Deciding whether to give kids with ADHD medication
April 2, 2010 9:54 AM Subscribe
Parents of kids with ADHD: how have you decided whether to give your kids medication?
I have a friend whose daughter has just been diagnosed with ADHD in second grade, and who is adamantly opposed to giving her daughter medication to treat it (they are doing diet changes and other things instead). I was shocked to realize I have no opinion on this at all (I usually have opinions on everything), and I am tremendously curious about it. I do believe that ADHD is over-diagnosed--I have a friend who is a Physician's Assistant who used to work with a doctor who would prescribe meds to kids based on a 5-10 minute conversation with the parents about the child's behavior, for instance. On the other hand, I have at least one friend with ADHD for whom, in adulthood, meds have been a life-changing.
I followed the recent AskMe question on ADHD with great interest, and it seemed like some people who responded there wished their ADHD had been better managed with meds as children. And yet, my friend is (quite reasonably, I think) concerned about possible side effects and long-term negative effects.
As parents, we have to make decisions for our kids all the time, but this seems like a really big one, with potentially huge consequences. I would be interested to hear from other people in similar situations about how you decided whether medication should be part of your kid's treatment.
I have a friend whose daughter has just been diagnosed with ADHD in second grade, and who is adamantly opposed to giving her daughter medication to treat it (they are doing diet changes and other things instead). I was shocked to realize I have no opinion on this at all (I usually have opinions on everything), and I am tremendously curious about it. I do believe that ADHD is over-diagnosed--I have a friend who is a Physician's Assistant who used to work with a doctor who would prescribe meds to kids based on a 5-10 minute conversation with the parents about the child's behavior, for instance. On the other hand, I have at least one friend with ADHD for whom, in adulthood, meds have been a life-changing.
I followed the recent AskMe question on ADHD with great interest, and it seemed like some people who responded there wished their ADHD had been better managed with meds as children. And yet, my friend is (quite reasonably, I think) concerned about possible side effects and long-term negative effects.
As parents, we have to make decisions for our kids all the time, but this seems like a really big one, with potentially huge consequences. I would be interested to hear from other people in similar situations about how you decided whether medication should be part of your kid's treatment.
My doctor gives her kid Vyvanse. I take it as well, and I'm aware that my own kids might need it, when they become of age. I can see ADHD in my dad as well, after having been diagnosed with it myself, interestingly enough. However, his work involves manual labor, where as my work can lead to distraction easily (or lack of motivation, even).
My doc explained it this way: the brain is asleep, and the H aspect of ADHD is the body's attempt to wake the brain up. However, since the issue is mostly chemical based, often only chemicals can remedy the situation. That's where stimulants come in... never try to suppress hyperactivity with something like Valerian. The brain is already asleep, and it needs woken up! :)
posted by purefusion at 10:22 AM on April 2, 2010
My doc explained it this way: the brain is asleep, and the H aspect of ADHD is the body's attempt to wake the brain up. However, since the issue is mostly chemical based, often only chemicals can remedy the situation. That's where stimulants come in... never try to suppress hyperactivity with something like Valerian. The brain is already asleep, and it needs woken up! :)
posted by purefusion at 10:22 AM on April 2, 2010
You might read We've Got Issues: Children and Parents in the Age of Medication where author Judith Warner initially wanted to expose this over-medicalization issue... and found that in fact the reverse was the problem: kids were more likely not to get medicine they needed because of distrust of the medical establishment, parental fears, etc.
posted by canine epigram at 10:22 AM on April 2, 2010 [3 favorites]
posted by canine epigram at 10:22 AM on April 2, 2010 [3 favorites]
There's not a blanket answer. It depends on severity, environment, and what the kid is going through without meds.
I was diagnosed way back in the day when it was call hyperactive and it was treated like a behavior problem. I was on Ritalin for a short time, but my parents felt it made me into a zombie. It took their exuberant, if uncontrollable, child and made me into a lump. Please note, there were less Rx options then and dosages where different.
We worked through my ADHD with a lot of structure and consistency. It wasn't easy, but we made it through. There are still moments when it really kicks in - times when I'm so hyper focused I can't hear people speak to me and times when I could fritter away hours surfing my own synapses. When it happens, I can go with it or I can draw on my learned behaviors to resume control.
