When should a clinician consider referring a child/adolescent to psychiatry for medication?

• A. If symptoms are mild and improving
• B. If parents demand therapy only
• C. If the child is under 5
• D. If symptoms are severe or poor response to psychotherapy

Answer: (D)

Medicating a child or adolescent is generally considered when symptoms are causing significant distress or impairment, or when they haven’t responded adequately to psychotherapy. This means the clinician looks for two red flags: the illness is severe enough to disrupt functioning in school, family, or social life, or the child has not improved after an adequate course of evidence-based therapy. In these situations, involving psychiatry for evaluation and potential medication management helps ensure appropriate dosing, monitoring of safety and side effects, and coordination with ongoing therapy.

If symptoms are mild and getting better, there’s little justification for starting medications, so ongoing psychotherapy and supportive measures are usually the path. When parents want therapy only, the clinician still considers meds if there’s clear evidence that anxiety, mood, or behavior is severely impairing functioning or has not responded to therapy alone. For very young children, especially under five, medications are not routinely used and are approached with caution, with emphasis on behavioral interventions and parent training rather than pharmacologic treatment.