Biological Interventions for Emotional/Behavioral Disorders

Medication

One of the most important concepts concerning the use of medication as treatment for biologically based emotional/behavioral disorders is that medication does not "cure" the disorder. but modifies specific symptoms of the disorder. Although medication can be effective with individuals identified as emotionally/behaviorally disordered. several logistical issues must be given consideration. Brown. Dingle. and Landau (l994) suggest that a pervasive problem is making sure that the individual is taking the medication as prescribed. Following medication schedules is complicated by the fact that medication may be prescribed for long periods of time and that parents and/or children may be ambivalent about the medication. Medications often have to be administered at school. and dispensation may be affected by school staff attitudes and availability. In addition, community attitudes and beliefs regarding the appropriateness of using drugs with children may intrude on the parents' decision-making process regarding medication.

Although the use of medication with children has increased greatly since its first use more than 60 years ago, the use of psychoactive medication for children has increased at a far slower rate than for adults (Wiener & Jaffe. 1985). The physician must not only be concerned with the individual child's personal status, but must evaluate the child's environment, potentially biased evaluations of those associated with the child, and the actual and potential effects of other interventions being applied with the child, including special education services (Shea & Bauer, 1987). Yet, among adults, medication is the primary method of therapy supplemented by other forms of treatment for some adult mental disorders (Baldessarini, 1985). Systematic research regarding the efficacy and safety of pharmacological agents in children, however, has been a recent phenomenon (Brown, Dingle, & Landau, 1994).

Several groups of medication are in general use with children and youth (Brown, Dingle, & Landau, 1994). Antidepressants are primarily used to treat depression, with target behaviors such as appetite and sleep problems, fatigue, lack of energy, and problems in attention and concentration. Antidepressants may also be used for nocturnal enuresis, sleepwalking, night terrors, school phobias, and with individuals identified as having both Attention Deficit Hyperactivity Disorder and mood or anxiety disorders. If the individual with Attention Deficit Hyperactivity Disorder has severe side effects, the antidepressant is prescribed with stimulants (Brown, Dingle, & Landau, 1994). Antidepressants are usually started at a low dose and adjusted until an optimal effect on target behaviors is attained. Throughout the time during which the antidepressant is used, both target behaviors and side effects should be monitored. The range of effective doses of antidepressants varies across medications, diagnoses, and individual differences, including the child's size and metabolism.

A less frequently used group of medications is antipsychotic drugs. However, a limited number of drug trials exists with children and adolescents using antipsychotic medication (Brown, Dingle, & Landau, 1994). Among children, antipsychotic medications are most commonly used for such developmental disorders as autism and severe aggression, with target symptoms of overactivity, aggression, hallucinations, delusions, and agitation.

The most commonly prescribed medications for children and youth identified as emotionally/behaviorally disordered are stimulants. Of these, the two most frequently prescribed are Ritalin and Dexedrine. Dexedrine is used with children who have not responded to Ritalin. The side effects of stimulants are similar and can be managed by administering the medication early in the day, after meals, and planning the time for other doses. An advantage of stimulants is that they last a short time, so may be administered when behavior is most problematic (Brown, Dingle & Landau, 1994).

There are several other medications that are used less frequently with learners identified as emotionally/behaviorally disordered. Antihistamines are sometimes prescribed for children and youth with insomnia. Antianxiety agents are very rarely used because few data on their efficacy and safety with children are available. These medications are reserved for times and occasions when other interventions are insufficient or inadequate (Brown, Dingle, & Landau, 1994). The use of antianxiety agents is discouraged for individuals with Attention Deficit Hyperactivity Disorder because they can produce symptoms of excitation and agitation.

Anticonvulsants are generally not the agent of choice for emotional/behavioral disorders and are typically used only when children have not responded to other medications (Brown, Dingle, & Landau, 1994). With regard to other medications, lithium is an effective treatment of bipolar disorder, depression, and severe impulsive aggression (Bukstein, 1992). Clonidine is effective with mood and activity level in some children with Attention Deficit Hyperactivity Disorder who are highly aroused, overactive, impulsive, and defiant.

Diet

In 1980, the National Advisory Committee on Hyperkinesis and Food Additives issued a position statement that there is no evidence to support the claim that artificial food coloring, artificial flavoring, and salicylate produce hyperactivity and learning disabilities. The Committee suggested that changes that are observed in children's behavior are related to what is called a "placebo effect." Even more recent studies have demonstrated no link between food ingested and problem behavior (Pescara-Kovach & Alexander, 1994).