It made school and social development more difficult, but not unmanageable. I was a large, friendly, happy child. I didn't have a lot of social stigma and when I did I didn't notice it. I was happy marching to my own drum. School was okay for me though I was a challenge for teachers, particularly bad teachers. (Miss Deutsch - You're still the worst teacher I ever had. Shame on you for snapping on a second grader on a daily basis.)
Not using meds worked for me. But lets say, I didn't have a family unit that could provide structure or that I was a social outcast or that every teacher I had was as horrible as Miss Deutsch. In that case, I'd have had no opportunity for success. Bring on the meds.
posted by 26.2 at 11:30 AM on April 2, 2010
I was diagnosed way back in the day when it was call hyperactive and it was treated like a behavior problem. I was on Ritalin for a short time, but my parents felt it made me into a zombie. It took their exuberant, if uncontrollable, child and made me into a lump. Please note, there were less Rx options then and dosages where different.
We worked through my ADHD with a lot of structure and consistency. It wasn't easy, but we made it through. There are still moments when it really kicks in - times when I'm so hyper focused I can't hear people speak to me and times when I could fritter away hours surfing my own synapses. When it happens, I can go with it or I can draw on my learned behaviors to resume control.
It made school and social development more difficult, but not unmanageable. I was a large, friendly, happy child. I didn't have a lot of social stigma and when I did I didn't notice it. I was happy marching to my own drum. School was okay for me though I was a challenge for teachers, particularly bad teachers. (Miss Deutsch - You're still the worst teacher I ever had. Shame on you for snapping on a second grader on a daily basis.)
Not using meds worked for me. But lets say, I didn't have a family unit that could provide structure or that I was a social outcast or that every teacher I had was as horrible as Miss Deutsch. In that case, I'd have had no opportunity for success. Bring on the meds.
posted by 26.2 at 11:30 AM on April 2, 2010
It would have been cruel to refuse to give my son medication for his ADHD. With it, he is happy and productive. Without it, he was miserable about his inability to accomplish anything.
I was concerned about the long-term negative effects of not treating. Diagnosed substance abuse problems occur at an incredibly high rate in teens whose ADHD has not been properly treated (either with or without medication, depending on what they needed).
posted by Ery at 11:31 AM on April 2, 2010
I was concerned about the long-term negative effects of not treating. Diagnosed substance abuse problems occur at an incredibly high rate in teens whose ADHD has not been properly treated (either with or without medication, depending on what they needed).
posted by Ery at 11:31 AM on April 2, 2010
Medication is only one of multiple treatments for ADD/ADHD. Even if a doctor prescribes meds, as they say, "the pill won't give the skill". There are additional things that can, and usually should be applied to address attention challenges.
I just wrote something apropos to your question elsewhere on askMeta. It spells out an approach that can be effective whatever you choose to do, whether there are meds involved or not.
posted by buzzv at 11:38 AM on April 2, 2010
I just wrote something apropos to your question elsewhere on askMeta. It spells out an approach that can be effective whatever you choose to do, whether there are meds involved or not.
posted by buzzv at 11:38 AM on April 2, 2010
Best answer: I'm a parent of a child who was diagnosed with ADHD two years ago. We did make the decision to medicate him as part of a four-pronged approach to his diagnosis and treatment. Bear with me for a few minutes. I'm going to fill you in on our 4 approaches and why we use them all. Medication is critical to our son's daily success. However, it is not a miracle cure all.
Prior to diagnosis, our son was given a physical by his pediatrician and then run through a multi-hour, multi-session battery of tests. There was a parent and a teacher evaluation which were also completed to provide additional feedback based on home and educational situations and settings. The whole process took weeks.
1. Medication - We work closely with his psychiatrist to keep him on the lowest dose possible. We looked at the studies and firmly believe that there has been years and years of evidence showing the effectiveness of medicating to help treat his symptoms. When we looked at the diet based approaches, we felt it fell too much in the wishful thinking and pseudo-science realm. We already have an approach to food which involves as little processed food as I feel we can reasonably get away with given our schedules. Additional dietary restrictions really struck us as unreasonable with questionable results at best.
When we began medication, the impact was immediate and very telling. His grades and behavior improved. His willingness to participate and stick with challenging tasks also improved. It didn't make him any smarter or less mischievous. It allowed him to tune out distractions to accomplish the task at hand.
