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ADHD and Medication: Some Helpful Facts

Deb Levy
June 22, 2017

Was your child diagnosed with ADHD? Here's what you need to know about medication.

When a child is diagnosed with ADHD, the second reaction of many parents is to ask "now what?"  (The first may range from, "No way, not my kid!" to "Gee, all this time I thought I was a bad mother.")

The answer to "now what" involves education, changes in parenting tactics, and more often than not, a prescription for medication.  Yet the decision of whether or not to give your child psychostimulants can be a daunting one, especially given the media explosion warning of a national overdependence on Ritalin.

It's important for parents who do choose to medicate to work closely with a trusted doctor who is well versed in the various treatment options, as there is no one-size-fits-all solution to medicating a child with ADHD.


To Medicate or Not to Medicate

Dr. Ned Hallowell, a child and adult psychiatrist and the founder of The Hallowell Center for Cognitive and Emotional Health, believes medication is advisable the moment a diagnosis is made.  "There is no reason to hold back," he says. "Do you want to squint before trying eyeglasses?"  He says that when used properly, medication is not only safe and effective; it is a godsend.

ADHD medications are known as stimulants, which seems counterintuitive for a child whose condition causes him to bounce off the walls.  But according to the American Academy of Pediatrics, these medications work by "stimulating" the area of the brain that deals with executive function - focusing attention, controlling impulses, organizing and planning, and sticking to routines.  Parents can take comfort in the fact that stimulants have been the widest and most studied of any group of medications for the behavioral and emotional problems of children.


What are the Medications?

These medications come in three classes - methylphenidate, dextroamphetamine and amphetamine compounds.  And within these classes are varying dosages, from short-acting (4 hours) to intermediate (8 hours) to extended release (about 12 hours).  Depending on the needs of the child, doctors can regulate these dosages to suit individual schedules.  For instance, a child may take an intermediate dosage that will last throughout the school day, and then a short-acting booster on days when an afterschool activity might force her to stay up later to do homework.  Stimulants do not build up in the body, but leave the child's system completely as they wear off at the end of each day.

How much of the medication should a child take?  It all depends, and not on the child's weight as is the case with other meds like antibiotics or cold medicine.  The optimal dosage is not the lowest amount that shows some benefit, but rather the one that most helps a child reach his target behaviors.  It is recommended that doctors start low and slowly increase the dosage until either no further improvement is noted, or side effects appear, though this gradual increase may actually help to diminish some of the side effects.


Do Meds Work?

Studies show that when taken correctly, 80% of children respond well to medication. But sometimes the medications don't work.  If there is still no improvement after tinkering with dosages or switching to another class of stimulants, parents may want to consider whether or not ADHD was indeed the correct diagnosis.  There might be another underlying cause, like anxiety or a learning disability that manifests in the same behaviors as a child with ADHD.

As with practically any medication, stimulants do have side effects.  The most common are a decreased appetite (until the medication wears off in the evening and you can expect your child to request a second dinner), stomachaches, headaches, jitteriness, difficulty falling asleep and social withdrawal.  With the exception of a lowered appetite, most of these symptoms disappear as the body adjusts to the medication.

Some children (15-30%) experience motor tics after almost a month of starting medication.  Though disturbing for parents to see, this usually goes away after about three weeks.  This may give pause to parents of children with both Tourette Syndrome and ADHD.  (Nearly half of all children with Tourette's have ADHD as well).  Yet according to the American Academy of Pediatrics, recent studies have shown that stimulants, at moderate doses, have no effect on the severity or frequency of tics, while the benefits to the ADHD symptoms are measurable.


Long-term Impact

Recent studies also show that stimulants have no long-term effect on the ultimate height of a child as had been previously thought.  Finally, in the beginning of treatment, a child may experience rebound as the medication wears off at the end of the day.  This is when behaviors erupt and seem worse than what they had been before medication.  Fortunately, this does not typically last long.

When a child takes medication for ADHD, he or she should be closely monitored - the parents and caregivers should note daily behaviors, and the prescribing doctor should schedule frequent follow ups to monitor treatment and ensure that the dosage is optimal.

Dr. Hallowell cites the MTA (multi-modal treatment assessment) study, the largest study ever done on the treatment of ADD in children, and says, "While medication makes the biggest difference immediately, as time goes by other factors come significantly into play, including the positive connections within family and elsewhere that make a crucial difference in outcome."

In other words, there is no such thing as a magic pill.  But used properly, medication can lay the foundation for success with other treatments as well.

Comments
User
Oct. 26, 2015

I am a mom of a child with mild autism and one who has to deal with ADD-ADHD. None of these are a fun thing to deal with but I honestly believe it's great to see how unique my children are. Two of my boys have these special characters, but they are a joy to always be around and there is never a dull moment with all of my kids. When Anthony was in 1st grade, I got called by his teacher because she felt he was \

User
Sept. 12, 2011

I can tell you that if your child has not been diagnosed by a licensed psychologist that you have no real vision of what a parant with a child with ADHD goes through on a daily basis. I can tell you that my son was diagnosed at the age of 3 and I can also tell you that I knew from the time he started walking there was something special about him. I was a parent against any kind of medication. By the time he was three we had been asked to leave 3 child care providers for impulse biting. We took him through right and wrong time after time after time. Immedately after it happend he was remorseful. He knew right from wrong that wasn't the issue. Shortly after that we found out from a psychologist that he definately had ADHD not just hyper, but impulse too. He couldn't control the impulses even if he knew it was wrong. For me, it was a matter of keeping my job or not. I put him on medicine and our lives began to make incredible changes! All of a sudden the papers he was doing in preschool came home looking 100% better. There was focus, and control of his actions. A very well mannered child emerged, still age appropriate things happen but that was expected. He is nine now and he get good grades in school, loves to read and is a great kid! I would not change the decision I made to medicate him for anything. We have a psychiatrist that closely monitors his medication. I would encourage any parent struggling with ADHD to seek the help of first a psychologist then a psychiatrist. Your child WILL BENEFIT from the medicine. With the proper fit, sometimes you have to try a couple, but keep going. We tried a few that didn't work, we saw it not working and simply stopped giving it to him and went back to the dr. With medication a child will be successful and have a great feeling of pride. Sure there are struggles with the appetite thing, but it is worth the battle every time he comes home so proud of his success at school, or church or cub scouts or any activity that he chooses. Good Luck

User
Sept. 12, 2011

I was the child with ADHD. I was (and still am) an extremely overactive person. As a child it was impossible for me to focus on anything because I constantly had my thoughts and brain moving at 1000 miles an hour. I couldn't cope easily at school with this. Finding the right type of ADHD medication was important for me and my family. My poor parents, trying to get me to sit still for homework or anything that wasn't fun was near to impossible. We went through three different medication choices. We started with Adderall, which was great. I focused in school, I was more aware of things in the classroom and not just reacting to everything, not paying attention. Except it lowered my appetite when I was on it. Weekends I'd be med-free and I would try to bring myself under control by myself. (Which is a hard thing for an 8-yr-old to do.) We eventually found a medication that worked for me and let me keep my appetite and didn't interrupt my sleep schedule. As I got older, and got to know myself and my ADHD tendencies better, I could go off of my medication completely and feel like I could think in a straight line, and stay at task, and like my brain wasn't going to overload on me. ADHD is real, and I feel like I wouldn't have been able to become what I am if I hadn't had help, medication-wise, when I was younger.

User
Sept. 6, 2011

Yellow number and Red number food color, and current diet concerns more health wise choices for kids even out. In the past years even the 1920-60's food was coked in lard, Pepsi-Coke Coke has actual stimulant in it, and other foods we have come far. Your blog seems a lot like Scientology http://newideas.net/adhd/adhd-... which is quite out there. I guess blood pressure meds, Bi-polar, and other very important conditions should be thrown out. Shonda the zombie mode I personally suffered through that for a year. It made a difference in grades, and the way things were done then my Dr. decided to try a different approach. If it were truly adhd or add it is not a pure attention thing even adults have it as proof. I am on adderall and have had positive effects. I am able to focus more, clean, have a want to be productive and have been on it long enough to know the side effects are very low to none for me.

User
Sept. 6, 2011

I am a parent of an ADHD 17 year old son. Of course, as a child he was an extreme handful and we went the medication route. We'e tried so many vitamins, diet changes and even magnetic therapy. None of which worked for him. Every child is different. Wheither your a parent of an ADHD child, teacher or even just someone giving their opinion about the condition, its important to not judge parents for the choices they make. Whats right for you and your child might not be right for the other person and their child. I always said regarding my sons condition, if a parent has a child like my son and they can function normal on cetain diets or vitamins, then they are extremely blessed or not ADHD at all, lol. God bless.

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