When parents disagree on a child's symptoms and treatment

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SpongeBob DoctorPants

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Fortunately I do not encounter this too often, but it's probably one of the most difficult scenarios I deal with from time to time. The patient is a child, and the parents are divorced but share equal custody. Parent #1 says the child has certain symptoms and benefits from medication. Parent #2 says the child is fine, and does not want him/her on psychiatric medications.

As an example, I am currently treating a patient with ADHD and ODD. I requested information from school teachers which was also supportive of these diagnoses. Patient is now on Focalin XR which seems to work well for her, but mother reports there is some wearing off in the afternoon. I recommended adding a booster dose of Focalin IR after school. Mother is very open to this, but father feels it is unnecessary and thinks that the medication would not really be helping her. Ultimately, father agreed to the medication change but it almost felt like we weren't going to get anywhere, and I would be stuck with having to either prescribe against the father's consent, or not change anything and cause the mother to be disappointed.

What are some effective strategies for handling this kind of situation, without giving the appearance of taking sides?

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What are some effective strategies for handling this kind of situation, without giving the appearance of taking sides?
Making decisions for patient
Get a judge to assign you instead of the parents as the decision maker?

Otherwise, I tend to try to get semi-objective evidence to support the decision (rating scales, other people like teachers). We can try a non-pharmacological option for some time, gather data, and then see if there was any improvement -- if not then medication is easier to justify. Ultimately, you could just get the mother to give the Focalin IR and the kid won't get it on the days the kid is with the dad.
 
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Making decisions for patient
Get a judge to assign you instead of the parents as the decision maker?
Wow! That sounds like a challenging situation. I hope you're able to get that straightened out.

Otherwise, I tend to try to get semi-objective evidence to support the decision (rating scales, other people like teachers). We can try a non-pharmacological option for some time, gather data, and then see if there was any improvement -- if not then medication is easier to justify. Ultimately, you could just get the mother to give the Focalin IR and the kid won't get it on the days the kid is with the dad.
This is essentially what I am doing. We started with teacher rating scales, which helped to convince the father that the child was having problems at school. Now that this has been addressed, I'm trying to help with the behaviors at home. It may end up being as you describe, that the child will get the extra Focalin only on days she is with mom. I suggested it can be used PRN anyway, such as on days when they anticipate she will need a little more help with focus and impulsivity. The father is of the opinion that their daughter won't actually learn how to behave better if she takes medication, and it is difficult to convince him otherwise. However, in the end he is agreeable to my recommendations if I think it will help the child.

One thing I wonder about, though, is how to handle a situation in which one of the parents absolutely refuses to let their child take medication, but the other parent wants the medication. Let's imagine the father in this case said no to adding any new prescriptions. Are there any legal consequences to prescribing against his wishes?
 
Someone probably knows better, but I think 2 dissenting decision makers with equal authority is a situation you can't overcome without the court. If there are legal agreements or if the family decides who should have the authority to make decisions, that's different.

If you do recommended a treatment and provide appropriate information to both parents, I don't see the problem with writing the script and letting them decide what they want to do (provision of the Rx being part of that shared information).
 
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