The "Medication Debate ADHD Edition" has been raging for years and the world isn't about to come to a consensus on this topic anytime soon. So where does that leave parents who are desperately trying to figure out what is the best way to help their child with ADHD? It leaves them needing to do their own research, that's where.
Parents must begin by finding a pediatrician they trust to receive a proper ADHD diagnosis. While you should always follow your doctor's medical advice, you also need to remember that no one knows your child better than you do and you are your child's best advocate. Don't hesitate to seek a second or even third opinion. But even with expert medical advice from your doctor, knowledge is power and the more you know, the more power you have to make the best decisions for your child's individual situation.
Medication Debate ADHD
The use of ADHD meds has been hotly debated for decades. These medications help millions of children and adults who have ADHD. However, like all medications, they do have some unpleasant side-effects. Quite simply put, there is no single answer for every child. Each child is different. You have to weigh the benefits of ADHD medications with the possible risks and determine what is right for you. There are pros and cons to everything and ADHD treatment options are no different. Whether or not medication is the answer depends on a multitude of variables and this is a decision only parents and doctors can make.
Despite the concerns of many, experts insist that ADHD medications are among the safest of all drugs that are prescribed to children and add that the pros almost always outweigh the cons.
“The risks of using these medications are very low,” says William W. Dodson, M.D., a Denver-based psychiatrist who specializes in ADHD. “The risks involved in not treating ADHD are very high. These include academic failure, social problems, car accidents, and drug abuse.”
In a survey of 934 parents whose children were diagnosed with ADHD, 84 percent had tried medication at some point. Only 52 percent of the parents strongly agreed that they would do things the same way if they had the chance to do it all over again and 44 percent wished there was another way to help manage their child's condition.
ADHD symptoms often get better as children grow up and become adults. Unfortunately, some people never outgrow their symptoms and need to use medications to manage their symptoms throughout their life.
“About 50 percent of kids with ADHD need medication into adulthood, and about half just get better with time,” says Timothy Wilens, M.D., associate professor of psychiatry at Harvard Medical School in Boston. “By tapering the medication off and then letting the child go without it for a couple of weeks, we can see if changes in therapy are needed.”
ADHD Medication Names
Common drugs used to treat AHD are divided into two categories: stimulants and non-stimulants (which have just recently been approved by the FDA). In some instances, anti-depressants are also used as a treatment for ADHD. These medications come in different forms, including pills, liquids for those who have a hard time swallowing pills, and even skin patches that last for an entire 24 hours. Most of the oral medications last for approximately 4 to 12 hours. Although some of these medications are stimulants, they actually have a calming effect on children and adults who are diagnosed with ADHD.
- Adderall (amphetamine)
- Ritalin (methylphenidate)
- Concerta (methylphenidate)
- Focalin (dexmethylphenidate)
- Daytrana (methylphenidate patch)
- Metadate (methylphenidate)
- Methylin (methylphenidate)
- Dexedrine (dextroamphetamine)
- DextroStat (dextroamphetamine)
- Vyvanse (lisdexamfetamine dimesylate)
- Strattera (atomoxetine)
- Intuniv (guanfacine)
- Wellbutrin (bupropion)
- Tofranil (imipramine)
- Aventyl (nortriptyline)
- Norpramin (desipramine)
With so many medications to choose from, many parents wonder how a doctor decides what medicine to prescribe first. Although there is no evidence that any particular medication is better than the others, most physicians have an order in which they usually prescribe these meds is based on their own personal medical experience. However, treatment guidelines recommend oral stimulants as the first-line treatment for ADHD.
Treatment of ADHD should begin with an oral stimulant, either an amphetamine or a methylphenidate-based formulation. None of these drugs is inherently more effective than another… The choice of a specific drug should be based on its rapidity of onset, duration of action, and effectiveness in a given patient.
ADHD Medication Benefits
Although more than half of the parents who participated in the survey did not know that they would make the same choices if they had a second chance, the survey did find that the medication was fairly effective in most cases. Thirty-five percent said that medication was very helpful with academic performance. Likewise, 35 percent said that ADHD meds were very helpful with behavior at school. Twenty-six percent felt that it also was very helpful with behavior at home. Another 19 percent said medication was very helpful with social relationships and 28 percent felt it was very helpful with self-esteem.
In general, kids with more severe symptoms see the most improvement from ADHD medication. However, having considered the medication debate, ADHD parents often struggle with this decision. How do you know if your child needs ADHD meds or not?
“If your child has been diagnosed with ADHD and is struggling, he probably needs medication,” says Stephen Copps, M.D., an ADHD specialist in Macon, Georgia. “Medication is the cornerstone of therapy. It’s appropriate for most children with diagnosable ADHD. It is not a last resort.”
ADHD Medication Side Effects
As mentioned before, all medications have side-effects and so do ADHD meds. This has helped fuel the medication debate ADHD experts have been fighting over for so long. The most important side-effects parents need to watch out for when their child starts on any of the ADHD medications include the following:
- Sleep problems
- Decreased appetite
- Delayed growth
- Rebound (irritability when the medication wears off)
- Moodiness and irritability
If you notice that your child is experiencing side effects after starting a new medication and they last longer than three to five days, contact your doctor right away. Most of these side-effects lessen over time but there may be another medication that would work better for you or your child.
