> Treatment with medication
> Treatment with psychotherapy
> Combination of treatment methods
Treatment with medication
General
We are constantly finding out more about the effect and application of most drugs. However, the long-term effect of these drugs is still an unknown factor. It is therefore necessary to deal with psychopharmaceuticals in a very careful fashion. When a child is prescribed medication, there are a number of important moments: informing the parents and child about the drug, performing a physical examination and phasing out or discontinuing the drug. There is now a protocol for ADHD, the theme for which the most medication (also referred to as stimulants) is prescribed. No protocols have yet been developed for the other themes. There is often too little known about the effect and adverse effects of certain drugs for a protocol to be drawn up.
For this reason, the Dutch Knowledge Centre for Child and Adolescent Psychiatry is helping to develop these protocols. Part of this help involves keeping track of the research literature on the different themes. The treatment specialists also use specially designed forms for keeping track of what is prescribed to patients in various cases and what their experiences with these drugs are. In this way, we will know more and more about the effect and adverse effects of medication.
In some cases, the parents or child will be asked to keep track of the potential effects of the medication on a form. Depending on the drug used, regular check-ups may be performed. The results of these check-ups are then recorded on the treatment specialist’s check-up form. The check-ups are conducted for both the safety of the patient as well as for the sake of scientific research into the effect of the drug in question.
Medication form and checklist
Parents and children must be well-informed about the drugs that are prescribed. The following is a checklist that can be used by both parents and treatment specialists:
• the reason the drug is being prescribed
• what and what not can be expected in terms of effects
• the exactness of the times that the drug must be taken
• the adverse effects that can occur in greater or lesser frequency
In many cases, treatment does not only involve administering medication. Medication is often combined with forms of psychotherapy (see combinations of treatment methods).
Treatment with psychotherapy
General
Protocols have also been drawn up for treating conditions with psychotherapy. These are rules which specify how one should act in certain situations. As part of the treatment of a condition, parents and children are sometimes referred to this kind of protocol. By reading these protocols, children and their parents gain a better understanding of the treatment itself, the steps being taken, why these steps are being taken and what is expected of them during the treatment. The protocols have a solid scientific basis and, in many cases, have been thoroughly studied and shown to be effective.
So far, most treatment protocols are fairly general. For example, there are treatment protocols for anxiety disorders or for behavioural disorders. This will probably change in the future, as the treatment protocols do not work for all children. This is sometimes due to the child itself (every child is different) and sometimes due to the kind of problem or circumstances.
Therapists therefore always pay close attention during the therapy to whether their method is catching on. During the therapy process, they assess the protocol in light of the individual child. This can ultimately lead to the current protocol being amended.
Cognitive behavioural therapy (CBT)
Psychotherapy often involves the use of cognitive behavioural therapy (CBT). CBT is a collective term for a number of similar therapies in which children learn to look at themselves and their environment in a way that corresponds to reality. This makes it easier for them to interact with other people. CBT also helps children control their mood so that they can make better decisions in their daily life. There are variants of cognitive behavioural therapy for various disorders, such as anxiety disorders, depression, post-traumatic stress disorder, behavioural disorders and eating disorders. The therapy is suitable for adolescents, adults and family. The therapy is useful to a lesser extent with respect to young children aged four and older. A CBT programme can vary in duration from three months to roughly a year.
In more concrete terms: Cognitive behavioural therapy has been shown to be effective in many cases.
Combinations of treatment methods
General
In many cases, medication and forms of psychotherapy are combined. Since the adverse effects of drugs are not always known, treatment specialists often exercise restraint with respect to prescribing medication. Psychotherapy is often tried first. Depending on the result, a decision can be made as to whether or not to administer medication. When psychotherapy has the desired effect, medication does not need to be used in a number of cases.
In the case of some disorders, such tics and sometimes ADHD, medication is started immediately. The medication makes the patient calmer so that he or she is more receptive to psychotherapy. In other words, the patient is prepared for the psychotherapy.
Frequently, it is precisely a combination of medication and psychotherapy that proves to have the best conceivable effect. Psychotherapy sometimes enables the patient to take a lower dose than when no psychotherapy is applied.
In general, the right combination and the right form of therapy can only be achieved in consultation between the treatment specialist and the patient and his or her parents/caregivers. The patient must tell the treatment specialist whether he or she has benefited from a certain treatment with psychotherapy and/or medication. Based on these experiences, the treatment specialist will further explore the treatment options and may make new proposals to the patient. Ultimately, the patient is the one who decides whether or not he or she wants to continue with the treatment.
