Medication can be an important part of treatment for some children and young people with ADHD, autism-associated difficulties, anxiety, depression, obsessive-compulsive disorder, sleep problems or other mental health conditions. It is rarely considered in isolation. A careful medication review should take account of the young person’s symptoms, development, physical health, emotional wellbeing, education, family circumstances and any psychological or practical support already in place.
At Healing Young Minds, our Medication Assessment, Initiation & Review service provides specialist psychiatric input for families who are considering medication, starting a new treatment or seeking an independent review of an existing prescription. We follow appropriate NICE-guideline diagnostic and treatment pathways, while recognising that every child and family has different needs.
What is a medication review?
A medication review is a structured clinical appointment to consider whether a medicine is appropriate, effective and well tolerated. It is not simply a question of whether a prescription should be continued. The clinician will review the original reason for treatment, the current symptoms, the benefits observed, any side effects and whether the treatment still fits the young person’s needs.
A review may be helpful when:
- a child or young person is starting medication for the first time;
- the current treatment is not providing enough benefit;
- there are concerns about side effects or the medicine’s impact on appetite, sleep, mood or daily functioning;
- symptoms have changed as the young person has developed;
- there is uncertainty about the diagnosis or the most suitable treatment approach;
- the family would like a second opinion or a more detailed specialist assessment; or
- the young person is taking more than one medicine and the overall treatment plan needs reviewing.
Where appropriate, a review may lead to continuing the same treatment, adjusting the dose, changing the timing, switching to another medicine, adding psychological or practical support, or gradually stopping medication under medical supervision.
Before medication is recommended
Medication should follow a thorough assessment rather than replace one. The clinician will usually explore the young person’s history, current difficulties, strengths and goals. This may include information from parents or carers, the young person, school or college, previous clinicians and other professionals involved in their care.
The assessment may consider:
- the nature, severity and duration of symptoms;
- the effect of difficulties at home, in education and in relationships;
- developmental history, including possible autism or ADHD;
- sleep, eating, exercise and substance use where relevant;
- physical health, allergies and current medication;
- family history of physical or mental health conditions;
- emotional wellbeing, self-harm, suicidal thoughts and other safety concerns; and
- what the child or young person and their family hope treatment will achieve.
For some medicines, physical health checks are important before treatment starts. Depending on the medicine and the individual circumstances, this may include recording height, weight, pulse and blood pressure, reviewing relevant medical history and considering further investigations. The clinician will explain which checks are needed and how they will be arranged.
Starting medication: a shared decision
If medication is considered suitable, the clinician will explain the proposed treatment in clear language. This includes what the medicine is intended to help with, how it is usually taken, when benefits might be noticed and how progress will be assessed.
Families will also be advised about possible side effects. These vary according to the medication and the individual. Discussions may include appetite, sleep, headaches, stomach symptoms, tiredness, emotional changes, agitation, blood pressure or effects on mood. The purpose is not to alarm families, but to help them know what to look out for and when to seek advice.
Consent and involvement are central. Parents or those with parental responsibility may need to provide consent, but the young person’s views and understanding should also be considered. Older children and young people may be able to consent to their own treatment if they have sufficient understanding. The clinician will aim to involve everyone appropriately and will discuss confidentiality and information-sharing, including any safeguarding considerations.
Medication is generally introduced cautiously. The treatment plan may include a low starting dose, gradual adjustments and a planned follow-up. Families should not change the dose, stop treatment suddenly or share medication without speaking to the prescribing clinician.
What happens during follow-up reviews?
Follow-up appointments are an opportunity to assess both benefits and difficulties. Families may be asked what has changed since the medication began, including whether the young person is finding it easier to concentrate, regulate emotions, attend school, sleep, manage anxiety or take part in everyday activities. The young person’s own experience is particularly important, as improvements may not always be visible to others.
The clinician may also ask about:
- the timing and consistency of doses;
- physical symptoms or new concerns;
- appetite, eating patterns and sleep;
- mood, anxiety, irritability and behaviour;
- school or college attendance and functioning;
- relationships and family life; and
- any other medication, supplements or changes in health.
Information from school or college can sometimes help build a balanced picture, provided appropriate consent and information-sharing arrangements are in place. Monitoring may include repeated measurements of height, weight, pulse and blood pressure when clinically indicated. The frequency of appointments and physical checks depends on the medicine, the young person’s age, their health and how treatment is progressing.
Balancing benefits, risks and alternatives
A useful medication review considers whether the benefits outweigh the risks for that particular young person. The aim is not necessarily to remove every symptom. It may be to support meaningful improvements in functioning, safety, participation, relationships or quality of life, while keeping unwanted effects to a minimum.
Medication may be most helpful when combined with other support. Depending on the assessment, this could include psychological therapy, parenting support, school-based adjustments, sleep interventions, occupational strategies or advice about routines and emotional regulation. For autistic children and young people, medication does not treat autism itself, but may sometimes be considered for a co-occurring condition or significant associated difficulty.
If treatment is not helping, or side effects are problematic, the clinician will discuss options rather than expecting the family to continue without review. Any change should be planned carefully, with clear advice about what to monitor and how to contact the service if concerns arise.
Preparing for your appointment
Families may find it helpful to bring a list of all prescribed medicines, over-the-counter products and supplements. A brief record of symptoms, sleep, appetite, school attendance, mood and possible side effects can also be useful. It is helpful to note what the young person would most like to improve and any questions they want to ask.
You can ask about the expected benefits, possible risks, alternatives, monitoring arrangements and what to do if a dose is missed. If the young person is nervous, the appointment can be adapted to their age, communication style and preferences wherever possible.
Arrange a specialist medication review
Whether your child is considering medication, has recently started treatment or needs a review of an existing plan, specialist advice can provide clarity and reassurance. Contact healingyoungminds.com to find out more about our Medication Assessment, Initiation & Review service and discuss how we may support your family.