Putting your child on long-term medication is never an easy decision. These are the pros and cons.
Understanding Treatment Plans for ADHD
Katherine Slack’s son was diagnosed with ADHD in kindergarten. He began taking medication for the disorder and, for Katherine, the decision simply made sense. “When he is not medicated, he cannot focus and concentrate,” says Slack, whose son is now in third grade. “When he’s not on meds, he will get up and walk around the classroom or sit and sing or hum during class, and he is not even aware of doing it. We chose to medicate him, not only for him, but also for all the other children in the class around him.”
For other parents, choosing to use ADHD meds isn’t so straightforward. “We struggled with the decision of whether to place our 6-year-old son on medication,” says Jilea Hemmings. “In fact, we tried and continue to incorporate holistic remedies along with his prescription medication.”
It’s a complicated decision. No parent wants her child to be on long-term prescription meds. They have side effects — most often, loss of appetite, trouble sleeping, and moodiness — and it may take some trial and error to find the right prescription and dosage for your child.
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There’s also the fact that ADHD is probably not the only thing going on: At least two thirds of kids diagnosed with ADHD are also diagnosed with at least one other mental health or learning disorder in their lifetime, according to the American Academy of Child and Adolescent Psychiatry. Some of the more common accompaniments: anxiety disorders, depression, and learning and language disorders. So you may be trying to find the right mix of treatments for multiple issues.
And, of course, there are societal expectations. “It’s one thing for your child to have a behavior problem, but if he has a behavior problem and is receiving psychotropic medication, there’s a possible stigma attached to it,” says Robert Volpe, Ph.D., an associate professor in the Department of Counseling and Applied Educational Psychology at Bouve College of Health Sciences at Northeastern University. “Many children benefit from medication but psychosocial interventions should be a first line of treatment.”
It’s no wonder that medication is one of the first things parents think about. “They ask me, ‘Does my child need to be on medicine for the rest of his life?'” says psychologist Mark Stein, Ph.D., director of the PEARL Clinic at Seattle Children’s Hospital. “Usually I say, ‘I don’t know, but I do know that in most children with ADHD older than 6, medicine often helps with the symptoms. And we can talk about the risks and benefits and how a medication trial is done to determine if a child is benefiting.'”
In short, the vast majority of children with ADHD who take meds don’t need it forever, but they may need it now, and parents have to revisit the medication question every year, because a child’s needs can change.
If your child’s ADHD is of the milder variety, you may be able to achieve the results you want from classroom-based intervention and parent training. For instance, accommodations at school such as seating the child near the teacher for increased eye contact, giving a daily report card with checks for desired behaviors, and giving frequent breaks can improve your child’s performance in school. At home, organizational strategies, a predictable routine, and behavioral charts can also help. (A good behavioral pediatrician should be able to direct you to the proper resources for parent training.)
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Medication — alongside behavioral modification — is the recommended strategy for ADHD when the disorder interferes with your child’s ability to function. “When the symptoms of ADHD are permeating, in a negative way, every aspect of your child’s life, then I recommend considering medication,” says Lee Ann Grisolano, Ph.D., a pediatric neuropsychologist in Hershey, Pennsylvania. If symptoms are mild or your child has another condition, you may be able to achieve the results you want through counseling and behavioral training.
Most medications prescribed for children with ADHD are stimulants and come in short-acting, intermediate-acting, and long-acting varieties. You’re probably familiar with Adderall (amphetamine and dextroamphetamine) and Ritalin (methylphenidate), for instance. One study found that stimulants were most effective in treating ADHD symptoms, as long as the dosage is tailored to the child.
There are nonstimulants that can be tried, such as Strattera (atomoxetine) and Intuniv (guanfacine), if stimulants aren’t a good fit. And if neither of these is helpful enough, other medications, such as tricyclic antidepressants, might help. It may take several attempts to find the right medication and dosage, with the least side effects.
Making the decision not to medicate a child with notable ADHD symptoms has its own risks as well. Children with ADHD tend to suffer in school and in social relationships, and unchecked symptoms can hinder their progress. “If they’re not doing well at school, it affects their self-esteem, which can make them anxious, so you often see depression and anxiety in children with ADHD,” says Judith Joseph, M.D., a psychiatrist and clinical instructor at the New York University Child Study Center.
A doctor convinced Jennie Daddabbo that medicating was the way to go for her 7-year-old son. “We had tried lots of lifestyle changes and he was still really struggling with day-to-day life,” Daddabbo says. “Our doctor finally said to us, ‘If your child had diabetes, would you withhold medication from him? Why is mental health treated so differently?'”
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