In many ways it depends on the child and the diagnosis and suspected dxes. Many docs liek to say bipolar but do not want to follow the medication protocol approved by the board of psychiatrists (group that certifies them). They want to give ssri antidepressants like lexapro, effexor, zoloft etc.... Or they want to do stimulants. The protocol for bipolar is done to take into account the effects of other medications on people with bipolar. Those medications can send a personw ith bipolar into mood cycling that can last months after the medication is stopped. The right way to handle that diagnosis is to start with mood stabilizers, one and often a second one is added to get full control of the mood cycling. Atypical antipsychotics are also used at this stage to help deal with aggressiveness, anger, violence. Once the person is stable mood wise, often the symptoms of depression, adhd, etc... just are not there. If they persist after moods are stable, very small amounts of a stimulant or antidepressant can be added slowly and carefully. Some years back a mom who isn't here often but is bipolar herself was swearing that lexapro was the right medication for her bipolar. A while later she ended up in a psychiatric hospital and got taken off all medications and put onto mood stabilizers - and she said that she was shocked at how different she was with those, at how much the lexapro had her moods totally out of whack and changing like a two year old's opinion. There were others here who said the same for their bipolar and for their children's (even if they didn't have it but their kdis did, they said following this protocol for medications amde a HUGE change).
I have had many docs try to say my difficult child is bipolar but NONE of them have EVER wanted to go the mood stabilizer route. They have also not been able to tell me WHY they didn't watn to follow the medication protocol. They each admitted that it was the wise thing to do, but none of them wanted to actually do it. The last one never spent more than ten min with Wiz, usually it was 3 min every 3 months, no joke. I started using a stopwatch to time the appts. never was it over 190 seconds (3 min 10 sec). I rattled him the day I whipped out the protocol and challenged him with it, and he never again did anything but write the rx for what Wiz was on (that was working anyway - medication change was not needed for any real reason, doctor just "felt like it").
You can find the protocol in the Bipolar Child by Papalos, also on the web.
As for stims for adhd, is that a diagnosis you feel is valid? How many visits do you think should happen before medication is given? There isn't ar ight answer, just something to think about. Stims have the benefit of being fast in and fast out. There are extended release forms that work for up to 12 hours or so, but even these are out within a day. So they would wear off. With Wiz the change after his first dose of stims was dramatic - not just to us. we gave it before a soccer game so that if it made him more hyper he could run it off. EVERYONE - coach, ref, parents on our team and ont he other team, teammates, they ALL wanted to know what we did because he was so very much different, so abel to focus and follow through. So he has been on them since age 7 with excellent luck. Many worry about stims leading to drug use. If the diagnosis is correct, this is NOT a valid worry.For those with true adhd, there is no high from them. They work to make the mind and body work at the same speed but do NOT give a speed high. Studies have shown that given appropriately, to kids with adhd, the incidence of drug use is actually less than in the general population. The probelm is that so many people diagnosis adhd for kids that are high energy but NOT adhd. Kids can be high energy and not have adhd, but schools esp do not want to deal with it. Not all schools/teachers, but enough that if a child is a challenge they push for medicating them. Those who get it and are NOT adhd do have an increased risk of drug use.
I would push for testing, but trialing medications in the summer can be a good thing. It takes away the pressure of having to perform in school and you can see what they are truly doing. Some medications, like mood stabilizers, take time to get to the therapeutic level and must be at that level for six weeks to know if they will work.
Go with your instincts. Many of us have found that we made the biggest mistakes by going along with something our gut screamed was wrong wrong wrong.
i will say that we medicated on the second visit with the psychiatrist with Wiz, but he was trully climbing the walls in her office during the appointment. psychiatrists do not do real therapy, talk therapy that is, the way the tradition image suggests. You know that freudian image of the doctor sitting htere while you lay on a couch talking, that is not done by psychiatrists anymore. tdocs do that, psychiatrists rx medications. So thinking about what you want from the psychiatrist is important, as is knowing what they typically are set up to do.
My mother did NOT think that Wiz should be on medications, esp stims. We went to visit her and he had medications before she was really around him in the morning. One day we went to bfast at a diner and I gave him his concerta (a stimulant) as we sat down and got water to drink. By the time food came he was a different kid. It was such a drastic change that it changed her tune in a huge way. It was also the first step in getting my bro diagnosis'd and on medications. He was never on stims as he is a recovering alcoholic, but strattera has made a giant difference in his life.