Risks of Medications for Children
Prenatally Exposed to Alcohol
© 2004 Teresa Kellerman
Medications should never be used as a means of sedating a child so that they will be quiet in the classroom or anywhere else. Medications are not to be used just to make it easier for parents or teachers to "control" children who are active or unruly. Many children are naturally active, noisy, and impulsive, some more than others. Natural impulsivity and activity in young children should not be controlled and should not be thought of as abnormal.
However, some children have neurological dysfunction that makes it impossible for them to consistently control their own behavior in a safe manner and in ways that allow them to interact with others without placing themselves or others at risk of injury or abuse. Sometimes the child's brain dysfunction impairs his or her ability to function normally in the family, in the classroom, or in the community.
In cases of neurological impairment, such as that which occurs in children exposed prenatally to alcohol (with or without a diagnosis), the brain damage causes an upset in the complex chemical balance in the brain and the central nervous system. Treatment to help restore the brain to maximum function may include medications such as stimulants or antidepressants.
Medications can be an integral part of a treatment program that includes dietary adjustments, vitamins, a sound behavior management plan, and counseling for the child or the parent or both.
In trying to decide whether or not to include medications as part of a treatment plan, the parents and prescribing physician will want to take into account the risks of taking certain medications.
It is wise to consider the risks of NOT medicating as well.
Without medications, a child may have little or no control over his or her behavior. There will be frequent incidents of memory lapses that interfere with ability to remember rules and school lessons. There will be frequent lack of impulse control and poor judgment, with the following potential consequences:
Decreased self esteem
Inability to engage in and maintain healthy peer relationships
Increased risk of accidental injury
Increased risk of being subjected to physical abuse
Increased risk of being subjected to teasing or ridicule
Frequent punishments and negative consequences
Suspension and/or expulsion from school
Exclusion from school events and/or community activities
Withdrawal and/or depression
Aggression and/or violence
Arrest or involvement with the law
Abuse of alcohol and/or other drugs
Suicidal thoughts or attempts
For children who are exposed prenatally to alcohol and have no serious mental health issues, the medications that have been found to be most successful are a combination of Stimulant and SSRI (anti-depressant). Stimulants, in order of their effectiveness in treating children and adults with FASD, inlcude: Adderall, Concerta, Dexedrine, Strattera, and Ritalin. SSRIs that are known to help children and adults with FASD inlcude: Paxil, Prozac, Zoloft, and Celexa. Doctors who are experts in the field of medications for FASD have noted that the stimulant seems to help the SSRI stay effective longer, and the SSRI seems to take the edge off the rebound effect that is sometimes observed with stimulants.
For children who are prenatally exposed to alcohol who also have serious mental health disorders, the above combination either will not be enough, or will not help at all. In some cases, like childhood Bipolar disorder, stimulants or antidepressants could make symptoms even worse. Sometimes this is the first indication to a doctor that the child has more than just FASD. For children who are prenatally exposed to alcohol and who also have a serious mental health disorder, a different set of medications might be needed. For more information on medications that have been found helpful in treating children and adults with FASD, see http://www.come-over.to/FAS/meds.htm
It is important to try one medication at a time, starting with a low dose and increasing until results are observed. If the effects are desirable, you know it works. If the effects are not desirable, try a different medication. Since several different neurotransmitters could be out of balance, there might be a need for several different medications to restore that balance.
If medications can minimize the serious consequences listed above, if medications can give a child more control over his or her behaviors, if medications can facilitate a child's ability to function with greater success in the family, the classroom, and the community, then in my opinion it would be criminal to deny children and adults the medications they truly need.
Here are the reflections of other mothers who have made decisions to medicate or not medicate their children with FASD: http://www.come-over.to/FAS/MedsMothers.htm
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