Friday

The Medicated Child

Friday, November 19, 2010
Opinion 4 I have been working for a family for just over three years as a full time nanny who is with the children from 8:00 am until 7:30-8:00 pm Monday through Friday. I have had a great relationship with the parents and have always been treated well by everyone. The parents and I have always worked together in handling issues that have come up with the children and the parents have always respected my opinion and supported how I address situations that come up with the kids. I have a background as an elementary school teacher and a degree in child psychology also.

When the family moved out of state I contemplated going back to a teaching position or moving with the family since I had no ties and decided I would move and continue to work for the family and pursue finishing up some more schooling.

The parents’ jobs are not working out as they anticipated (they thought they would have a lot more time with the kids, which motivated them to move), and the dad is gone much more frequently now. When he does have time with the kids on weekends his latest solution is to buy them any toy they would like and just be fun dad. In the past getting new toys were reserved for special occasions, not just everyday occurrences. Also, in the past the dad was heavily invested in helping make sure all five children got some one-on-one attention with him and he was involved with any disciplinary issues. One of the children, a six-year-old boy, gets lost in the shuffle in my opinion and seems not to be getting any parental attention or one-on-one time since the move in late August of this year. When things have gotten chaotic and there have been changes in the past, like new siblings, this little boy has gotten especially rambunctious and naughty, which results in extra attention from his mom and dad.

The move has been hard on all the kids, especially this little boy. He has not made friends as easily as he did in the past, his dad is gone during the week and the only waking time he sees his dad is on the weekends, his mom has been working like crazy and has not been getting home until around his bed time, and he misses his extended family who are all still in his home state. With this being said, the little boy has been acting out by talking back to his mom a lot whenever he is with her, pushing and being mean to his siblings, hurting the baby by pinching and knocking her hands away any time she comes near him, and acting out in school by talking back to the teacher. He listens to me, does not talk back, and openly tells me how sad he is that he doesn’t see his parents much.

The little boy’s teacher had a conference with his mom, and the mom came home early the following day to spend time with the kids (this is the first time she has done this since the move and used to do this in the past), and announced the next morning in front of him that little boy is out of control, she doesn’t know how I put up with this everyday without wanting to kill myself. She also informed me that she is making an appointment with a psychiatrist because or his behavior and had already spoken to the therapist who informed her that he probably has an impulse control disorder and will most likely need to be medicated. I was shocked to hear this and I told the mother this and that I would like to speak to her later without the kids around. I told her I am very against medicating a child unless absolutely necessary and there is no other alternative. I also told her I am surprised this is the first option she is looking at as to how to treat the issues occurring. I suggested that she enroll him in counseling and tell the counselor she would really like to wait on medicating him until she knows that it’s absolutely necessary. Her response was that he is out of control with being mean and aggressive to his siblings and the teacher complained about his disobedience in school and she never thought about medicating him until problems in school developed.

I am so upset and disturbed by this because I know he is not a child with a chemical imbalance that requires medication to function as expected. I also know that he acts out when there is chaos surrounding him and I think that his entire life has changed so drastically, but instead of addressing these changes in the family dynamics, the mom has just decided medication is the easiest way to handle the situation. I do not think I can continue to work for this family if the result of parents not being able to spend time with their children is by medicating them. I do not want to leave the family and am very attached to them, but I’m not sure what I can do in this situation. Obviously these are not my children and the parents get to make decisions like this, but it is so hard for me to sit back and watch a big mistake occur. Does anyone have any suggestions? I have not heard the dad’s opinion about the situation and am tempted to talk to him. I know he really comes to me for advice about the kids and values my opinion. I do not want to go behind the mom’s back or disrespect her. Any thoughts on what I should do?

20 comments:

MissMannah said...

I agree with you, children should not be medicated unless absolutely necessary. Their brains are still developing at such a rapid rate that any chemicals introduced could really mess it up.

The doctors know this as well and I got the impression from your post that the boy hasn't seen a psychiatrist or neurologist yet, so he has no reason to be on meds yet. He can't get meds just because mom says so if the doctor doesn't recommend it.

