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      For parents, the decision to medicate or pursue talk therapy for
children suffering from mental illness is never easy and should involve
extensive research.

     Pills vs. Talking
      When It Comes to Mental Illness, Parents Face Dilemmas Over
Medication, Talk Therapy
      By Bryan Robinson
      ABCNEWS.com
      June 7, 2004- When Chad Taylor noticed his son was apparently
experiencing serious side effects from Ritalin prescribed for attention
deficit hyperactivity disorder, he decided to take the boy off the
medication. Now, he says he may be accused of child abuse.

In February, 12-year-old Daniel began displaying some symptoms that
his father suspected were related to the use of Ritalin.
      "He was losing weight, wasn't sleeping, wasn't eating," Taylor told
ABC News affiliate KOAT-TV in New Mexico. "[He] just wasn't Daniel."

      So Taylor took Daniel off Ritalin, against his doctor's wishes. And
though Taylor noticed Daniel was sleeping better and his appetite had
returned, his teachers complained about the return of his disruptive
behavior. Daniel seemed unable to sit still and was inattentive. His
teachers ultimately learned that he was no longer taking Ritalin.

      School officials reported Daniel's parents to New Mexico's Department
of Children, Youth and Families.Then a detective and social worker made a
home visit.

      "The detective told me if I did not medicate my son, I would be
arrested for child abuse and neglect," Taylor said.

      A spokesman for New Mexico's Department of Children, Youth and
Families told KOAT-TV that they could not comment on the case because of
state confidentiality laws. John Francis, a detective for the Rio Rancho
Department of Public Safety, said that Taylor was not threatened but told
KOAT-TV that parents could be charged in situations like his.

      "People can be charged with child abuse, child neglect or various
other crimes involving a child," he said.

      More Kids on Antidepressants

      Taylor is among many parents facing a dilemma over whether to medicate
children who suffer from mental disorders. A recent study by Express Scripts
Inc., a medical benefits management company, found antidepressant use
increased 49 percent among consumers younger than 18 between 1998 and 2002.
Preschoolers up to age 5, the study found, were the fastest-growing users of
prescription antidepressants.

      Some parents have been concerned about overmedicating their children
and the potential short- and long-term effects of the drugs. Some have
wondered whether their children would receive the most benefit from
medication or talk therapy.

      Despite these concerns, experts say parents should never take their
children off medication without checking with the child's doctor.

      "I would never recommend that anyone take themselves or their children
off prescribed medication without first consulting their doctor,
particularly if they're taking multiple medications," said Jay Reeve, senior
psychologist at the Children's Inpatient Unit at Bradley Hospital in East
Providence, R.I.

      What Is the Best Approach?

      There has been debate over whether medication is more effective than
psychotherapy in treating children and adolescents with serious mental
illness. A study sponsored by the National Institute of Mental Health found
the antidepressant Prozac helps teenagers battle depression better than talk
therapy. But the study also found a combination of the two methods produces
the best results.

      Experts agree that a combined medical and psychotherapeutical approach
could be the best way to battling depression in teens and adolescents. But
the approach depends on the severity of the illness.

      "Medication can be a very helpful component of treatment for children
and adolescents with depression, but medication alone is rarely an adequate
or sufficient intervention," said Dr. David Fassler, clinical associate
professor of psychiatry at the University of Vermont's College of Medicine.

      "It should only be used as part of a comprehensive treatment plan,
individualized to the needs of the child and family," he said. "Most
children and adolescents tolerate medication well, with minimal side
effects. But all children taking medication need to be monitored closely to
make sure the symptoms are improving and to identify any potential problems
or reactions."

      The Children's Challenge

      Doctors say treating depression in children - especially young
children - is difficult because they generally are not able to explain their
feelings or give sophisticated answers to questions about their moods.

      Unlike teenagers and adults, they sometimes cannot link events in
their lives to their feelings - or at least eloquently explain how an
experience affected them. Most often, children lash out, showing signs of
trouble either through various kinds of misbehavior or through drawings at
school.

      "Generally speaking, the younger a child is, the more difficult it is
to diagnose the illness," said Reeve. "It's safe to say the younger you go,
the more difficult it is to distinguish one disorder from another."

      Children's general lack of sophistication plays a role in the
difficulty in determining whether they suffer from a mental illness and
whether they would benefit from medication, psychotherapy or both. Some
critics argue that many primary care physicians are not adequately trained
in diagnosing illnesses in children.

      "There are so many providers that are dispensing antidepressants to
children and teens without appropriate knowledge and skills to administer
these medications, as well as without accompanying cognitive-behavior
therapy, which is critical in the improvement of depressive symptoms," said
Bernadette Melnyk, founder and chairwoman of the National Association of
Pediatric Nurse Practictioners' Keep Your Children/Yourself Safe and Secure
Campaign.

      She said many doctors do not evaluate children for depression. "In a
recent survey of over 600 providers from 24 states across the country, we
found that many providers are not screening routinely for depression in
children."

      Doctors also sometimes misinterpret behavior that stems from
depression as a symptom of attention deficit disorder.

      "Many children with depression also are being misdiagnosed with
attention deficit disorder," Melnyk said. "Younger children with depression
often present differently than older children. That is, they are most likely
hyperactive and restless, versus sad and depressed."

      Do Your Homework

      For parents, mental illness in kids can be frightening, especially if
their children are having suicidal thoughts or showing suicidal behavior. In
severe cases like these, immediate medical intervention can save lives and a
subsequent combined medical and talk therapy could be the best remedy.
Still, every case is unique and treatment strategies should fit a child or
teen's individual needs.

      But sometimes parents panic when they see what they believe are
adverse side effects in their children after they begin taking medication.
To avoid any misunderstandings or rash decisions, experts recommend that
parents do their homework. Thoroughly research mental diseases and
treatments and consult the child's physician about the disease and potential
side effects of medication. It also helps to know the qualifications of the
child's doctor.

      "Parents need to be advocates for their children," Fassler said. "They
need to ask lots of questions, and they need to get as much information as
possible about both the diagnosis and the treatment options."

      Meanwhile, Chad Taylor remains convinced that he has made the right
decision for Daniel. He says his son is acting like himself again, but
officials are continuing to monitor Daniel's case.

      Taylor told KOAT-TV he is not putting Daniel back on Ritalin, no
matter what the consequences for himself may be. "Yeah, I'll go to jail for
it," he said. "I'll go as long as I have to go."