should my child avoid while o Should it be taken with food or on an empty stomach? o What are the side effects, and what should I do if they occur? o Is there any written information available about the medication? o Is this medication likely to be covered by my insurance? • After the child begins medication management:
o Help to monitor the child to make sure he/she is actually taking the medication and taking the proper dosage on the correct schedule (especially if this is occurring in your setting). o Keep in touch with the medical professional who prescribed the medication, with the parent, and with the teacher (if possible). Discuss all favorable results as well as any negative side effects. o Recommend that the parent notify all caretakers involved in the child’s life (e.g., other family members, teachers) so that they can also actively monitor the child; however, it is the parent/guardian’s and the child’s decision as to whether they want to notify others about the child taking medication.
Key Resources/Links
1. National Institute of Mental Health – This webpage/printable booklet is
designed to help mental health patients and their families understand how and why medications can be used as part of the treatment of mental health problems. It also offers a children’s medication chart that lists brand and generic names of medications under each of the main childhood disorders.
2. U.S. National Library of Medicine and the National Institute of Health
(Medline Plus) – The website offers an alphabetical list of drugs, supplements,
and herbal information. It also provides you with an explanation of why this
medication is prescribed, how this medicine should be used, precautions, side
effects, storage conditions for the medicine, brand names, and other important
information.
3. The Center for Health and Health Care in Schools – Psychotropic Drugs and
Children: Use, Trends, and Implications for Schools. This brochure discusses
the use of psychotropic medications specific to the school population.

4. American Academy of child and Adolescent Psychiatry – These articles
discuss psychiatric medication for children and adolescents specific to how medications are used, types of medications, and questions to ask when becoming educated on medication management. and and 5. National Institute of Mental Health (Your Child and Medication) – This
article tells parents what you need to know about your child’s medications. 6. Children and Adults with Attention-Deficit/Hyperactivity Disorder
(CHADD) – This website offers information detailed information regarding
AD/HD.
7. National Institute of Mental Health (NIMH) – This article is specific to
antidepressant medication management for children and adolescents with 8. The Mental Health Association of Maryland (MHAMD) - seeks to increase
research and greater public understanding and awareness of the needs of children and adults with me *Developed by the Center for School Mentaln collaboration with the Maryland School Mental Health Alliance.

Source: http://www.schoolmentalhealth.org/Resources/Clin/Medicationmanagementclinicians7.28.08.pdf