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Choosing to put your child on medication for ADHD is often a difficult and emotionally challenging decision. Parents are reluctant to have their child require medicine. Their fear is made worse by news stories of recently discovered dangers with common medications. While many of these “dangers” are unfounded, parents don’t want to subject their child to any risk of harmful treatment. Additionally, parents don’t want their children to take a pill when non-medication alternatives could produce similar or better results.
While occasionally parents may view drug therapy as a “quick and easy fix,” most tend to err on the side of waiting too long to consider it. As a psychiatrist who treats children with ADHD, I spend a great deal of time educating and reassuring parents that medications can be a safe and effective treatment when non-medication options have been inadequate. Timing is everything when deciding to use medication to manage ADHD symptoms. Parents don’t want to jump on the medicine bandwagon too early, but waiting too late can also have negative repercussions. Ambiguous or contradictory advice from health care information resources and professionals makes the decision all the more difficult.
Why is it so hard to get a straightforward and consistent answer on how best to treat ADHD? First, there is no consensus on the correct way to diagnose and treat ADHD. There are strong opinions in favor of and against medication treatment. Many health care providers have biases towards specific types of therapies they have developed, or in which they’ve been trained. Finally, every child (and adult) with ADHD presents with a unique set of challenges at home, school and work. They may have other confounding issues such as co-existing medical or psychiatric problems, and they may not have access to alternative treatment options, either because of their financial situation or because of where they live. With all of these conflicting challenges, parents have to become strong advocates for their children and be an active part of the treatment process.
Many of the medications used to treat ADHD have been around for several decades, and there is extensive experience showing that they are safe and effective. Still, all medications come with the risk of side-effects. As a whole, the stimulant class of medicine (including Ritalin/methylphenidate and Adderall/mixed amphetamine salt) has been scrutinized more than most other medications on the market today. Even non-stimulants such as Strattera, Intuniv and Kapvay, which are thought to be safer, have potential adverse side effects. Fortunately, only a small sub group of children is more at risk for dangerous side effects. With careful screening and monitoring by a qualified physician, these risks can be greatly minimized. Any possible harm from a medicine must be balanced with the dangers of not using medicine when it is indicated.
This includes worsening difficulties in school or work, as well as behavioral issues that can effect relationships and overall success in life. Many children with ADHD exhibit severe impulsivity which can have serious consequences for their emotional and physical health.
While ADHD medicines work in many children, there is no guarantee they will help your child, or in what areas they will have the most benefit. While some children have a remarkable turnaround in school performance or behavior with medicine, a dramatic improvement with medication alone is usually the exception, not the rule. A positive result from medication ranges from a 25-30% improvement in symptoms to 80-90%. Everyone’s experience is different.
Before putting your child on medicine, consider (and beware of) the following:
- 1. Get a diagnosis and treatment recommendation from a health care professional who specializes in ADHD. Some counselors, psychologists, family physicians, pediatricians, and psychiatrists are more up-to-date on the newest research in ADHD and are more current on the latest diagnostic tools and treatments.
- 2. Consider a thorough neuropsychological battery of tests to determine if there are other learning issues that may mimic or worsen any underlying ADHD. Make sure the tester has special training in this area. Beware that when insurance does not cover comprehensive testing, or reimburses at a low rate, the tester may compromise quality. If you can afford it, pay out of pocket for the best testing possible. It’s a worthwhile expense in the long run.
- 3. Get a second or third opinion if you are not completely confident in the thoroughness of the evaluation, or that all options were adequately presented to you.
- 4. Beware the “one-trick-pony” health care professional, the person who treats everyone with the same therapy and may not be open to other treatment options.
- 5. Stay on top of the latest developments in ADHD treatment with reliable health care information resources. Some reliable sources that do not have a hidden agenda or promote limited treatment options include www.chadd.org, www.addresources.org, and www.ImpactADHD.com.
- 6. If you do start your child on medicine, get regular teacher feedback and keep a diary of your observations. Get frequent follow up care, especially early in treatment. Over time, expect your child’s ADHD needs to change, and the treatment to change as well.
- 7. Listen to your child. His/her experience and feelings about medicine are critical to medication success, regardless of their age. They should be an active participant in the process.
Finally, if you put your child on medicine, do not stop other non-medication interventions, such as therapy, parent training and coaching, school accommodations, occupational therapy, tutoring, student ADHD coaching, exercise and nutrition. If your goal is that one day your child may be able to come off medicine, it is all the more important that s/he learn and practice behavioral techniques, organizational skills, and impulse control. Medicine is usually just one part of a successful management strategy. With the right education, effort, and treatment, the ADHD hurdle your child faces early in life will equip him/her to deal with life’s challenges and prepare him/her for a happy and successful future.