the drugs don't work

June 10, 2008 9:48 AM

What can we do? Kid's parents are divorced and his mom wants him to be on drugs for ADHD/bipolar disorder, but his dad is vehemently against it. He's 7.

His mom took him to three doctors before she found one who said he is bipolar, an assumption the doctor made in one visit. His dad said he won't give him any medication because 1) he's seven, 2) he doesn't seem that out of sorts, 3) he needs discipline more than a drug to wipe him out and 4) he's already in counseling and his counselor says she sees no signs of him being bipolar. (In counseling because his mom thinks that the divorce has traumatized him beyond saving him & he had some trouble in kindergarten not listening to his teachers.)

His mom demanded that it was doctor's orders and that he NEEDS to be on the medication, so they compromised to give him a half pill for a "trial period." (Which we thought would be a couple weeks but is actually three months!) So then this morning (before he comes over for the week) she casually dropped the bomb that "the doctor called on Friday and said that he needs to be given a whole pill now..." His dad didn't want him on ANY pills in the first place and now she's changing his dosage without consent.

We're trying to avoid court, but we don't want him to be on medication for the rest of his life. What the heck can we even do?!

posted by thisisfake to health & fitness (33 comments total)

What does the divorce decree say? The child custody arrangements?

I'm not sure this is a situation where you can or should avoid court. Dad should be calling his lawyer; a meeting with a judge may happen; the judge may assign someone to mediate between mom and dad, or to make additional medical assessments.

If mom and dad are not able to negotiate this situation themselves, then I don't understand why you want to avoid court - it's what it's there for, in custody situations like this.
posted by rtha at 10:00 AM on June 10, 2008

IANAD

Do Mom and Dad have joint custody? Dad should definitely speak to his lawyer
immediately.

Research the side-effects and long-term consequences of the use of ADHD stimulant meds- I recall reading about users developing heart valve problems. (you didn't say what meds he is using) Mom might be interested in this information.


Make sure Dad has records of the child's diagnosis from the doctor and then insist on a second opinion. (although it sounds as though Mom will resist this.)


You haven't said how son responded to the medication- does Mom say there has been an improvement?
posted by mistsandrain at 10:02 AM on June 10, 2008

Regardless of how overprescribed stimulants may or may not be, I sure wish someone had taken notice of my problems when I was growing up, or else I wouldn't have spent my entire life feeling like a total fuckup. It wasn't til I was 31 that I found out that hey, maybe I'm not just a smart person trapped in a stupid person's body. Even if you don't personally believe ADD exists or whatever, it can have a very real effect on a person's life. Would the father refuse to give medication if his child was diagnosed with diabetes? Depression?

They should take it to court or see an arbitrator, and get a second opinion on the diagnosis. But don't let this kid become a pawn in this apparently acrimonious divorce. It sounds like you may be the father's new girlfriend. If so you should be letting the parents resolve this, it's not your place.
posted by loiseau at 10:17 AM on June 10, 2008 [3 favorites]

Ditto what loiseau said. It sounds like there are some very unreasonable people involved struggling at polar opposite ends of the issue. Essentially what has happened over the last decade or so is that ADD has been wantonly overdiagnosed in people who do not have it and the detractors have taken this to mean that ADD does not exist. The truth is that is both overdiagnosed in the general population and underdiagnosed in those who actually have it. The suggestion to take 1/2 pill as a compromise is rubbish, that's not how medications work. If the child doesn't improve, what will that even mean? That the medication didn't work or that 1/2 pill wasn't effective?