Don't go behind mom's back and talk to the dad, wait until he brings it up if he does. Maybe from time to time casually mention to mom how well the boy did with you on a certain day, and encourage his teacher to do the same. This boy is dying for some positive reinforcement, not medication to "fix" what's wrong with him.

5 kids for 12 hours a day?? Girl, you must be some kind of saint!

bostonnanny said...

This is what our society has come too. I'm sorry you have to go through this but I think you need to sit down with the mom and tell her what you told us. Remind her of your degree and experience and try to guide her. She could just also be over reacting because of the stress of her job.

myob said...

I think that you are not the child's parent. A decision to put a child on medication is a parent's and a parent's alone. This child should be diagnosed and if he needs medication, a doctor will prescribe it.

I would be cautious of accepting diagnosis from ISYN posters: they have not met the child nor are they qualified to diagnose him. lol

As the child's caregiver, the only thing you can do is recommend the child be seen and evaluated: sounds as if the mother is going to do this. Your philosophy of medicating children should not come in to play at all, in my opinion.

I have a special needs child who is not on medication. Her pediatrician is not a big fan of medication unless absolutely necessary and frankly neither am I. However, I respect a parent's right to make medical decisions concerning their child.

It seems to me that your philosophy and values are clouding your ability to respect these parents' abilities to parent their own child.

Rocket Scientist said...

myob, did you miss the part where she explains in detail that this is obviously a behavior of acting out because of the little boy's loneliness? The parents make the decision, of course, but they should make a fully informed decision, not one based on stress, only partial information, and a desire for him to be "good"!

OP, if I were you, I would ask for a meeting with the parents. They need to see your point of view, as you spend so much more time with him than they do. Also, you are the only constant in this little boy's life right now! He is in a new home, new school, new teacher, new classmates, far away from old friends and family, with a new situation of very limited time spent with his parents. How do they expect a 6 yo to deal with that much stress? Good luck!

Chrissy said...

My 8 year old son suffers from OCD, bipolar disorder, and is on the autism spectrum. It took months of testing and interviews before he was diagnosed and medicated. Any good doc will look at the child's behaviors from infancy on up and will not medicate just because the boy is acting up since the move. I had to provide a very extensive log of my son's behaviors since birth. I also had to see 3 different doctors until someone would take me seriously. I wouldn't worry about it yet. The doctor will set this mom straight.

Elle said...

"My 8 year old son suffers from OCD, bipolar disorder"

Impossible!

Psychiatrists should not be diagnosing Bipolar disorder this young, esp in conjunct with the other referenced diseases.

TC said...

Sadly there isn't a darn thing you can do, I've been down this road with a family member.

My cousin and her husband have 4 children and once they started 'misbehaving' she found people who said the kids needed meds and put them all on major drugs. Major drugs that caused major side effects like hitting puberty, including a period at 9yrs old. The parents loved it because the kids just sat there like zombies.

I called CPS as did other people and nothing happened.

Not that I recommend this but when I would have my cousins at my house and they were on Ritalin (not the stronger stuff) I would just 'forget' to give it to them yet still take the pills out of the bottle so that it looked like I gave it to them

In your case you can try to talk to mom again, make sure you tell her hes talked to you and what his fears are and then I would tell her that you wouldn't be able to continue working for them if they chose that route....you aren't telling them how to raise their kids you are just saying you can't work for them if they go down that road

another nanny said...

Honestly, I think you overstepped your bounds and missed a golden opportunity by immediately becoming confrontational "I don't believe in medication." If I was the mom, I would definitely hear that as criticism. It could have been better approached with, "You know, I think Tommy is having a hard time adjusting to the move. He could probably benefit from some counseling to help him through it." Or "They said the same thing about my little cousin, but his parents decided to try therapy first, and it helped a lot."
Although you made a mjor move with the family, you still have your same job. You are not dealing with having a new job, having less time with your kids, and having the school jumping down your throat about kid's behavior. My guess is that Mom is really stressed right now.
I disagree with a therapist who will diagnose and recommend meds over the phone. I disagree with giving kids meds as a quick fix. That having been said, the child's behavior sounds serious- at 6 years old, he knows better than to be aggressive toward an infant.

optimist said...