“No one should have to tolerate side effects,” says Larry Silver, M.D., clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. “After all, the problem can usually be solved with a simple adjustment to the medication’s dosage or schedule.”
However, Michael L. Goldstein, M.D., warns parents of another potential aspect of side-effects they may not have previously considered.
"Some children don't want to take medication," Goldstein says. "It must be determined if they are doing well on the medication but just don't want to bother taking it despite the positive effects, or whether they are really having increased anxiety or mood changes from the medication."
Rare But Serious Side-Effects
Due to rare cases of possibly fatal cardiac side-effects, ADHD medications cannot be safely used in children or adults who have any type of heart defect. Between 1999 and 2003, 19 children died while taking stimulant medications to treat ADHD.
“People who have existing cardiac problems are already at risk for sudden death, and it’s not clear that these medicines increase that risk,” said Dr. Wilens. “If taking a stimulant does raise their risk, it is estimated to be about the same as what it would be if the person was physically active in sports.”
The FDA now requires these drugs to carry a warning on the label that these medications should not be taken by people who have been diagnosed with heart disease or any other cardiac defect.
Other ADHD Treatment Options
These concerning side-effects are the driving force behind the medication debate ADHD parents find themselves caught in. Medication is not the only treatment option available for children and adults who have ADHD. There are a variety of non-pharmaceutical treatments for ADHD. Actually, patients have reported the best results when they combine medication with other treatment options, such as behavioral modification therapy. However, while some people with mild ADHD symptoms may find significant relief without medication, these therapies are almost never enough to effectively treat more severe forms of ADHD on their own.
Medically, ADHD is classified as a psychiatric disorder. As such, the treatments for this condition include various forms of therapy. Common forms of counseling used to treat ADHD in both children, teens, and adults, include the following:
- Behavior therapy - This kind of therapy teaches behavior-changing strategies and skills.
- Psychotherapy - This treatment allows the patient to discuss their symptoms with a psychologist or a psychiatrist and teaches them how to better cope with the symptoms of their condition.
- Family therapy - This form of therapy helps teach parents, siblings, and spouses how to cope with someone who has ADHD.
- Parenting skills training - This type of therapy teaches parents effective ways to guide their child's behavior.
- Social skills training - This treatment teaches appropriate behaviors to children who have ADHD.
There are a variety of lifestyle changes that can help lessen the symptoms of ADHD. Although these changes are rarely enough to be therapeutic on their own in any meaningful way, they can be a great addition to other treatment options, such as medication and counseling.
- Follow a regular schedule
- Keep all areas organized and uncluttered
- Avoid distractions
- Use simple words, eye contact, and clear commands whenever you give your child instructions
- Find ways to boost your child's self-esteem
- Avoid overwhelming situations that are triggering
- Show affection
- Use appropriate discipline methods consistently
There are multiple natural remedies for ADHD, however, by definition, these treatments have not been proven effective. Once again, as with lifestyle changes, these home remedies may be a useful addition to other ADHD treatments.
Dietary changes - Some people claim that following certain diets reduces ADHD symptoms in their children. Usually, these diets focus on removing certain substances, such as food colorings, gluten, sugar, etc.
Vitamins, minerals, or herbal supplements - There are a ton of vitamins and supplements that are available at your local drug store. These include L-Theanine and Creatine. It is important that parents know that these are not necessarily safe just because they can be bought over the counter. Make sure you check with your doctor before giving your child any medications, even if they don't require a prescription.
Yoga and Meditation - Both yoga and meditation are safely used to help children relax while teaching them self-control and allowing them to learn how to focus their attention.
Neurofeedback - During this treatment, children are attached to a machine that shows them their brainwaves while they focus on various tasks. This therapists and patients a visual representation of what is actually happening in the brain.
Is ADHD Medication Right for You?
The medication debate ADHD drugs have stirred is enough to make any parent leary. Because some of these drugs are controlled substances with a potential for abuse, parents are understandably hesitant about giving them to their children. These are legitimate concerns and the side-effects can certainly be off-putting. However, it may be necessary children with severe ADHD to at least see if they get relief from medication.
Parents concerned about their child's behavior should contact their child's pediatrician. Your child's doctor is the best one to assess your child. Only a trained professional is able to determine whether or not they fit the medical criteria for ADHD. This condition is treated with a variety of medications as well as non-pharmaceutical options, such as behavior therapy and psychotherapy. Lifestyle changes are helpful as well, and so are activities such as yoga or meditation. Regardless of what you ultimately decide is the best treatment plan for your child, your doctor is the best person to settle the medication debate ADHD parents are stuck in the middle of.
For parents who decide medication is a good option, they should remember that the first drug prescribed may not be the one that works for their child. Often, a child tries several ADHD meds before they find the one that effectively treats their symptoms without intolerable side-effects. As children grow, their bodies change and their medications need adjustment accordingly. Your child's doctor may decide to add medication or to change medications entirely. Whatever you do, don't give up hope. You and your child will get through this as long as you support your child and love them enough to find the answer that works for them, as an individual.