This book comes at a high time: psychiatric medications for children have been front-page news. Untoward effects of Prozac and Paxil, including risk of suicide, led to warnings on packages. Widespread use of stimulants to treat attention deficit hyperactivity disorder (ADHD) has been debated. New, powerful anti-psychotic medications have increasingly entered the picture, although scientific support for their use has been spotty.
The author, a top child psychiatrist at the University of California, San Francisco, has, besides his M.D., a Ph.D. in pharmacology. He writes straightforwardly, balancing enthusiasm and caution regarding medication, paying due respect to psychotherapy and parent education. He divides his book into four sections: “Beginning to Take Control,” “Understanding Behavioral and Mood Disorders,” “Getting to Know Psychiatric Drugs,” and “Looking Beyond Medications.” He explains disorders of behavior and attention, depression and mania, anxiety, obsessive-compulsive disorder, sleep problems, and developmental disorders including autism.
“All too often my patients start as labels rather than children,” writes Elliott, asserting that parents, influenced by teachers, pediatricians, or things they have read, are too ready to accept diagnoses superficially made. Parents often expect miracles, when medications are only one element in a complex process of evaluation in which no two cases are exactly alike, and several trials may be needed before the best approach is determined. While drugs often have side effects, Elliot points out that overreaction to hazards can deprive patients of effective treatments.
Psychopharmacology remains an inexact science. Readers will gain an overview of medications and how they are used (not necessarily how they work, since often the mechanism is not known): antidepressants, stimulants, tranquillizers, mood stabilizers, etc. Elliot cautions against choosing the newest drug, because the relatively brief testing before marketing may not reveal the downside of long-term use. He endorses generic drugs, when they become available, because they are far less expensive than brand names. He covers practical issues of health insurance, describes the roles of professional helpers, offers interesting case examples, and provides a list of resources. A bibliography would have helped, at least a mention of notable books like The Boy Who Couldn’t Stop Washing by Judith Rapoport, and How to Keep Your Teenager Out of Trouble and What to Do if You Can’t by Neil Bernstein.
Most pediatricians and general psychiatrists have too little experience treating psychiatric problems of children. Teachers are the front line in dealing with these issues every day. This excellent book is a boon not only to parents, but also to educators, physicians, psychologists, and others who work with kids and families in a society where most childhood psychiatric disorders go undiagnosed and untreated.