I would agree with the idea of some sort of arbitration/mediation, maybe even by the child's current counselor, with both parents present. Some goal setting may be a good idea as well; i.e., how long do we keep him on the meds/keep adjusting doses until we decide it doesn't work?
posted by mattholomew at 10:31 AM on June 10, 2008

i'm skeptical about the 'half pill' process ... from my experience, that really wouldn't be a proper 'trial period'. that sets off my bs detector big time.

the option for medication is somewhat subjective, but if she had to go through three doctors before she found one that was willing to medicate indicates that the kid might not need the meds. as long as the kid can function in school without problems, i think dad's right.

in my divorce, medication and psychological treatment was a major issue. it required me to obtain legal rights above normal joint custody, which took a year and two court visits. would have been harder except my ex was self medicating.

i would stress to mom that medication should be used when there is a significant problem at school. school behavior is a good indicator because it's usually more objective then perental observation. if this kid is not causing major disipline problems, and functioning at an acceptable level in school then waiting a few years to start meds won't hurt.
posted by lester's sock puppet at 10:35 AM on June 10, 2008

Am I missing something? Aren't the drugs for bipolar quite different from ADHD? Are we talking Lithium, or Ritalin?
posted by miss tea at 10:39 AM on June 10, 2008

I think rtha's right, this is perhaps not a situation for which mom and dad should be avoiding court.

It sounds as if it is going to be difficult for mom and dad to agree on this issue without some sort of mediation. Why is mom adamant about this diagnosis? What are the credentials of the counselor -- is this person qualified to diagnose? Is dad opposed to psychiatric medication completely, or would he agree if he was comfortable with the doctor who prescribed it?

I've had friends' kids who were pushed toward medication by their schools, or have been given some pretty doubtful diagnoses (willfully ignoring dysfunction at home) in order to get them into LD programs. On the other hand, I've known kids who were textbook ADHD or Aspergers whose parents never got them the help that they needed. Nthing to counsel against letting this kid become a pawn in a battle of conflicting expectations/ideologies of parenting.
posted by desuetude at 10:41 AM on June 10, 2008

I am the father's new girlfriend of three years, yes. He just gets pissed instead of trying to come up with a solution, thusly I ask here. I just want to offer helpful suggestions. I live here, I can't just act like nothing is happening.

The medication is Tenex, which isn't FDA approved for use in children under 12.

His dad agreed to getting him evaluated and agreed that if reports were conclusive one way or the other he'd be willing to give medication a try. However, the first two doctors said there was nothing wrong with him and the last neurologist said he is bipolar in one visit.

The initial onset of the medication wasn't the best, he slept in two hours longer than usual, had nightmares, sat around like a zombie and hardly ate. Then he acted normally for the next two weeks (we have trouble noticing changes because there didn't seem to be anything wrong in the first place -??) and last week he was at his mom's and she said he's been aggressive and easily agitated, so they're just bumping up his dosage....
posted by thisisfake at 10:41 AM on June 10, 2008

I would think that any counselor (even if not a psychiatrist, etc.) is pretty well-versed in detecting mental illness in their patients. It seems like 1 out of 4 professionals thinks this kid has a problem (which is also one of the mental illnesses that usually strikes around adolesence). Also seems like 1 out of 3 adult supervisors thinks the kid has a problem.

You should really try to stop the mom, whether she needs therapy herself or just wants to zombify her kid, because 2/7 is far from conclusive. The kid is seven! What seven year old doesn't have some behavioral problems, especially with divorced parents and all the ping-pong lifestyle changes that brings about.
posted by shownomercy at 11:02 AM on June 10, 2008

This sounds really similar to a situation I was recently in. I sent you MeFi Mail about it.

On the other hand, I would be really, really skeptical about the bipolar diagnosis. And if, as you say, he acted normally in the first place, being 7 years old may in fact be his only "problem".
posted by kiripin at 11:09 AM on June 10, 2008

Whether or not drugs are called for (and which drugs those would be), it sounds like both parents need to be working together ASAP, because the kid is going to need consistent parenting and guidance one way or the other. Maybe that would be the place to start.
posted by Good Brain at 11:21 AM on June 10, 2008

