ADHD: Making Medication Decisions

ADHD: Making Medication Decisions

One Family's Story

Amy Schneier of Needham, Massachusetts, said that she didn't want to put her son Adam, who has attention deficit hyperactivity disorder (ADHD), on medication until his second-grade teacher suggested that it might help.

"I didn't want him to become reliant on medication. However, Adam's teacher said that she couldn't read his writing, he was distracted, and, when recess ended and his peers knew how to calm down in class, he couldn't."

After consulting with a neurologist and hearing positive things about Ritalin, Amy and her husband Eliot decided Adam should try it. Although his behavior and academic performance improved after taking the medication, they discontinued it after six months when he complained of stomachaches, nausea, and sleeplessness.

It wasn't until he got Cs and Ds as a freshman and sophomore in high school that Adam decided to go back on Ritalin and proceeded to make honor roll in his junior year.

"Before Ritalin, I had a million thoughts in my head, and I couldn't do any of them," Adam said. "I was struggling and overwhelmed. When school became more of a priority, I knew that Ritalin would help me concentrate."

Now a junior at St. Lawrence University in Canton, New York with a 2.6 grade point average, Adam has learned how to manage the side effects of Ritalin. He eats before taking Ritalin to help settle his stomach and doesn't take it too late so he won't be up all night.

Success in school and learning how to manage his condition has helped Adam feel more positive about himself.

"There are pros and cons to having ADHD. Some things I'm better at than other people because I have ADHD, such as thinking faster than everyone else."

Using Medication
Deciding whether or not to put a child with ADHD on medication can be a difficult decision for parents. Edward Hallowell, M.D., a child and adult psychiatrist who is co-author of the bestseller Driven to Distraction, said that the most important part of the decision-making process is to seek competent medical guidance, and, if you choose medication, watch for side effects.

"Consult with the child's pediatrician and a child psychiatrist who knows medication and can explain the pros and cons," says Hallowell. "Make the decision only when you have all the facts. If you decide on medication and your child complains of side effects, listen and stop it or lower the dosage. The main reason there's dissatisfaction with medication is when side effects are not monitored."

Although not a cure, when used properly, medication helps 80 percent of individuals with ADHD, says Hallowell. The major benefit is "mental focus" - being able to stay on track and not getting distracted. Medication, he said, should be part of a comprehensive treatment plan that includes non-medication approaches such as the following:

• Getting enough sleep, exercise, and a balanced diet
  
• Structuring a child's life: family dinners, regulating TV and video access
  
• Hiring a coach and tutor
  
• Getting organized: working at a desk, learning how to do homework
  
• Managing time

Asking the Right Questions
When deciding whether or not to put your child on medication, Jerome Schultz, Ph.D., learning disabilities and ADHD expert and clinical director of the Learning Lab in Cambridge, Massachusetts, says to first consider the following questions:

• Has my child been helped by non-medication approaches? Self-calming techniques, deep breathing and yoga often can help children with ADHD.
  
• Has the school tried to teach my child to be more attentive and less active?
  
• Is the decision to put my child on medication the result of behavioral observations over time and in different settings, such as in school and at home?
  
• When is my child at his or her best? Fishing with his uncle or playing video games? Help the physician understand how pervasive or selective the problem is.
  
• Does my child have other conditions that can be mistaken for hyperactivity? Children exposed to toxic chemicals or who haveundiagnosed learning disabilities and low-level anxiety disorder may produce similar behaviors.

• Hallowell, E. M., Ratey, J. (1994). Driven to Distraction. Pantheon Books.
• Silver, L.B. (1993). Dr. Larry Silver's Advice to Parents on ADHD. American Psychiatric Press.
• Barkley, R. A. (1995). Taking Charge of ADHD. The Guilford Press.