This is a question that many foster, kinship and adoptive parents ask themselves and their children’s physicians. It is an important question to ask for several reasons. During the past two decades more and more children with emotional and behavioral disorders have been prescribed medications from a growing list of available ones. Usually these medications are safe and effective. But sometimes they are not. Sometimes they are not even approved for use in children. Even when a medication has proven to be helpful, parents may feel that they have not been educated about issues like possible side effects, recommended duration of treatment and non-medication options. Occasionally parents feel that a quick, superficial evaluation followed by what feels like a "knee jerk" prescription has replaced a thorough evaluation and broader plan of treatment. Given the large number of psychoactive medications available, parents need to know that their child is on the right one.

In this article we will discuss these issues and review what a medication evaluation should include, how a recommendation for or against medications is determined, which disorders warrant medication treatment, which medications are appropriate for which disorders, and how medications should be managed.

Let’s begin with the medication evaluation. While several categories of adults involved in a child’s life may say, "This child needs to be on meds," only a licensed physician is actually qualified to make this decision. So while experienced teachers, professional mental health workers like social workers, therapists and psychologists, and even well-meaning relatives may feel that a child would benefit from medication treatment, only a physician can write that prescription. Which physician evaluates your child will depend upon availability. In large metropolitan areas you may be able to see a child psychiatrist. In rural areas far from the big city you may be seen by a family physician. The most important thing is that the physician who evaluates your child has experience doing this kind of work, has a good understanding of children, and will be able to provide timely follow up to evaluate your child’s response to medication.

So, how does a physician know if medications are indicated? The answer to this question is complicated, but basically, diagnosis determines medication. A diagnosis is a consistent, recognizable set of symptoms and signs. And a correct diagnosis can only be arrived at by conducting a thorough evaluation.

The evaluation of children is complicated. For one thing, because children are not yet cognitively mature, their descriptions of what they think and feel and how they behave is usually pretty simplistic even when it is accurate. We must therefore rely upon the observations of reliable adults who are familiar with the child. This process is of course more challenging in the case of foster and adopted children, because their parents may not be totally familiar and up-to-date regarding the child’s history. Nevertheless, an appropriate evaluation involves gathering information about the current problem; past emotional, behavioral and medical problems; pregnancy, labor and delivery; developmental milestones; academic history; social history including the nature of family functioning prior to and since the current placement; family history of mental and medical illness and substance abuse; any history of trauma, abuse, or neglect and other information.

In addition, the physician doing the evaluation will pay close attention to the child during the evaluation noting level of consciousness, intelligence, verbal abilities, insight, thought processes and sociability. At the conclusion of such an evaluation, the physician will probably be able to develop a case "formulation" which is a description of the interplay among biological, psychological and social factors that best accounts for the child’s problems. As a part of this formulation, one or more diagnoses of psychiatric disorders may be made. It is these diagnoses that determine a recommendation for medication. Only psychiatric disorders, not psychological or social diagnoses, warrant medication treatment.

What are the psychiatric diagnoses? These are disorders of brain function, many of which have a chemical or neurological basis. In psychiatry, we categorize the more common ones as follows:

• Mood Disorders: Major Depression, Dysthymia, Bipolar Affective Disorder.

• Anxiety Disorders: Overanxious Disorder of Childhood, Panic Disorder, Phobias, Social Anxiety Disorder, Performance Anxiety Disorder, Separation Anxiety Disorder, Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder.

• Psychotic Disorders: Schizophrenia, Major Depression and Bipolar Disorder with psychotic features, certain intoxications.

• Disruptive Behavior Disorders: Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder.

• Developmental Disorders: Pervasive Developmental Disorders including Autism and Asperger’s, Mental Retardation, Fetal Alcohol Spectrum Disorders.

• Substance Use Disorders: Alcohol, drugs.

• Personality Disorders: not diagnosed in children younger than 15.

Each of these disorders is associated with a specific set of symptoms. This allows us to set up diagnostic criteria, that is, a certain number of consistent thoughts, feelings and behaviors that are required to be present in order to make the diagnosis of a given disorder. Once the diagnosis is made we can turn to the various medications that we know can be effective at treating the underlying chemical or neurological problem causing the disorder.

What medications are available to us? Let’s take a look at the various categories of psychoactive medications.

Antidepressant and Anti-anxiety Medications: