What Parents Need to Know About Medication for ADHDADHD medications turn kids into compliant zombies.”

“They’re only prescribed to simplify a parent’s job.”

“They boost the risk for drug abuse.”

“They change kids’ personalities.”

These are just some of the many myths about treating attention deficit hyperactivity disorder (ADHD) with medication. And these misconceptions no doubt leave parents confused and overwhelmed about the best ways to treat their child’s disorder.

“Medications aren’t a cure-all but they can be very helpful,” according to Mark Bertin, MD, a board-certified developmental behavioral pediatrician and author of The Family ADHD Solution.

As he writes in his book, “What ADHD medications really offer children is a skill they lack that most peers already have — the ability to self-regulate.” Specifically, medications may improve symptoms like poor focus, distractibility, impulsivity and emotional reactivity, according to Dr. Bertin.

Stimulants, for instance, stimulate an underactive part of the brain to become more responsive so kids can self-monitor, he said. “Underactive frontal lobes disrupt multiple paths of development throughout the brain and may limit any aspect of learning, from play skills to reading to tying a shoe,” Bertin writes in his book.

“Medications, however, permit typical functioning for extended periods of time, and skills persist even after medications are no longer used,” he writes. “They may help you engage well enough to learn to read or pick up math facts, or perhaps even to negotiate particular social situations in a new way, even if ADHD symptoms return during time off medication,” Bertin said.

Below, Bertin shared insights and tips for parents considering medication for treating their child’s ADHD.

1. Balance benefits with the risks.

Bertin stressed the importance of balancing the benefits of treating ADHD with the potential side effects of medication and untreated ADHD.

ADHD has a neurological basis, he said. In The Family ADHD Solution, Bertin describes living with ADHD as “a continual battle with the brain.” He further explains, “It may take grueling levels of exertion to overcome distractibility, forgetfulness, and keep track of all the details of life.”

Untreated ADHD may lead to various negative consequences. Kids with ADHD are at greater risk for falling behind in school, physical injuries and strained relationships with their parents and peers, according to Bertin. Older kids are at greater risk for drug abuse, early drinking and sexual behavior.

2. Consider the severity of the situation.

Bertin suggested parents ask themselves “How acute is the situation?” For instance, “In older kids, choosing a next step for treatment may depend on how they’re doing. “If it’s not a crisis, you may choose to take a step-by-step approach.” Parents may start with educational interventions and behavioral plans before considering medication, he said, while remaining aware of the possibility. “Then check in with your kids every few months to make sure they’re thriving.”

3. Understand that finding the right medication is a process.  

Unfortunately, physicians don’t know who will respond to what medication. That’s why finding the right medication for your child requires some trial and error — and patience on your part.

For some kids the first medication works well. But it’s more common for doctors to switch doses or medications until they find the best one. In fact, “The best responses in the research are often from weekly comparisons of different medications and doses,” Bertin said.

So if your child experiences side effects or only shows a slight improvement with one stimulant, don’t stop there. The next medication (or dose) might work better — and without the side effects, he said.

Stimulants take effect the day they’re taken, so you can tell right away whether the medication is helpful or has side effects. In other words, as Bertin said, “What you see is what you get.”1 The only exception is that some mild side effects dissipate within a short time, Bertin said.

“It’s best to wait several days to a week before changing medications to get the clearest view possible of what’s going on for a child,” he said. However, if there are significant side effects or “if your child isn’t [acting] like themselves, move on to the next medication sooner,” Bertin said.

For instance, zombie-like compliance isn’t a treatment goal, he said; it’s a possible side effect that requires either an adjustment in dose or a new medication. “The goal is someone feeling more consistently their best self when it comes to their ADHD symptoms, hopefully without any side effects at all,” he said.2

In short, “If you don’t like what you’re seeing, [your child doesn’t] have to take the medication.”

4. Record your child’s symptoms and side effects.

Writing down your child’s symptoms and any side effects helps you monitor their progress, spot patterns and provides you with valuable information to bring to your next doctor’s appointment.

For instance, divide a piece of paper into two columns, with one column for symptoms that improve and the second column for side effects, Bertin said. “If you see benefits, any side effects that tag along won’t necessarily be present with a different choice of medication,” he said. This detailed scale also can help parents track their child’s behavior.

5. Find a doctor who will monitor your child closely.

Finding the right medication for your child requires careful and continuous fine-tuning. So it’s important to work with a doctor who will monitor your child closely. Your doctor also should have a thorough understanding of ADHD and the different treatment options, Bertin said.3

6. Pay attention to timing.

Stimulants are most effective within 30 to 90 minutes after they’re taken, Bertin said. Their effects dissipate within four to 12 hours. In order to get the most of the medication, it’s best to schedule homework and other challenging tasks around these times, he said.

7. Add other interventions.

While medication improves some symptoms of ADHD, it doesn’t help with all of executive functioning, Bertin said. Also, it’s common for kids with ADHD to struggle with other disorders such as anxiety and learning disabilities, which these medications don’t directly help, he said.

It’s important to have a comprehensive treatment plan, such as behavioral therapy and various educational interventions, along with a focus on healthy habits, such as getting enough sleep, exercising and eating nutritious foods.

8. If symptoms don’t improve, get a second opinion.

Somewhere between 1 in 5 and 1 in 10 kids with ADHD don’t respond well to any medication, Bertin said.  One other thing to consider when medications aren’t successful is to reevaluate the ADHD diagnosis itself.  Parents might want to see a specialist — or another specialist — to confirm that their child really has ADHD, he said.

Bertin also encouraged parents to avoid thinking in terms of being for or against medication. Instead, he suggested weighing the importance of avoiding medication whenever possible with treating a disorder that has a neurological basis and profound effect on children’s lives.

Further Reading

CHADD has valuable information on medication, including a medication guide for parents.

 

Child taking medication photo available from Shutterstock

 

Footnotes:

  1. Other medications, including Strattera and Intuniv, take longer to show benefits. []
  2. This article in ADDitude magazine offers advice on minimizing side effects. Dr. Larry Silver, who penned the piece writes, “No one should have to put up with side effects of ADHD meds. Often, a simple adjustment in the way a medication is used is all it takes to remedy the problem.” []
  3. The nonprofit organization CHADD, Children and Adults with Attention Deficit/Hyperactivity Disorder, has good information on finding resources and professionals. []

 


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    Last reviewed: By John M. Grohol, Psy.D. on 2 Jan 2013
    Published on PsychCentral.com. All rights reserved.

APA Reference
Tartakovsky, M. (2013). What Parents Need to Know About Medication for ADHD. Psych Central. Retrieved on December 19, 2014, from http://psychcentral.com/blog/archives/2013/01/05/what-parents-need-to-know-about-medication-for-adhd/

 

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