Monday, March 27, 2023

Regarding last week’s “Name Withheld” letter to the editor (“It’s Time to Sound the Alarm,” October 6, 2016), who are you and what are your qualifications to write this? Yes, there are likely children who are misdiagnosed, but the majority of children sent for evaluation have a real clinical diagnosis. They often have struggled for a lengthy period of time. Their parents, families and friends have watched them suffer and be unable to participate in basic life events such as birthday parties, bar/bat mitzvahs, sitting in a restaurant, reading a book, traveling on an airplane or even taking a short road trip. These parents have consulted multiple professionals and agonized over the decision to medicate their child. Maybe you are one of these parents and maybe this is your reaction to a negative experience you had with mental health professionals. If that’s the case, it is very unfortunate, but writing such negative generalizations that blame psychiatrists and guilt parents is completely false and actually places children at high risk.

All children are unique. All symptoms have different levels of severity and impact functioning differently so each child must be evaluated based on his/her own circumstances. As a clinical psychologist, I work with the children who suffer, those who fall into depression and can’t seem to just be a child and snap out of it, those who have debilitating anxiety, preventing them from enjoying even their own celebrations/triumphs, and those whose real symptoms of ADHD have detrimental impact on their self-esteem and social skills. I work with their parents, who are at their wits end trying to do everything to help their children. The parents who cry all night as they watch their kids have trouble falling asleep, staying asleep or wake up screaming, frightened from nightmares. The parents who daven to Hashem to give them strength to continue to help their child since they are truly exhausted and depleted. Have you ever sat with a parent trying to help an unmedicated child do homework, especially after a long day at school where it was hard enough for the child to just successfully stay in his/her seat? Have you ever sat with a mom in a psychiatric ER waiting room as her child, her baby, is being evaluated for suicide? Have you ever seen a teenager with unmedicated bipolar disorder and watch the chaos that literally takes over, often involving self-injurious behaviors such as cutting and head banging? Well, I have, and it is not just part of regular childhood experiences. Mental illness—it is REAL!! It is excruciating! The suffering is unnecessary since we have effective, research-based treatment that often includes medication. The stigma must end and we as a community must be empathic, supportive and encourage each other to get help as needed.

Often, children initially go to several doctor’s appointments to rule out anything medically based, then come to a psychologist for evaluation, behavioral, cognitive and psychodynamic treatment. I look at all of the potential factors that could be influencing what is happening. I look at family life, classroom set-up, diet, social interactions and learning issues, just to mention a few. And yes, we try to make environmental modifications to help the child function optimally. Sometimes that is sufficient, often it is just a piece. However, only after all options have been exhausted is a referral made to psychiatry. And the psychiatrists, especially the ones in this community, are well-trained professionals who care for these children like they are their own. They are careful not to over-medicate as these children still have developing bodies and minds. The symptom relief that is experienced is real and sometimes life-saving. Medication also helps the child maximize their use of the therapy. It is hard enough to teach coping skills to a 10-year-old, but nearly impossible with one who just can’t seem to stop crying and feels so helpless and out of control. So, please, PLEASE tell me why you would encourage parents not to medicate?! They feel badly enough already that they are at the point where this is their only option. This letter is so dangerous and unacceptable. No one should judge anyone else. Each family must make the right decisions for their child.

By the way, teachers sometimes spend more time with your children than you do and they see your child in a different context that requires different skills. Their information is very valuable and should be taken seriously. Medication should be the last resort but when it is prescribed, it is usually necessary since, without it, there would often be unnecessary prolonged suffering. If you are so concerned about children being able to enjoy being children, then we should celebrate that we have ways to help them fully participate! There is valid research that shows that the brain chemistry for those who have a psychiatric diagnosis is different, and I don’t know of any psychiatrist getting a kickback from a pharmaceutical company… screaming fraud is beyond frivolous.

My message to all of the parents out there with kids who are suffering: be brave and don’t judge yourself. You need to fight for your child to be able to achieve his or her potential in life, no matter what that might be. If that means some medication along the way or even long term, so what? Hire competent professionals who come recommended and you can trust, question everything, keep them informed of all side effects, large or small, and any changes that you observe. And...most importantly, as hard as it can be sometimes, when it gets very dark, you are at your breaking point and you don’t think you can take it for one more second, just look into your child’s eyes, find the sparkle and remind yourself that there is always tomorrow...

Michelle R. Kohn, Psy.D.

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