You must have your hands full watching five kids. Your job will be easier if the kid who misbehaves is medicated. Medicated kids act like zombies. You can take a break and not be a referee or bodyguard for the baby. I say encourage this. Maybe mom boss will like the results of her drugged child and decide to get them all medicated and you can have a relaxing job.

Jenn said...

I a a former nanny who finished grad school and is now a full time social worker who works intensively with children and adolescents with Serious Emotional Disturbances. I have to be honest with you, most of the kids I work with are over medicated and misdiagnosed. There are very few professionals out there who really take the time to really get to know and diagnose a child correctly. You wouldn't believe some of the diagnoses some of the kids I work with have that are way off base. On top of that the number of medications these kids are on is ridiculous.

I don't blame you for being concerned, especially when the little guys is only 6 years old. I would encourage you to speak up and let your mom boss know your opinion and thoughts. You are the one who spends the most time with him. I would suggest trying to do it in a manner that is not judgemental and accusatory. Remember that your mom boss is probably concerned and is feeling fed up because she doesn't know what else to do. I would definitely try therapy and other interventions before medicating him. I'm certainly not anti-medication as it can do wonders when used appropriately, but just think it needs to be used more cautiously especially in children so young.

Good luck OP!

Jenn said...

Chrissy-

I am not trying to be rude but there are many medical professionals who diagnose and medicate children without spending much time with them at all. Some of the kids I see have just been diagnosed and medicated by their pediatricians. You are fortunate to have someone who spent a lot of time and effort before diagnosing and medicating your child. I would encourage you to question a Bipolar diagnosis in such a young child though. Bipolar has become a very popular diagnosis for kids/adolescents in the past several years. Many of the kids I work with have that as one of their diagnoses but don't show the true manic cycles that must be present to be truly Bipolar.

I know having a special needs child is very difficult and I'm not criticizing you at all. I hope that you are getting the right help and support for your son and that he is doing well.

nycmom said...

As a psychiatrist I say the best thing you can do here is ask mom if you can also speak with the new doctor to give information. Explain that you spend a great deal of time with the kids and would like to contribute your perspective. Any good doctor is going to want your input. Most Child and Adolescent Psychiatrists agree that medication is a last resort. It is also WELL known that the primary problem with most of these kids is their parents. Unfortunately you usually can't change the parents. But most good docs will want to get the family into family therapy and attack this from all angles. Most will also very much want to try therapy, especially with a 6-year-old, before going to meds. The only time meds are looked at as an early option is in cases where the child is becoming dangerous to himself or others. Hopefully the parents don't get stuck with a bad doctor. Though this is another area where you may be able to contribute positively. Do some research yourself on finding C&A Psychiatrists with a good reputation in your area and help mom find a great doctor. It can make all the difference!

Gracefire said...

I know it may be very hard for you to see this child that you obviously care about end up being medicated, but, please, for the sake of that little boy, try yo to stick it out. It sounds like the root of his problems is all the upheaval he has experienced. You leaving would just be another upheaval and would only serve to traumatize him further.

Also, to the people who say it is "impossible" to diagnose a young child with things such as OCD and bipolar, please mind your own business. Unless you have walked a mile in the shoes of the parents who deal with that particular child, keep your opinions to yourself.

Bostonnanny said...

Chrissy, my 8 year old brother has aspergers which is autism spectrum. I don't want to criticize you because I don't know your child but children with AS can often be misdiagnosed with OCD, and even di-polar because the characteristics of children with AS are similar. SInce Aspergers has only really been recently researched in the last 20 years many doctors don't know much about it. These children need more therapy rather then medication. They need to be taught in schools that specialize in special needs.
If your son has Aspergers I highly recommend you get a second opinion from different doctors and psychologists that know the disorder. Also do some more research, Aspergers can be hard to deal with but those children are exceptionally bright and just learn differently.

a book you might like... said...

We've Got Issues by Judith Warner is a book you might want to check out. She takes a close look at the "ickiness" many of us feel when it comes to medicating kids, and concludes that in most cases kids are actually being under-medicated, not over-medicated. I am not saying that's what's going on with your charge-- not at all. But this book might give you some useful perspective on the situation.

