If you are reading this article,
you are no doubt wrestling with a difficult decision. You have probably read a lot about different
medications and their side effects. And
you definitely have seen your child struggle with the effects of ADHD. Medication is often the first thing that
doctors reach for to treat ADHD, but it is not always the first thing that
parents want to hear, and it isn’t the best decision for every child. This is a guide to help you work through the
decision step by step, so that you can know for sure that medication is, or is
not right for your child.
1) How
much are your child’s symptoms affecting life?
A child who has had long standing
trouble with academics or with relationships in the family or with friends, is
in greater need of something that will work reliably and well—medication. You may, at some point, be able to get your
child off medication, but for now, you
know that if things continue this way, something bad will happen. Change needs to happen now.
You know your child falls into this category
if he or she:
Has problems with self esteem, is
being bullied, or is depressed due to ADHD symptoms.
Is failing or near failure
academically, has had disciplinary consequences such as detention or suspension
for behavior problems, or is near being banned from riding the schoolbus.
Has frequent and/or prolonged
tantrums for some one of the same age.
Also has a diagnosis of ODD.
Has no friends.
Is causing strain on your
marriage to the point where separation or divorce is being considered.
Is a safety risk due to reckless
behavior—darting into traffic, jumping out of trees, sticking their hand on the
cutting board while you are chopping food, running with scissors, playing with
matches/knives/firearms, etc.
A child who does not have these
issues has time. Medication is still an
option, but other approaches could first be given a trial.
2) What
have you tried already?
Some children with ADHD may be
able to avoid medication for a time, or forever, with other
supports and interventions. In these children, there is a balance,
however, between being open to trying different ideas and trying too many things
that are likely to be a waste of time and money. A smart approach is to frequently assess where
your child is with regard to question (1), as well to carefully evaluate the
various therapies you may want to try.
3) Are there other medical or psychiatric
issues that need to be taken into account?
For example, children with
seizure disorders, tic disorders, and heart problems should get clearance/reassurance
from the appropriate specialist before taking any kind of medication. Anxiety can be made worse (or better) by
medication and sometimes needs to be treated in its own right before ADHD
medication can be started. Children who
need to take a lot of rescue medication for asthma may need to wait until their
asthma is stabilized before starting certain ADHD medications.
4) Consider
both risks and benefits of medication.
Medication definitely has downsides. Side effects like seizures, tics, heart
rhythm disturbances, insomnia, and appetite loss are all real risks. Younger children (under the age of 6) may be
at higher risk for certain side effects.
Also, some of the medications have an addiction risk—which isn’t a
problem if you take the medications as prescribed, but can be a problem if
there are people in your house who struggle with substance abuse, or if there
are teenagers who are risk takers.
It’s important to not only know
which side effects are possible, but also to have some idea of how likely they
are to occur. Life threatening side
effects are rare. Some of the more
common side effects can sometimes be made manageable. The good thing about side effects is that for
most stimulants (the most common medications prescribed for ADHD) almost all
side effects will go away within a day or two of being stopped.
An important point to think about
at this stage is whether you are scaring yourself with side effects without
thinking about the benefits of medication. Consider what the risk of not giving
medication will be. For this, you need
to combine your thoughts on parts 1-3 to come up with some idea of how things
could look if no medications are involved.
For example, a child with relatively few symptoms and who has not had
any school accommodations might try the accommodations first. But a child who has mild symptoms, but who
has tried a lot of non-medicine therapies already might go to medication as a
next step rather than try another round of alternative therapy. A child with severe symptoms may fail a
grade, get suspended, or get hurt if medication isn’t started soon.
3)
Discuss your
concerns with your doctor.
The best chance you have to get
good treatment is to communicate with your physician. If your doctor doesn’t listen to or dismisses
your concerns without addressing them, you may want to find another doctor
before starting medication, as concerns will probably continue to crop up along
the course of treatment. Usually it is
possible to find a doctor—a generalist or specialist—who will work with you to
help you come to a decision you can be at peace with.
References:
Subcommittee on Attention-Deficit/Hyperactivity
Disorder, Steering Committee on Quality Improvement and Management. "ADHD:
Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of
Attention-Deficit/Hyperactivity Disorder in Children and Adolescents." Pediatrics (2011): n. pag. Pediatrics. American Academy
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