I don't think this is the place to discuss whether ADD is overdiagnosed because none of us have met this kid except the OP, and most of us aren't medical professionals. That being said, my understanding of joint custody arrangments is that both parents get to make medical decisions and when they can't agree, a court appoints a mediator. (IANAL either, but my mother fought for sole custody for just this reason - I had a lot of medical problems growing up and she didn't want to get into a standoff with my father.)
posted by desjardins at 12:00 PM on June 10, 2008

in conjunction with miss tea: are these bipolar meds or ADD meds? 2 pretty different things.

also, I don't know much about ADD medication, but I do know quite a bit about mood disorder medication, and 3 months for a mood disorder med trial is not especially unusual. anti-depressants, for example, can take up to a month or more to get to full effectiveness. OTOH, that's usually also a "ramp-up" period, with gradually increasing dosages, and it doesn't sound like this is quite what's going on.

knowing nothing about psychiatric care & kids, especially in the context of a divorce, but my instincts are with those above who say to get a lawyer and/or mediator involved.
posted by epersonae at 12:06 PM on June 10, 2008

Perhaps his counselor, the father, the mother, and the doctor who prescribed the medications can all meet so that everyone's concerns can be addressed, and a treatment plan can be put into place.

Even if he does have bipolar (which doesn't necessarily mean he needs to be medicated) then coordination of treatment is important--his counselor and the doctor prescribing his medications need to discuss his treatment and work as a team, with BOTH Mom and Dad as full participants in their child's care. At the very least, your partner needs to learn about his son's condition so that he can participate in its treatment.

I would also suggest that your partner keep an open mind. Bipolar is cylical, and there might be something there that he's not seeing. Sometimes kids are on their best behavior when they're with the non-custodial parent. I don't know why Mom would be on a mission to medicate him unless there were something "off", but of course, I don't know the people involved.

In counseling because his mom thinks that the divorce has traumatized him beyond saving him & he had some trouble in kindergarten not listening to his teachers.)

Do you agree that he needs counseling?
posted by sondrialiac at 12:11 PM on June 10, 2008

My first thought is to wonder if there are significant differences in how he acts in each household. It may well be that there are stressors at his mom's, or he feels like he needs to behave more around his father and you because discipline is stricter or he doesn't feel secure, or he blames one parent or the other for the divorce, or any number of things. Do the parents ever spent time with their son together? What do his teachers say?
posted by hippugeek at 12:33 PM on June 10, 2008

get a diagnosis from a psychiatrist specializing in children. many general pracitioners prescribe stuff like this without fully understanding or having enough experience to manage the medication.

also, with many drugs like this, less dosage does not equal less effect....it's not like salting your food. half a pill may have been completely ineffective or even made him feel worse.
posted by thinkingwoman at 12:37 PM on June 10, 2008

BUT, fwiw, my sister was bipolar from age 3--and wasn't actually diagnosed until she was an adult. it does exist in children, and it can be very hard to identify. so take that as you will. that's why i'd suggest the psychiatrist.
posted by thinkingwoman at 12:38 PM on June 10, 2008

You can get an emergency court order to stop the treatment till the case is resolved. Psychoaffective drugs for a little child are irresponsible and cruel.
posted by ChabonJabon at 12:42 PM on June 10, 2008

I'm speaking as a parent who has a child that was just diagnosed with ADHD and a minor mood disorder. I can not speak to the bi-polar disorder. I'm sure others who post can speak directly to that


First, make sure the father has copies of all evaluations done on the child. If this takes a court order, then so be it. You need proof of the diagnosis.

There should have been multiple tests done, including written evaluations from the parents and the current teacher. I don't know if the parents would be given two sets of the parent evaluations to fill out since they're divorced. It should be asked about. It may also help to ask to do a parental evaluation and submit it for consideration with all the other tests.

The evaluation we received on our son was 7 pages long and detailed each test administered, each evaluation submitted and their results. It also detailed what everything combined meant. When we met with the child psychologist to go over each page of the results, he explained to us that ADHD needs to be reported in multiple areas (home and school, for example) and having a negative impact for there to be a diagnosis. So, is Mom reporting one thing but the teacher is reporting something else? Did Mom "shop around" for the diagnosis?