Chrissy said...

Elle,
Who are you to say my son couldn't be bipolar at such a young age? Are you a child psychiatrist? You sound like an idiot.

To all of the others who had the same concern but were polite about it, thank you. I know kids are misdiagnosed a lot nowadays, but we had him tested by 3 different psychiatrists (not telling them what his previous diagnosis was) and they all came up with bipolar. It is more and more common with children as young as 4 or 5 nowadays. I know A LOT about BP in kids from lots of research I've done, and my son displays all of the symptoms (the book The Bipolar Child could have been written about him). I knew something was different with him since he was not even 2 years old. Also bipolar in children most often includes OCD, sensory integration disorder, ADD (or what appears to be ADD but is actually just the child being manic), and some autism-like behaviors.

Anyway, my life is hard enough struggling with my son everyday. I don't need some moron like Elle saying he couldn't be bipolar because of his age. Hopefully whatever doctor the OP's boss takes her charges to won't be quick to diagnose and medicate like some are.

Bostonnanny said...

Chrissy,
Does your son have AS or does he just have bipolar with similar symptoms to autism? I'm just curious, I'm very interested in special needs children and how their characteristics differ. I haven't taken my class in special needs and would love to hear about parents personal experiences with their special needs children.

If you feel uncomfortable talking about it on a blog I understand.

BipolarNanny said...

Some people just don't have a clue. Did it not occur to some of you that the reason more and more people are being diagnosed with bipolar disorder at a younger age is because we're learning more about it and are able to see it easier in younger children?

I wasn't diagnosed until I was 25 years old and when I told my mother and she read up about it, she told me I could have been diagnosed when I was 5 because I've been acting this way for so long. She knew there was something wrong with me back then but everyone just said I was hyperactive and moody.

If you suspect something might be off about your child, don't hesitate to get a psychological evaluation! Spare him the 20 years of wondering "why the hell isn't everyone as angry as I am?" that I went through. But also keep in mind that a lot of medications have only been approved for adults and some can make children worse. Behavioral therapy is usually the best way to start off.

Kristin said...

As a mom, I have to tell you that I really value the input of my children's teachers and nannies. I think most parents are probably like me and realize that you often see a side of our children that we don't, because your relationship is different. It sounds as though this poor mom is just under so much stress she may not be able to step back and look at the situation clearly. Five kids, a new move, no family around, the dad is always gone, and she's working all the time?! She probably just can't handle this added pressure of a child acting up and can't figure out what to do.

I wonder if you could try approaching her again in a more indirect way. She knows about your degree, and it sounds as if this family really values you. I think she will be receptive to what you are saying--if she is not concentrating on the possibility that you might be criticizing her parenting. I liked the suggestion somebody had about describing a similar a situation, about your "cousin," who really benefited from therapy. Also, if you could volunteer to share your experiences with the child with his therapist/psychiatrist, I think that would be great. Finally, as the mom of a little boy who acts up a lot and is in therapy now, I have a feeling that anything positive you have to say about this child will make this mom feel so good. So let her know about what he says, the nice things he does, etc!

You sound like such a thoughtful, loving professional. They are lucky to have you!

caresforkids said...

I am the OP.

Thank you all for your advice. I really appreciated the suggestions to ask to speak with the therapist and share my thoughts and views on this little boy.
To follow up, there is an appointment this week for the little boy and his mother. I told the mom and dad both that I was very concerned about this situation and want to do whatever I can to help. The dad wanted to hear about my concerns and the mom seemed frustrated with me for bringing this situation up and not just agreeing with her. She did not end up staying in out meeting to discuss her son and I was told she would meet with me and discuss this after she discussed it with this new therapist. The dad was very interested in what I had to say and was receptive to my suggestions with what to do going forward. To end our conversation he thanked me for my input, agreed I should speak to the therapist also, and will not agree to medication until other options are exhausted.
I feel badly that the mom was upset with me for not agreeing with her but also know I would feel worse if I just went along with things. I hope in time she will come around and see that we all wants what is best for him and although we don't agree on what the solution might be we can agree that medication should not be the first or only solution.
Thanks again!