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MAY 2007

Your Child In The Balance: An Insider’s Guide For Parents To The Psychiatric Medicine Dilemma by Kevin T. Kalikow, M.D.

Few situations are as distressing for a parent as having a child who has problems. Even more distressing is when there seems to be no simple fix, or when the solution may create significant risks.

In this thoughtful, accessible and practical book, Kevin Kalikow, a child and adolescent psychiatrist with a private practice in Westchester County, explores the compelling question of when–and if–psychiatric medicines should be used and for whom. As a parent himself, Dr. Kalikow’s sympathy for parents’ dilemmas in difficult situation is palpable, and reassuring.

The critical question, as he succinctly expresses it, is “Does diagnosis drive treatment, or has available treatment begun to drive diagnosis?” The prevalence of Ritalin for the treatment of what has been considered an epidemic of attention deficit disorder diagnoses, for example, is one of the most striking examples. Parents, teachers and physicians are quick to “solve” the problem of an overactive or restless child with a recourse to Ritalin. As Dr. Kalikow asks, “Can a child’s difficulties be reduced to a label?”

And then there’s the issue of whether the problem is really the child’s, or the adult’s–as when an overburdened teacher can’t handle a student who has difficulties sitting still, or a mother is exhausted from meeting the demands of her restless pre-schooler. Is it reasonable to put a child on medication so she can focus on schoolwork, or reduce her anxiety in new social settings? What if there was a magic bullet to eliminate whining, or even sadness in children? He asks us to consider that “symptoms are frequently the result of an interaction between our biology and the environment we choose to live in or our style of living within that environment.”

In fact, Dr. Kalikow wonders if the prevalence of medicine to address a wide variety of behavioral issues means that we’re too quick to abandon other strategies to change behavior. He believes that parents are correct in having qualms to use medicines on their children, when the full effects on those-still developing brains are still unknown.

Further, he suggests that “Perhaps the most pernicious consequence of taking medicine is that it can prevent parents from learning to accept their child as he or she is.” A powerful concept, and one to take quite seriously before embarking upon these medication for one’s child–this is a book whose message deserves as wide an airing as possible.#

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