Blogging Baby Size Six: Approaching ADHD medication
Categories: Preschoolers, Teens & tweens, Safety
My six-year-old son has ADHD. Last fall, when he was struggling in school, we talked extensively with our pediatrician and our psychologist and Henry's teachers about how he might benefit from some medication. Twelve months and five medications later, we have found what works for him. Along the way, I learned a few things about how to manage the trial-and-error phase of ADHD meds.
1. Be choosy about who prescribes the medication. Your pediatrician is always a good place to start, but you shouldn't assume that he or she will be the right doctor to manage your child's medication. Talk to your doctor about his or her philosophy of treating kids with ADHD, specifically with drug interventions. Ask how much experience he or she has with ADHD meds, and with the other therapies for children with ADHD. My pediatrician was very up front about her limited experience with ADHD medication; when the first thing she prescribed didn't work, she recommended that we call a developmental pediatrician specializing in kids like our son. Don't be afraid to get a second--or third or fourth--opinion before committing to medication. Take the time to find a physician who is comfortable with these drugs, and whose approach to them is one YOU are comfortable with.
2. Be clear about your expectations. Really ask yourself why you think medication is the right solution right now for your child and your family. What specifically is your child struggling with? What symptoms is she exhibiting and how are they interfering with her functioning? What other approaches have you tried, and to what degree have they helped? What are you hoping will change or stop if your child is on medication? What are your concerns about the medication? Be honest with yourself about what you are hoping the medication will do for your child, and your family. If you are looking for an instant cure-all, be aware that medication will probably not offer that. Instead, think of it as one more strategy to help your child learn and succeed and be happy.
3. Be attentive to details. When your child starts taking medication, keep a detailed log of how much medication your child takes, what time of day he takes it, and how you are dispensing it (mixed with applesauce or pudding, for example). Note any changes in behavior or appetite or sleep, and any days that your child skips his medication and why (illness or travel). I keep all my notes on my calendar, right next to the playdates and school programs and birthday parties. This helps me keep track of all the factors that may be affecting my son's behavior, and it allows me to see the whole picture at once.
4. Be an advocate for your child. Talk to her teachers as frequently as possible; if you can, ask for regular progress reports (weekly or even daily, if the teacher is willing). Ask the teacher to identify specific problems your child is having in class; follow up after your child starts medication to see if she is functioning better. Ask your child's teacher to watch for changes in behavior, particularly negative changes (aggression, for example). Tell teachers about any changes to the dose or the type of medication your child is taking. Call your doctor if you have any questions or concerns.
5. Be persistent. Medication works best in combination with behavior therapy, which incorporates specific systems of reward and punishment. Find a system that works for your child; for example, a good week at school might earn her an ice cream cone, or a treat from the dollar store, or ten extra minutes of television. Think as well about ways to help her unwind and relax, like a hot bath or some quiet music. Create a peaceful place for homework or reading or quiet time. Medication is only one part of the picture for kids with ADHD; to really help your child, you will need to keep working at all the other pieces.
6. Be patient. ADHD drugs work wonders for some children; for others, they don't seem to help at all. Our son tried four different medications in a six month period, but every drug had untenable side effects. We finally found a medication that works for him and doesn't have any side effects at all, but it took time and effort. Don't expect miracles from ADHD drugs; instead, be realistic about how you hope this will help your child and your family.
1. Be choosy about who prescribes the medication. Your pediatrician is always a good place to start, but you shouldn't assume that he or she will be the right doctor to manage your child's medication. Talk to your doctor about his or her philosophy of treating kids with ADHD, specifically with drug interventions. Ask how much experience he or she has with ADHD meds, and with the other therapies for children with ADHD. My pediatrician was very up front about her limited experience with ADHD medication; when the first thing she prescribed didn't work, she recommended that we call a developmental pediatrician specializing in kids like our son. Don't be afraid to get a second--or third or fourth--opinion before committing to medication. Take the time to find a physician who is comfortable with these drugs, and whose approach to them is one YOU are comfortable with.
2. Be clear about your expectations. Really ask yourself why you think medication is the right solution right now for your child and your family. What specifically is your child struggling with? What symptoms is she exhibiting and how are they interfering with her functioning? What other approaches have you tried, and to what degree have they helped? What are you hoping will change or stop if your child is on medication? What are your concerns about the medication? Be honest with yourself about what you are hoping the medication will do for your child, and your family. If you are looking for an instant cure-all, be aware that medication will probably not offer that. Instead, think of it as one more strategy to help your child learn and succeed and be happy.
3. Be attentive to details. When your child starts taking medication, keep a detailed log of how much medication your child takes, what time of day he takes it, and how you are dispensing it (mixed with applesauce or pudding, for example). Note any changes in behavior or appetite or sleep, and any days that your child skips his medication and why (illness or travel). I keep all my notes on my calendar, right next to the playdates and school programs and birthday parties. This helps me keep track of all the factors that may be affecting my son's behavior, and it allows me to see the whole picture at once.
4. Be an advocate for your child. Talk to her teachers as frequently as possible; if you can, ask for regular progress reports (weekly or even daily, if the teacher is willing). Ask the teacher to identify specific problems your child is having in class; follow up after your child starts medication to see if she is functioning better. Ask your child's teacher to watch for changes in behavior, particularly negative changes (aggression, for example). Tell teachers about any changes to the dose or the type of medication your child is taking. Call your doctor if you have any questions or concerns.
5. Be persistent. Medication works best in combination with behavior therapy, which incorporates specific systems of reward and punishment. Find a system that works for your child; for example, a good week at school might earn her an ice cream cone, or a treat from the dollar store, or ten extra minutes of television. Think as well about ways to help her unwind and relax, like a hot bath or some quiet music. Create a peaceful place for homework or reading or quiet time. Medication is only one part of the picture for kids with ADHD; to really help your child, you will need to keep working at all the other pieces.
