Ask An Expert / Medication

My aggressive 6-year-old, who has had many diagnoses, reacted badly to stimulants and an SSRI. What else can we try?

It's critical to understand the behavior better before trying new medications

Natalie Weder, MD
Natalie Weder, MD

Child and Adolescent Psychiatrist

Child Mind Institute

My son is 6 years old. Since birth I knew there was something different about him. We¹ve been searching for help ever since. He has been diagnosed with ADHD, DMDD, depression, anxiety, ODD, and a possible auditory processing disorder by various doctors. He is not perfect in school, but much better behaved there versus home. At home he is defiant and aggressive, mostly towards his father and 8- year-old sister. We have tried three different stimulants, all which caused a rebound effect that magnified his aggression and impulsivity. We recently tried a SSRI, which two weeks later caused suicidal tendencies. I am at wits end. Can you please offer suggestions? I have heard good things about Intuniv, but I don't know if this will be right for my child. I am terrified of a mood stabilizer because of the horrific side effects I have heard of.

I can’t give you specific advice because I haven’t seen your son. But I can say that right now the best thing for your son will be to get him a very thorough evaluation. Evaluations are important because different behaviors indicate different things — for example aggressive outbursts can be caused by ADHD, anxiety, depression or several other psychiatric disorders. These disorders are all treated differently, so it is important to find the correct diagnosis.

You’ll know that your child is getting a thorough evaluation if the clinician asks detailed questions that look into your son’s history, his functioning in different settings, and triggers or aggravating factors that can lead to his problematic behaviors. Your clinician might also request to speak to your child’s teacher or other professionals involved in his care to get detailed description of his difficulties.

Whatever diagnosis your son gets, it is likely that his treatment will require not only medication but also evidence-based behavior therapies. Combined treatment usually gives you the best results for complex behaviors that stem from complex disorders.

Now about side effects: most of these medications have been around for a long time, and they have been very well tested. Medications can have side effects, but if the diagnosis is the right one and an experienced clinician is monitoring the medication, then any side effects are usually controlled.