We continue to weigh the benefits of the medication against the risks. The risks and side effects are real. At this time, however, because we keep him on the lowest effective dose for him, we believe the benefits are still outweighing the risks. Annually, his liver function and heart are checked to make sure the medicine is not damaging them. Perfect there.
We give him one day a week without medication and allow him to pile on the calories because his appetite is so diminished during the week. This has allowed him to keep a normal body weight for his age. Because we're using the lowest effective dose for him, we do see behavioral and focus-related changes in the evening as his medication wears off. We don't expect perfect behavior and are willing to work with this. As a result, we try to have homework and dinner done before his daily dose wears off. When he's not medicated, routine becomes more important than it is otherwise.
2. We work with a child therapist to help him learn and improve social interaction skills with his peers. One of the symptoms of ADHD is impulsiveness. One of the consequences of impulsiveness is difficulty with peer interactions. The first year after he was diagnoses, we worked with his therapist twice a month to improve his ability to interact with his peers. They did a lot of role playing and games oriented towards making it easier for him to make better choices. At this point, we try to see her about every six months to give him refresher training. Seriously, this helps. The medication helps, but it doesn't make decisions for him. He still has to take responsibility for his choices.
3. We worked to get him evaluated for an Individualized Education Plan (IEP) in school. Just medicating and working with the therapist is insufficient to help him succeed academically. He qualified and the IEP has been one of the tools that has helped him do well this year and last. The IEP started with the evaluations done during his diagnosis and then added more hours of testing and evaluations, including about 4 hours with a social worker to provide a socio-economic and family pattern analysis.
4. Finally, our approach to working with his ADHD involves physical activity. We only added in this component this year. This four-pronged approach was recommended to us by the psychologist who evaluated him and diagnosed his ADHD. My son does not participate in a group sport like soccer because it does not interest him. However, he is taking Tae Kwon Do and LOVES it. Organized physical activity helps develop executive functions. The kids have to think about their bodies and about what they are going to do before they do it. This is the physical aspect of what we're doing with the counselor in approach #2. Additionally, it gives him a physical outlet for his energy.
Ok, that's our approach and why we do each thing.
If you decide, as a result of this thread, that your opinion now supports medicating, then, as a parent, I must warn you that your friends may not want to hear your opinion on their chosen course of treatment of their child's ADHD. I understand why parents want to go the diet route. I know the risks associated with the medicine. However, what convinced us was all the reputable studies of ADHD treatment that indicate medicine is the way to go. We are firmly in the camp that believes that medicine helps with a vast array of conditions. What makes ADHD a challenge is that it is a physical disorder (abnormal serotonergic function) with behavioral symptoms. People want to change behavioral symptoms by either saying something like "just do what you're told/expected to do" or by assuming it is willful disobedience.
posted by onhazier at 11:50 AM on April 2, 2010 [7 favorites]
Prior to diagnosis, our son was given a physical by his pediatrician and then run through a multi-hour, multi-session battery of tests. There was a parent and a teacher evaluation which were also completed to provide additional feedback based on home and educational situations and settings. The whole process took weeks.
1. Medication - We work closely with his psychiatrist to keep him on the lowest dose possible. We looked at the studies and firmly believe that there has been years and years of evidence showing the effectiveness of medicating to help treat his symptoms. When we looked at the diet based approaches, we felt it fell too much in the wishful thinking and pseudo-science realm. We already have an approach to food which involves as little processed food as I feel we can reasonably get away with given our schedules. Additional dietary restrictions really struck us as unreasonable with questionable results at best.
When we began medication, the impact was immediate and very telling. His grades and behavior improved. His willingness to participate and stick with challenging tasks also improved. It didn't make him any smarter or less mischievous. It allowed him to tune out distractions to accomplish the task at hand.
We continue to weigh the benefits of the medication against the risks. The risks and side effects are real. At this time, however, because we keep him on the lowest effective dose for him, we believe the benefits are still outweighing the risks. Annually, his liver function and heart are checked to make sure the medicine is not damaging them. Perfect there.
We give him one day a week without medication and allow him to pile on the calories because his appetite is so diminished during the week. This has allowed him to keep a normal body weight for his age. Because we're using the lowest effective dose for him, we do see behavioral and focus-related changes in the evening as his medication wears off. We don't expect perfect behavior and are willing to work with this. As a result, we try to have homework and dinner done before his daily dose wears off. When he's not medicated, routine becomes more important than it is otherwise.
