Many of the students I work with have ADD or ADHD (often referred to simply as ADHD), and I often hear from parents that they are concerned about making the decision to give their child medication. A parent recently asked me for my opinion of medicating kids with ADD and ADHD.
Children with ADHD are suffering; some suffer quite a lot. One way of looking at ADHD is that it is difficulty with managing the multiple aspects of “paying attention.” Attention is not a simple, easily defined matter of focusing on one thing. Attention is the management or orchestration of the information being received by the senses, interpreting this information, and responding to this information.
Kids with ADHD often find it hard to get their bodies to cooperate in their attempts to “stay focused” and no amount of saying “you need to pay attention” is going to help. To use an analogy, telling a person with extremely poor eyesight that he just needs to try harder to see clearly will not convince or shame him into “getting serious” and producing perfect vision!
The metaphor of eyeglasses is a great one for thinking about the use of medication for a kid with ADHD. If your child is nearsighted or farsighted, naturally, you provide the physical tools necessary for him to see clearly, to participate fully in life and to move ahead in meeting his goals.
For about 80 to 90 percent of kids with ADHD, medicine is the equivalent of glasses. With the aid of glasses, a kid with poor vision can see what’s around him. It gives him the opportunity to interact more fully with the environment—an opportunity he didn’t have before putting on the glasses.
The proper medicine, in the right dose puts kids in a better position to interact productively with people, form friendships, learn more successfully, develop a strong self-concept, and more easily develop to their full potential.
Myths and fears about negative effects of drugs
I agree that drugs are serious business and I don’t want any child to use a drug that isn’t right for her. It just won’t help, and it could have negative side effects that give her more problems.
Statistics show that 80 to 90 percent of kids are helped by medication. Kids who get the right medicine, in the correct dosage, and who regularly work with a skillful doctor to make adjustments to their medical treatment as their needs change, have a much easier time managing the areas of their life that challenge kids with ADHD, such as relationships and school work. What is the evidence for this conclusion?
A very famous study that you may have heard about called the MTA or The Multimodal Treatment Study of ADHD (MTA Study) is the largest ADHD treatment study ever conducted. A total of 597 children with ADHD-Combined Type (which means they had both inattentive and hyperactive-impulsive symptoms) were randomly assigned to 1 of 4 treatments:
These treatment conditions were: medication management, behavior modification, medication management and behavior modification, or community care.
The medication and behavioral treatments provided in the MTA study were far more thorough than what children typically receive in community settings.
The kids receiving medication treatment underwent a thorough process to determine the optimum dose and medication for each child, and were closely monitored and adjustments made when necessary.
The behavioral intervention was rigorous as well. It included over 25 parent training sessions, an intensive summer camp, and extensive support provided in children’s classrooms.
In contrast, children in the community care condition received whatever treatments parents chose to pursue for their child in the community. Although this included medication treatment in most cases, the MTA researchers felt this treatment was not as intensive or thorough as the medical treatment given to students in the “medical” condition.
The overall pattern of results suggested that children who received intensive medication management – either alone or in combination with behavior treatment – had more positive results than children who received behavior therapy alone or community care. There was also some evidence that children who received the combined treatment were doing better overall than children who received medication treatment alone. This speaks to the effectiveness of medication in improving the lives of children, and it also suggests that using more than one approach to support kids with ADHD is necessary for best results.
There are some common side-effects of drugs that you should be aware of. Finding the right medicine in the correct dosage for your child involves trial and error. Your child will probably have some issues surface while she’s adjusting to the medicine.
The typical issues that tend to come up for kids are sleep disruption, decrease in appetite and weight loss, impulsivity when the medication wears off, irritability, and suppression of personality. Longer acting medications have greatly reduced the likelihood of these side effects. Naturally, bring these concerns to your doctor so that adjustments can be made.
How to find a skillful doctor for your child
The best doctors really, really like people! Seems obvious, right? But how often have you been to a doctor who seemed irritated that he or she had to be working that day? The point is, doctors are people first, and caring people are fairly easy to spot, even when they’re having a bad day. Here’s some tips for finding them:
They spend time getting to know your child. They get to know your child’s strengths, weaknesses and challenges. They strive to understand the school challenges and the family dynamic.
They are up-to-date on all the latest research, theories and medications. These doctors spend lots of time staying educated in their craft. In my opinion, one of the biggest clues that your doctor is up-to-date is that they sometimes say “I don’t know.” This tells me they pay attention to what’s really going on in their field, because we don’t know everything yet. Doctors who never admit they don’t have all the answers, even if you really push for an opinion, aren’t comfortable sharing their lack of knowledge and that can spell trouble for your child.
They will talk about other types of non-medical intervention with you. They’ll encourage you to get other kinds of support. For example, they may suggest dietary changes, or behavior plans or family counseling or educational therapy. In other words, they really understand what the research shows: medical plus non-medical interventions is a much more effective approach than either medical or non-medical intervention alone.
I can highly recommend my colleague, Dr. Audrey Griesbach, whose practice is in Los Angeles. She is the kind of doctor I’m describing above.
If you’re not in Los Angeles, you should talk to parents in your area. Get lots of opinions and then phone the doctor’s office and talk to the staff. Ask if they have a client welcome packet that discusses the doctor’s approach to treating ADHD. If your town is small and you don’t have a doctor who specializes in the treatment of ADHD, use the criteria above to find a practitioner who is a caring person, widely and deeply knowledgeable about kids and ADHD, and who spends the time needed to search for and find the right kind of medicine and dosage that gives your child the chance to be on a more level playing field.
If your child is one of the 80-90 percent of kids helped by medicine or is one the 10 to 20 percent for whom medicine is not producing better outcomes, there are other non-medical as well as behavioral and academic interventions that can give her support. Use the links below to investigate some of these alternatives.