Medication - Yes? or No? (Our Pros and Cons)

My almost 13yr old has been on meds since 9, but I have tried going with out more than a few times.

I always end up back to using them because the positives outweigh the negatives

I have never had the experience of a personality change. I hear this a lot and frankly can’t even envision it. Perhaps because my son is inattentive ADD and daydreaming less is not noticeable??????

Anyway, I think every family has to line up the columns of + and - and see where it falls out

I would definitely try all non-medication methods FIRST, remembering that a child with ADHD will inevitably do well with any new situation(new school, therapy)because it is a novel stim. If, however, it + efffects dont wear off with time, you have most likely found a good solution

If that fails, I would try some different meds. Your description of his reaction sounds pretty heavy duty to me

I think medicating a kid for ADHD who has anything else going on is a much trickier business than one whose only issue is the ADHD itself. Your sons anxiety puts him there. IF you decided to go with meds I think you need to realize there will be some false starts

When a kid taking stimulants (which is what I presume this child was prescribed) seems zoned out and as though his personality has disappeared, that is a sign that he has received too high a dose. Stimulants given at the proper dose DO NOT alter basic personality or turn a kid into a zombie. A child who is hyperactive or impulsive certainly may become calmer and quieter on stimulants, but he should not lose the spark that makes him a unique person. Try lowering the dose to see if personality returns and school improvements continue.

BTW, therapeutic riding is wonderful. My child has been doing it for years. It has made him physically stronger and helps him with certain aspects of motor skills, but it doesn’t really do anything for ADHD symptoms. Nor is it billed as such. Instead, the fantastic thing about therapeutic riding is that children whose lives often can feel out of control find themselve having a relationship with and being in control of a gigantic animal. The bond my son has developed with the horses he rides is so inspiring and riding makes him happier than almost anything does.

I am a mental health professional who has worked a lot with children and a parent of three children, two who definitely fit the “ADHD” critera.

You have identified a difficult dilemma. I don’t know that there is a “right answer”. It appears from the wide variety of comments I have heard and my own observations that some people have very positive experiences with medications and others have very negative experiences. I think every parent needs to decide based on their own valued and experiences.

I raised my children without medication. Some have suggested that they “must not have been that bad” - believe me, they were VERY challenging to raise! But we just decided that we were not willing to go the medication route. We ended up homeschooling and using alternative schools to avoid having to deal with the school structure that we felt was not going to support our children’s unique needs. We spend a LOT of time working on different approaches to behavior problems, and it literally took YEARS to get our oldest on track behaviorally. But he voluntarily agreed to return to school in 6th grade and was on the honor roll every quarter afterwards. Our youngest got the advantages of what we learned from raising the oldest, so he is very manageable at age 9, but we still have steered clear of public schools for similar reasons.

Two things you should know. First off, 40 years of research have never been able to demonstrate any long-term advantages for medicated kids over unmedicated kids with ADHD diagnoses in any area, including academic performance, delinquency measures, social skills or self esteem. This doesn’t mean that individual kids don’t do better with meds - it might also mean that every child who has improved outcomes from taking meds is balanced by another child who ends up worse off. So taking medication is no guarantee that your child will end up better off - in fact, the odds are about even that they will do just as well without.

(For those interested in the references, I am not at work but will post them tomorrow. JM Swanson did a “Review of Reviews” in 1993 which drew this conclusion. Russell Barclay reviewed the literature as early as 1978 and concluded there were little or no academic gains. There have been reviews since that time which draw the same conclusions. I have never seen a review that disagrees with this conclusion.)

The second thing to know is that there were two excellent studies done in the 70’s where kids that were diagnosed ADHD were observed in standard classrooms and in open classroom settings. There were dramatic differences in the ability of teachers to identify the ADHD children in the open classrooms - they could barely tell the difference, while the difference was obvious in the regular classroom environments. The main factors that seemed to be essential in the open classroom were the child’s ability to control how long they worked at a particular workstation, and some control over which workstation they chose to pursue. This is completely in tune with our own observations of our own children. They hate being told what to do, and once they are “into” something, they like to stick with it until THEY decide they are done. