ADHD and Medication
If you are a caregiver staring down the barrel of the decision on whether or not to medicate your child for ADHD, it is very likely that you are feeling overwhelmed.
I have found that many of the articles and studies we research do not include what families can really expect when they embark on that journey, or what they can expect if they don’t. Many studies and statistics that state medication treatment in addition to therapy for ADHD is very beneficial. I, too, am a believer in this idea, but that was not always the case, and of course every child, family, and situation is different; this is really important to keep in mind as you read this post. I want to share with you some information about ADHD and treatment thereof, as well as my personal journey of growing up while trying to figure out how to manage my diagnosis.
Background of ADHD and Medication
ADHD is the disorder of short attention span, impulsivity, and overall inability to focus on tasks, and has been treated with medication for almost 70 years now. Ritalin (methylphenidate) was the first stimulant used to treat ADHD in 1955, and it did work in many cases; kids achieved higher grades in class and teachers noticed the shift from impulses and inattention to focus and motivation. However, Ritalin also came with side effects. Difficulty sleeping, loss of appetite, headache, nausea, vomiting, and the big one: increased anxiety! Since the introduction of Ritalin, there have been many medications formulated for the treatment of ADHD in both children and adults. Many of them are considered controlled substances (a scary phrase, to be sure). But the data supporting medicating children for ADHD is clear.
Research has reported that treatment was beneficial in these common domains:
90% of self-esteem outcomes
83% of social function outcomes
71% of academic outcomes
67% of drug use/addictive behavior outcomes
50% of antisocial behavior outcomes
50% of services use outcomes
33% of occupation outcomes (Shaw et.al., 2012).
In the aforementioned study, treatment included medication in combination with therapy. Even the American Academy of Pediatrics, an organization that represents somewhat of a parental instruction manual to many folks, states that one should treat and possibly medicate your child as soon as they are diagnosed with ADHD. These are big decisions to make all at once! You’re diving into an absolute rabbit hole trying to figure out where to start with treatment, and it usually ends up being a process of trial and error. Basically, you have to keep trying until you find the right way to manage the ADHD diagnosis.
As I promised, I’ll share my experience growing up with and managing (and sometimes not managing) my diagnosis. Again, this is not certainly not what every family will experience, but take notice of how many different things we tried and how I personally reacted to them. My hope is that it will give you an idea of how it can feel going through this process, and how it can still turn out pretty great in the end.
ADHD Management
I was diagnosed with inattentive-type ADHD in early adolescence after an assessment with a behavioral neurologist. Soon after, my family found a therapist for me, then we began the task of finding the right medication and dosage. Ritalin (Adderall) seemed to make it more difficult for me to control my emotions. I did not feel much of a difference with Focalin. Eventually, I settled on Concerta; it helped me focus very well with fairly minimal side effects. When I was a teen, I started to have trouble falling asleep with the higher dose I was on, so we tried a few other medications. One was Strattera, which is one of the only medications to treat ADHD that is not a stimulant. After I started taking it, I felt all my ADHD symptoms getting worse. Every time I came into a room, I forgot why I was there; I trailed off in the middle of my sentences constantly, and I could not remember which textbooks to bring home for the life of me. I was so worried that my ADHD had somehow gotten worse. I was scared that was how I was going to be for the rest of my life.
Then, I decided to read the label on the side of the bottle, which stated: “may worsen condition in teens”. I was instantly filled with righteous anger. How did my doctor not tell me something so comically obvious? Ridiculous! It was at that point I swore off ADHD medications for several years. My caregivers seemed to respect that decision, but my performance in school did suffer.
Throughout college, I managed my symptoms with caffeine and profuse apologies to professors if I forgot a deadline. It was not until adulthood that I realized coffee was not going to cut it anymore. My symptoms had a profoundly negative effect on my work output in my first couple of jobs. Even though I could feel everything slipping away from me, I was still so adamant that I did not need medications, that I could manage my symptoms by myself, I just needed to “try harder.” I thought of medication as some kind of unnecessary crutch, and I did not want to have to take a pill to feel like myself. Eventually, I realized I did need medication to help with my ADHD diagnosis, but here is the shocking part: I also realized I did not have to feel guilty for needing it. I did not have to feel weak or lame for needing medication; after all, if I had asthma, I would take asthma medication, and now I truly view my diagnosis the same way.
The reason I am telling you this story is not to turn you off or on to medications or to tell you not to trust your doctor or anything along those lines. I wanted to share my journey mostly to convey that dialing in the management of ADHD is an ongoing and sometimes messy process. Sometimes, families start treatment and they see a change immediately. Other families have a more winding road toward symptom management, and it is always subject to change. Changing circumstances, interests, expectations, and responsibilities can all affect someone’s ability to manage their ADHD. Management of ADHD can require medication, but also discipline and effort on the part of the person with ADHD, as well as caregivers (and significant others–shout out to my wife!).
What You Can Do
So what do we do about any of that, Ben? If you are the caregiver of a child with ADHD, below are some things I believe will help your child on their road to success:
Observe your child closely when you try something different in regards to their ADHD treatment, and try to discuss your observations with your child when you can.
Encourage your child to be aware of the differences they feel when they start different aspects of their treatment; this will help them be aware of what works for them and what does not. You might get some “I dunno” responses at first, but asking this coupled with your observations will help them develop some insight and awareness of their diagnosis.
Understand that this can be a difficult process for a child: confronting the reality of ADHD is no easy feat. Children can often feel “less than” with this diagnosis because they have trouble with things their peers have no trouble with. I could write a whole blog on this, but in summary: there needs to be accountability, but there also needs to be compassion.
Develop a problem-solving mindset in yourself and in your child. If something isn’t working (ex. Your child is missing deadlines at school), try to move straight to “what can we do about this? What adjustments can we make?” This will help your child to not take a long detour through the “I’ll never be enough” thought spiral.
Don’t forget to encourage them—point out progress when you see it! (“You used to forget ___ pretty often, but now you don’t. You can figure this out!”)
References:
Barkley, R. A. (2015). History of ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 3–50). The Guilford Press.
Goodman, B. (2011, October 17). New guidelines: Diagnose kids for ADHD at age 4. WebMD. Retrieved May 24, 2022, from https://www.webmd.com/add-adhd/childhood-adhd/news/20111017/new-guidelines-diagnose-kids-for-adhd-at-age-4#:~:text=Oct.,the%20American%20Academy%20of%20Pediatrics.
Shaw, M., Hodgkins, P., Caci, H., Young, S., Kahle, J., Woods, A. G., & Arnold, L. E. (2012). A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC medicine, 10, 99. https://doi.org/10.1186/1741-7015-10-99
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WRITTEN BY BEN KINSEY, LCSW (HE/HIM/HIS)
Ben has worked with children and families in many different contexts: Summer camps, schools, foster care and children's shelters, hospitals, medical clinics, and private therapy. He’s worked with teens, toddlers, and everyone in between. He can tell you one thing for certain: there is no handbook for the challenges and hardship you and your child are facing, both in and outside your relationship with one another. The goal in his room is to give your child the tools to cope with and navigate through any troubles they may be wrestling with, and with the family's support, empower them to use those same tools in the future.
