Ask A Therapist: Special Needs & Medical Diagnoses

 

Early Childhood Intervention

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Therapist Questions & Answers - Special Needs & Medical Diagnoses

My son is 10+ years old and in 5th grade. He started having seizures when he was one and half years old. After six months he would get attacks (Generalized epilepsy). He was put on Tagretol. While taking his medicine, he got attacks once more. After one year his dose was increased and continued for another 3 years. His medicine was stopped by the doctors slowly in August 2006. My son is shy, quiet and an anxious kind of child. Sometimes he has odd behaviors but no complaints from school. But from the last 5-6 months, he started crying excessively, clingy and his odd behavior has increased.
His physical tests like EEG, MRI and thyroid tests were normal. He is more difficult to handle. I want to know to how much extent we should be strict with him. He is taking Cilentra as advised by the doctor. What do you think about his problem? Sometimes he says he wants to be the last in line if someone comes behind him. In the car he wants to sit down but not on the seat. We are handling him strictly yes for yes and no for no. He doesn't want to study at all. He attends school but is not doing his class work. I want to love him but his behavior or habits don't allow me to do that all the time.  I am feeing very distressed.

I am glad that you have taken your son back to the doctor for the EEG, MRI and thyroid tests to make sure that he is not currently experiencing seizures or other medical problems. I was not familiar with the drug Cilentra that you mention, but upon looking it up on WebMD, I have found that it is the Asian brand name for the drug called Escitalopram, which is commonly used to treat depression. I am not a physician, only a therapist, and my specialty is birth to age three, not school age children such as your son. However, in the USA, many physicians are very careful these days when prescribing certain drugs for depression in children and young adults under the age of 25 because sometimes these drugs can make symptoms worse, rather than better in these youngsters. Here is what WebMD says regarding the drug your son is taking:

Escitalopram Oral (Cilentra): Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.

Tell the doctor immediately if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. From what you have described it does sound like your son is very anxious, having perhaps panic attacks and being impulsive by fighting with other children if someone is standing behind him, as well as being very restless-not being able to sit in the car. These could all be side effects of the drug itself, unless these exact same behaviors were occurring before he started the medication. I also read that seizures can be a side effect of this drug, so perhaps you also want to be careful using this drug given your son's past history of seizures.

I would definitely suggest discussing your son's behaviors again with your doctor and asking him if his symptoms could have actually increased DUE to taking the new medication. You may also want to take your son to a child psychologist or psychiatrist, who may be more familiar with disorders of mood and behavior in young children. There are many other diagnoses that affect a young child's behavior, such as attention deficit disorder (ADD), but these all need to be diagnosed by a doctor and medication alone is not the answer. Children with diagnoses affecting mood and/or behavior need therapy, family training, schedules and routines for home and school life, as well as sometimes medication to help their conditions.

Make a list of what behaviors you saw BEFORE your son started the Cilentra and then make a list of what behaviors you saw AFTER he started the medication and let your doctor know if there are new behaviors or if any certain behaviors have become worse since starting his medication. If you son's behavior originally was not due to depression or a diagnosed mood disorder, than perhaps this medication is not right for him? But these are all things you will need to learn directly from a physician, psychologist/psychiatrist. I would also suggest talking to your son's teacher and school counselor if there is one, and address your concerns with them as well. Ask them to document his behaviors in the classroom, so that you can let the doctor know about the behaviors both in school and at home and how they differ, if at all.

 

Therapist Questions & Answers - Special Needs & Medical Diagnoses

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