Second, find out the names of all the individuals who have evaluated the child. Find out what their qualifications are. Are they child psychologists, a neurologist, a physician, etc? If the evaluation was done by a psychologist, the child would be referred to a psychiatrist who could then prescribe the meds for ADHD and work with the child on treatment, including counseling.

Third, has a child study been requested through the child's school? If so, and if it has been done, what are the results? Get a copy of those results as well. Again, this is more proof of a real diagnosis.

Fourth, as suggested above, bring all treating professionals, parents and, possibly, lawyers together for a consult. There's a HUGE mismatch here between one individual diagnosing and several others not. This mismatch needs to be resolved. I urge this to be resolved before more changes occur in the meds.

Be prepared for Dad to have to step in and fight for custody if it turns out that Mom really did shop this around to get a diagnosis she wants. Seriously, if she did, why did she?

While the child may benefit from counseling because of the parent's divorce, the statement that "the divorce has traumatized him beyond saving him" scares the crap out of me.

Also, if the child really does have ADHD or bi-polar disorder, meds may indeed be appropriate and called for. What needs to be determined first is IF this child really has these issues or not.
posted by onhazier at 12:48 PM on June 10, 2008 [2 favorites]

If she might be open to it, you might have the mother watch this Frontline about how giving children bi-polar medication can permanently screw them up and even kill them. It has a lot to say about how doctors can be quite wrong, and how the dosages are complete guesswork when it comes to children.

That's not to say that there's not something here worth medicating -- though I'm very skeptical -- but I would err on the side of caution. At the very least, it should make her think twice if she cares about her son.
posted by Nattie at 1:18 PM on June 10, 2008

First, lawyer up and find out from the doctor what exactly has been said and done.

Any good ADHD/personality assessment should include evaluations of the child's behavior by both parents, done independently. And from teachers. You may make better progress if you can get your child's school psychologist involved and have him do ADHD, behavioral, and learning disability assessments which will give both parties some objective information. All the involved parties sitting together in a room with teachers, a school administrator, a school psychologist, and a fat stack of test results has a way of diminishing drama. And if the mom refuses to let this assessment be done, talk to your child's teachers and see if they can refer him to the school psychologist for a screening. And lawyer up some more.

In my experience parents who see a medical doctor before a school psychologist for problems like ADHD or bipolar disorder have some really unhealthy attitudes towards their children. The fact that the child's counselor has never noticed any ADHD-type problems and has not referred him for any school-based screening, but three different doctors were consulted is setting off major warning bells.
posted by Benjy at 1:34 PM on June 10, 2008

There are several problems here that need work:

1. Is son being properly diagnosed? Under this heading there is a significant subset of questions that many previous comments have addressed.

2. If there is a diagnosis does he need medication?

3. If there is a diagnosis are there alternative therapies rather than meds?

You should contact your lawyer now- she may be able to suggest a path (through the advice of a child advocate/ parenting coordinator/ child psychologist) for your family and the ex-wife to follow to determine what is going on w/ son and what steps to take with fair involvement from Dad.
posted by mistsandrain at 2:00 PM on June 10, 2008

Meta.
posted by desjardins at 2:21 PM on June 10, 2008

definitely lawyer up and reread what onhazier wrote. Especially the parts about getting documentation from all of the doctors. A counselor who's been seeing him on an ongoing bases, and two doctors who might have seen him on multiple occaisions versus one doctor (who being the third, might have been a bit more "well chosen" who diagnosed nearly onsight.

It's sad to hear that this just makes your boyfriend angry, but he has to get over any negative feelings towards his ex, and start thinking about his son. She's his son's mom; he can't get mad at anything to do with her, nor badmouth her. At the same point, he's his son's father, he can't abdicate responsibility. It sounds like the two of you (and most of mefi, but we count way less than you two) disagree with the method of diagnosis, and the meds. So fight. But be good adults while fighting.

