Kids On Meds by Dr. Kevin T. Kalikow is both an education and a go-to guide for the medical professional and layman alike. Parents will find this book particularly informative, whether they want to know how the body uses psychiatric medications or if they are even right for their child.
A cautionary note in the beginning of the book states that “writing a prescription for medicine is the last in a series of steps” (Kalikow, 2011, p.1). Kalikow goes on from there to take novice and professional alike through the process — from evaluating signs and symptoms (and their origins: situational, organic, etc.) to the moment of decision: do we medicate or not in this situation?
From there, says Kalikow, the subjective signs and the resulting symptoms (which the doctor collates from observation and evaluation of both external and internal environments) should result in medication only if the calculated risk outweighs the damage that would be caused by not intervening medically. In many cases, health is often quantitative, not qualitative. In this case a nonmedical therapeutic approach might be indicated in the lesser but use of medication definitely would be beneficial in the greater, depending on the effect the issues have on the patient’s quality of life.
Kalikow takes the reader through the history and evolution of psychopharmacology and defines the many terms in use so that the reader will be well informed when talking with the professionals. Parents and advocates alike will be on the same page when making the important decisions that will affect their child.
Starting with Chapter 6, Kalikow offers composite or fictionalized accounts of children and adolescents in examples that underline the premises and choices in treatment he describes. He makes the very important point that this entire process of psychiatric evaluation realizes its success in fully understanding the patient’s behavior in order to arrive at proper treatment. He also identifies risk factors like “how comfortable should prescribers be when giving these medications to developing children” (Kalikow, 2011, p. 330)? In effect, does medicating stigmatize the patient? Or does it legitimize and therefore bring comfort to their situation simply treating a disorder like any other disease?
The tables provided for drug names and dosages are clear and helpful to parents who need facts as well as the diagnosis itself and to follow the course of treatment.
Kalikow supports his statements with documented studies on drug families and the way the brain works with and without them, as well as each medication’s life cycle and the reason behind its name. An entire, lengthy chapter is devoted to the definition of and medications for use with ADHD symptoms. Other areas, such as the prescribing of antipsychotic drugs for use with Tourette’s syndrome, also are treated in-depth detail.
The dissonant tone in the book regards prescribing medicine for those who do not fit the criteria for any noticeable disorder (i.e. the treatment of symptoms without diagnosis). While I understand that this might be a necessary issue in emergency cases it goes against my feelings and experience that, in most cases, children reflect their environment. I do not like to blame parents, but so many times I have seen people focused on their child when the entire family unit is laboring under dysfunction. The patient is then the scapegoat. This happens, I think, much more often than we care to admit. The guilt of the parents and the stressors in their daily lives may be what keeps them from seeing clearly. Although the doctor touches upon this phenomenon, I got the impression that he does not feel that it is as endemic. In most cases, it seemed that he would tend toward the prescriptive answer.
Kalikow does consider teachers, the family physician and others in the child’s life besides the parents to be important in gaining an objective baseline regarding the patient’s behavior. This is a technique he uses to chart the history of the therapy going forward.
The rise in numbers of child disorders such as ADHD and the augmented use in medicinal answers is the very important question for this book to address, “Are we using these too often or not enough” (Kalikow, 2011, p. 331)? This issue can be answered only on a case-by-case basis. Every single human being is unique physiologically and mentally. Environment compounds this issue. Then, too, there is a move toward identifying biological causes for some disorders.
I would have liked to see the chapter on Alternative Medicines and Treatments enlarged, although I must concede that this is not the doctor’s area of expertise and he does not pretend it to be. He made a good point regarding how many patients do not think to mention the use of, say, St. John’s Wort (in conjunction with treating depression) when they are listing “medicines” their child is taking. Here the doctor points out how important it is to communicate completely with the health care professional for the best results. He was also painstaking in his research regarding the remedies he listed.
It is no wonder that this process needs to be monitored by qualified personnel, informed parents and other advocates for our children. The book addresses this issue as well as serving as an easy-to-read reference to make some sense between the facts and the art of psychiatric medicine as it affects children and adolescents.
Kids on Meds: Up-to-Date Information about the Most Commonly Prescribed Psychiatric Medications
By Kevin T. Kalikow, MD
W.W. Norton & Company: September 12, 2011
Hardcover, 448 pages