2. We work with a child therapist to help him learn and improve social interaction skills with his peers. One of the symptoms of ADHD is impulsiveness. One of the consequences of impulsiveness is difficulty with peer interactions. The first year after he was diagnoses, we worked with his therapist twice a month to improve his ability to interact with his peers. They did a lot of role playing and games oriented towards making it easier for him to make better choices. At this point, we try to see her about every six months to give him refresher training. Seriously, this helps. The medication helps, but it doesn't make decisions for him. He still has to take responsibility for his choices.
3. We worked to get him evaluated for an Individualized Education Plan (IEP) in school. Just medicating and working with the therapist is insufficient to help him succeed academically. He qualified and the IEP has been one of the tools that has helped him do well this year and last. The IEP started with the evaluations done during his diagnosis and then added more hours of testing and evaluations, including about 4 hours with a social worker to provide a socio-economic and family pattern analysis.
4. Finally, our approach to working with his ADHD involves physical activity. We only added in this component this year. This four-pronged approach was recommended to us by the psychologist who evaluated him and diagnosed his ADHD. My son does not participate in a group sport like soccer because it does not interest him. However, he is taking Tae Kwon Do and LOVES it. Organized physical activity helps develop executive functions. The kids have to think about their bodies and about what they are going to do before they do it. This is the physical aspect of what we're doing with the counselor in approach #2. Additionally, it gives him a physical outlet for his energy.
Ok, that's our approach and why we do each thing.
If you decide, as a result of this thread, that your opinion now supports medicating, then, as a parent, I must warn you that your friends may not want to hear your opinion on their chosen course of treatment of their child's ADHD. I understand why parents want to go the diet route. I know the risks associated with the medicine. However, what convinced us was all the reputable studies of ADHD treatment that indicate medicine is the way to go. We are firmly in the camp that believes that medicine helps with a vast array of conditions. What makes ADHD a challenge is that it is a physical disorder (abnormal serotonergic function) with behavioral symptoms. People want to change behavioral symptoms by either saying something like "just do what you're told/expected to do" or by assuming it is willful disobedience.
posted by onhazier at 11:50 AM on April 2, 2010 [7 favorites]
My son's situation was so dire that we were willing to give medication a try. Now that we've found the right medication (after a misdiagnosis by a doctor we no longer see), it's amazing the difference it's made in his life. We do a whole lotta other stuff to help him with his issues, and medication has given him the ability to actually benefit from all the work we do.
posted by The corpse in the library at 11:55 AM on April 2, 2010
posted by The corpse in the library at 11:55 AM on April 2, 2010
Response by poster: onhazier, thanks for your great answer. I wasn't asking so I could give my opinion to my friend, only because I was curious for myself. I do worry that her absolute refusal to consider medication may not be the right choice for her daughter, but I try to only give advice when asked!
posted by not that girl at 1:54 PM on April 2, 2010
posted by not that girl at 1:54 PM on April 2, 2010
As a child with ADHD, I wish I had been medicated for it.
posted by fifilaru at 2:17 PM on April 2, 2010 [1 favorite]
posted by fifilaru at 2:17 PM on April 2, 2010 [1 favorite]
If it was necessary, I wouldn't hesitate in a second.
However, I would make a concerted effort to make my own determinations as to whether it was necessary. I have ADHD and wasn't diagnosed until into my 30s. [Insert standard childhood trauma story here] I wish I had been treated, but not in the crappy style of "take these pills and come see me in 3 months".
Focus is an acquired skill, and while some people struggle with it more than others, you still have to learn the skill. Working with someone to teach those skills, prior to trying pills, would be my first step. And for sure would be part of a treatment plan along with medication if necessary.
I think the "zombified" thing may turn out to be a sign of over medicating. The kids end up being literally strung out and don't get quality sleep, and then the stimulant's effects get "used up" just keeping the kid awake during the day. And so at the next checkup, the parents tell the doctor "it's not working anymore" and the doctor ups the dosage. Which leads ultimately to a failed treatment program...