For those asking, Tenex AKA Guanfacine is high blood pressure medication which is sometimes prescribed for ADHD.
posted by nobeagle at 2:25 PM on June 10, 2008

He just gets pissed instead of trying to come up with a solution...

He needs to put his grown-up hat on and act like one: he needs to advocate for his child, because his child cannot do it for himself.

Onhazier's comment looks like an excellent guide to how a diagnosis is handled, presented, and documented. If Dad doesn't know if this stuff was done, he needs to get on the phone to the doctors now. If he needs to talk to the ex to get the doctors' names, he needs to to that now. If neither he nor the ex can talk to each other without yelling, this is what laywers are for (you pay them a lot to yell for you). Even if they can talk to each other civilly, if they can't agree on a course of treatment, they need to talk to lawyers, and judges, and mediators.

A lot of us here suffered from divorced-parents-blowback. It is anything but fun, even when it's fairly mild. Do not dick around "trying to avoid court." This is about a child who cannot make decisions for himself and deserves to have someone competent help him.
posted by rtha at 2:35 PM on June 10, 2008 [1 favorite]

You better tell the dad to get the lawyer involved. I don't know about custody issues and the sorts, but the dad's lawyer sure does.
posted by hal_c_on at 2:54 PM on June 10, 2008

The poor kid is a pawn in Mom and Dad's squabbles. It doesn't sound as though either parent is able to be a parent, and put the child's needs first.

This isn't trivial stuff - mom and dad are jacking with a developing child's brain chemistry. Before you get dismissive of the one visit diagnosis, keep in mind - Mom and Dad diagnosed it with no medical degree. No one here know what medication the child does or does not need.

We do know that that this child needs someone who doesn't care who wins in the Mom v. Dad battle. The best advice you can give the parents is to have an advocate appointed for the child. It's a big step, but it's better than playing roulette with a child's longterm brain function.
posted by 26.2 at 3:30 PM on June 10, 2008

As backward as it might sound, I think the parents need to be out of the decision-making on this particular issue. They need to mutually agree on a judge/mediator to obtain independent medical evaluations and assess the results. The parents at this point--no matter how hard they try, no matter to what degree they refuse to believe it--have tied this issue up in their own animosity, and for them it is now probably more about each of them trying to win the argument. It's not that the parents should not be concerned and involved, just that they need to be adult enough to recognize that their decision-making (and the judgments of those who have already taken sides) on this important issue is tainted by something else.

And btw (as someone diagnosed with severe ADHD at age 38 and now thriving on medication after a lifetime of frustration) the idea of being on medication for life is not a tragedy, if it is something that makes one healthy. You wouldn't discredit the idea for someone who has diabetes or asthma, so it's wrong to do so automatically just because the condition is a mental one.
posted by troybob at 3:43 PM on June 10, 2008 [1 favorite]

That kid needs a guardian ad-litum. A lawyer whose client is the kid, who will stand up for the kid's rights. If he needs treatment, he should get it. If he doesn't, he shouldn't.
posted by gjc at 4:47 PM on June 10, 2008

Wow. I'm generally in consensus that there's been some mismanagement here, but some of the scenarios being assumed and concocted in various places in this thread are kind of sinister.

A few points below. For the record, although I was not diagnosed as a child I have chronic health issues that started in my teens, and I've been round the block in the medical system.

1) "Shopping" for a diagnosis doesn't have to be malicious per se. If she's seen behavior that's convinced her that something is really wrong - and maybe the kid's acting very differently at her household - than she's trying to find a medical authority to provide answers and help. Doctors can dismiss legitimate concerns or fail to see problems outside their specialties, too. There's nothing wrong with looking for a second or third opinion. On the other hand, there's a such thing as pathologizing your child and refusing to accept the doctor's addressing of your concerns. Obviously, none of us can tell you which one the kid's mother is up to.