6. Be patient. ADHD drugs work wonders for some children; for others, they don't seem to help at all. Our son tried four different medications in a six month period, but every drug had untenable side effects. We finally found a medication that works for him and doesn't have any side effects at all, but it took time and effort. Don't expect miracles from ADHD drugs; instead, be realistic about how you hope this will help your child and your family.
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Reader Comments (Page 1 of 1)
tulip 2-09-2007 @ 1:22PM
What a great post. You guys are obviously invested in helping your child be the best person he can be. Good for you for being realistic and helping others with your experience. Thanks!
Reply
SKL 2-09-2007 @ 2:12PM
I would also suggest that, before trying any medication, the parents try more natural approaches such as: ridding the diet of toxins, irritants, and uppers (e.g., switch to organic foods, reduce sweets and caffeine, etc.); checking on whether the child sleeps well and making lifestyle changes if this is not the case; reducing TV and other media that encourages the mind to jump around rather than focus for a sustained period; making sure the child's basic health is not a distraction; making sure the child plays hard at appropriate times to improve sleep and to promote calmness during other times; and making the child aware of the importance of concentrating on a task. Even if the child still needs medication after these changes, a lighter or more temporary dose may be possible, and the unhealthy effects of one toxin competing with another may be reduced.
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margalit 2-10-2007 @ 1:10AM
As the parent of a teenage child with SEVERE ADHD, I would change several points you made. I would NEVER recommend that you start with a pediatrician as the first person to prescribe medication. Not only are peds not qualified, they also do not provide therapy in addition to the meds, nor do they know first and second line defense of meds. And they don't see children often enough to follow along and see if the meds are working.
It is recommended that ALL children see a psychopharmacologist, a psychiatrist that specializes in medications, to both diagnose and treat the child. Appointments should be made monthly to ensure that the meds are working appropriately. In addition, a child should work with a therapist, but NOT necessarily a behavorist. ADHD kids have a lot of issues with behavorism, and forcing them to tow the line often escalates into anger and aggression. Some kids will NEVER cooperate with a behavioral therapist. That kind of kid lives in my house.
I would NEVER tell a teacher that my child is trying medication. If the teachers knows, they put unfair expectations on the child, expecting that the meds will be miraculous. In fact, every psych we've gone to has recommended NOT telling the teacher, and seeing if the teacher notices a difference after a week or so. This way you get a much more accurate indication whether or not the meds are working.
Be very open to change. Not only do certain meds not work for certain kids, certain doses and times of dosage work better than others. Be open to experimentation and remember that what worked last week may not work this week.
Lastly, if your child has ADHD, please don't put them on ridiculous diets and try things that have been proven over and over not to work. I've read some of the most ludicrous recommendations for treating ADHD without meds. NONE of those things work. Not diets, not eliminating dyes and sugars, not eliminating gluten, not biofeedback. Not anything. ADHD is a neurological problem. People with ADHD have distinct brains. They cannot be cured by all-natural organic diets and it's cruel to force a kid that already feels different and has self-esteem issues to eat differently than his/her friends.
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SKL 2-10-2007 @ 2:13AM
Margalit -
Just for the record, I never suggested trying to treat severe ADHD without meds. I was simply pointing out that kids identified as having ADHD are often sensitive to a lot of the unnecessary crap in food. For mild cases, adjusting this COULD mean the difference between meds and no meds. For more serious cases, better diet, exercise, and sleep could impact the necessary dosage. Less unnatural crap in the system is always healthier, especially for those who are sensitive to toxins. I have known many kids whose behavior is markedly affected by sugar, caffeine, processed foods, and sleep problems. I personally am noticeably affected by these as well as by drinking nonorganic versus organic milk.
There is research to back up these suggestions. Sure, the rich drug companies' research isn't going to support these alternatives, because there is no money in them. But it is no coincidence that the incidence of ADHD has increased as kids' exposure to toxins, electronic media, and sleep disturbances has increased.
Furthermore, there is nothing "cruel" about feeding a child organic food, etc. Having my child take organic apples, carrots, and pbj for lunch is a lot less "different" than having him leave class to go get his meds. If that's not your style, fine, but without seriously testing these alternatives, don't jump to the conclusion that they are "ridiculous" and "ludicrous."
Although it may be easier to go the meds-only route, some parents prefer to minimize meds if they can, so I was just pointing out some alternative approaches that have proven successful in some research. Obviously nothing works for every kid - just like no ADD medicine works for every kid - but there is nothing wrong with trying a few alternative approaches before you commit a child to medication for the rest of his childhood or even beyond. Personally I would try every non-chemical alternative before I would introduce drugs into the picture.
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Nicole 2-12-2007 @ 11:25PM
As a psychologist, I have to say that you gave all good advice. However, the one thing I would add is that to never let someone diagnose your child with ADHD without a full and proper battery of tests.
What presents as inattention, distractibility, and hyperactivity in children can be caused by many many many things. Only with appropriate tests to rule out learning disabilities, neuropsychological difficulties, and emotional problems, should a child be diagnosed with ADHD.
Seek out a reputable, caring psychologist to do the testing. Someone who will explain the test results, teach you to be a consumer of your child's test scores, and who will make good well thought out recommendations specific for you child and not from some premade copy and paste report that they write for every client.
Almost every client calls in wanting their child screened for ADHD, but the prevalence and incidence rates tell us that it is unlikely that ADHD is the diagnosis in most of these cases. Out of countless ADHD referrals, I've so far seen 2 or 3 actual cases of ADHD that I have diagnosed.
Also, seek out someone who suggests a medication consultation as one of multiple options...as with young children this often should be a last course of action, not a first.
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