So if I were a parent, I would make it a priority to work with a physician who is willing to work with me and my kid on those fronts, and try "baby steps" with medication dosages.
posted by gjc at 4:51 PM on April 2, 2010
However, I would make a concerted effort to make my own determinations as to whether it was necessary. I have ADHD and wasn't diagnosed until into my 30s. [Insert standard childhood trauma story here] I wish I had been treated, but not in the crappy style of "take these pills and come see me in 3 months".
Focus is an acquired skill, and while some people struggle with it more than others, you still have to learn the skill. Working with someone to teach those skills, prior to trying pills, would be my first step. And for sure would be part of a treatment plan along with medication if necessary.
I think the "zombified" thing may turn out to be a sign of over medicating. The kids end up being literally strung out and don't get quality sleep, and then the stimulant's effects get "used up" just keeping the kid awake during the day. And so at the next checkup, the parents tell the doctor "it's not working anymore" and the doctor ups the dosage. Which leads ultimately to a failed treatment program...
So if I were a parent, I would make it a priority to work with a physician who is willing to work with me and my kid on those fronts, and try "baby steps" with medication dosages.
posted by gjc at 4:51 PM on April 2, 2010
(Forgot to add- when I hear or read stories of parents struggling with ADHD kids, and adults, who seem zombified, they often go along with stories of "I have to drag him out of bed and shove the pill down his throat at 4am just so he'll be ready for the school bus at 7." That seems to me like a text book case of poor sleep quality.)
posted by gjc at 4:53 PM on April 2, 2010
posted by gjc at 4:53 PM on April 2, 2010
Onhazier, I wish I had had a parent like you.
posted by thatbrunette at 5:12 PM on April 2, 2010 [1 favorite]
posted by thatbrunette at 5:12 PM on April 2, 2010 [1 favorite]
Thank you. *blushes*
Don't get me wrong though. ADHD is a challenge. There are days when we wonder at what age is it legal to sell the kids off to the highest bidder. That's just kids being kids, though.
I have to agree with gjc about the over medication issue. Our doc literally started with the lowest dose possible for our son's weight and we gradually increased to the current dose over the course of a year. He's been at his current dose for a year now and we see no reason to change it yet. We're still under 1/3 the maximum dose recommended for his age. Medication should not be used to make the child 100% compliant. Kids without ADHD are not compliant. They test boundaries, make bad decisions and let their mouths run wild sometimes. That's normal behavior as kids grow and learn. Using medication to try and eliminate normal behavior is completely the wrong approach. The medication should be used as an aid to help the child; not make them a zombie. Parents and teachers who advocate for more and more medicine are wrong. You cannot replace good parenting with meds. The lowest effective dose is what's needed.
posted by onhazier at 6:16 PM on April 2, 2010
Don't get me wrong though. ADHD is a challenge. There are days when we wonder at what age is it legal to sell the kids off to the highest bidder. That's just kids being kids, though.
I have to agree with gjc about the over medication issue. Our doc literally started with the lowest dose possible for our son's weight and we gradually increased to the current dose over the course of a year. He's been at his current dose for a year now and we see no reason to change it yet. We're still under 1/3 the maximum dose recommended for his age. Medication should not be used to make the child 100% compliant. Kids without ADHD are not compliant. They test boundaries, make bad decisions and let their mouths run wild sometimes. That's normal behavior as kids grow and learn. Using medication to try and eliminate normal behavior is completely the wrong approach. The medication should be used as an aid to help the child; not make them a zombie. Parents and teachers who advocate for more and more medicine are wrong. You cannot replace good parenting with meds. The lowest effective dose is what's needed.
posted by onhazier at 6:16 PM on April 2, 2010
As someone who finally started taking ADHD medication at age 30, I really wish my parents had given it to me sooner. My life would have probably turned out a lot better.
posted by Jacqueline at 3:59 PM on April 4, 2010
posted by Jacqueline at 3:59 PM on April 4, 2010
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The great thing about stimulant medication is that the effects occur right away (unlike antidepressants, where you need to spend weeks/months building up the right level in your bloodstream), and if you stop taking them, the effects go away rapidly. As far as I know, there is nothing in the literature about negative long-term consequences for taking stimulants to treat ADHD (when diagnosed properly, and when medications are managed by a doctor).
Good luck to your friend!
posted by purlgurly at 10:11 AM on April 2, 2010