Also, I'll note that if she's skipping steps in the diagnosis procedure, it may be out of confusion or an impression that the "normal" authorities (i.e. at school) are misguided, not out of malice.

2) It is completely normal for a doctor to be able to diagnose a complex condition in one visit, if it falls within the purview of their specialty. Nothing fishy about that.

3) If one doctor feels your bf's kid has bipolar and several others don't, that doesn't necessarily mean that the one doctor is wrong. Maybe s/he is! Maybe the other two are. You pointed out that the diagnosing doctor is a neurologist, which suggests to me that the other two aren't. My health issues require me to see a variety of different specialists, and I can tell you that they disagree, and unsettingly, have no idea what the other doctors are talking about, all the time. You need a second opinion, but this doesn't mean the neurologist is a quack.

4) Your description of the medication onset period makes me worry more about the couple communication issues and mutual "medication culture" biases crashing than about the medication. Apparently, the doctor thought after observation that perhaps the kid should go straight to a higher dose, without hearing feedback from the father about concerns over medication. The father freaked out over the dose increase and saw it as a power play/attempt to get what the mother really wanted (medication) rather than, say, a decision after observation to see whether the benefits of the medication can be brought out sooner rather than later. The mother assumed the father was on board, or knew he wouldn't be but carried along anyway.

On a 3 month trial plan, it's perfectly all right for the doctor to tweak timing a bit; this is perfectly all right as long as everyone knows what's going on.

5) There is NOTHING wrong, in principle, with being on medication for life. It takes care, especially if one starts in childhood, and if it's not necessary it should of course be avoided, but the sense of lurking horror really isn't necessary. Please don't stigmatize. The kid will notice, believe me. I did.

6) All the adults in this mess need to sit down, chill out, and think about their biases, because as it is, you all are seriously just playing games with this kid's welfare and not really getting anything done. Medication is not automatically bad. A diagnosis is not automatically bad. However, the kid might be fine. You're not going to figure this out until you talk to each other, so do exactly what onhazier says. But stop making assumptions about the "other side" until you do, and concentrate on the kid.
posted by bettafish at 7:50 PM on June 10, 2008

Who has primary custody of this child? Has one parent spent considerably more time with the boy than the other? What I am getting at here is that in a situation like this what is in the child's best interest is what's most important, not some power play. I can see that you are on Dad's side--does Dad really know the boy better than Mom?

Let's assume he does. Rather than making this uglier than it has to be, then, I would certainly ask to sit down (Dad, Mom, you, and other involved adults) with the counselor first as a team, and then with the doctor recommending medication. If Dad doesn't have the power to enforce this (for example, if Mom has control over the child's medical stuff), then consider getting a lawyer to deal with this.

For what it's worth, you may very well be right that the child needs no medication. But it's also possible that Dad is in denial about the son's condition. So talk to all the experts rather than relying on what could very well be emotional baggage left over from the divorce.
posted by misha at 8:03 PM on June 10, 2008

I've had severe ADHD and bipolar disorder since I was a child. I finally saw a psychiatrist in my late twenties who diagnosed me and put me on meds. Over the years, drugs have been added and changed to find the right mix for me. Being on meds for life is not at all a bad thing for me. It has enabled me to live a normal productive life. Without them, I would probably be something akin to a Bowery bum.

Is it possible that your bf is troubled by the stigma of having a son with a mental illness? It's not the end of the world. Many people who have chronic mental illnesses are able to lead good lives.

I agree with many others here that a third party is needed to sort this out. I'm just trying to suggest that, if the mother is correct, catching a serious mental illness early and treating it early are good things. I wish someone would have taken me to a good psychiatrist when I was a kid. It would saved me a lot of pain.
posted by SteveTheRed at 2:09 PM on June 12, 2008

you are very stoung person I Hope Everthing go the best
posted by jarrybomb at 9:38 PM on June 17, 2008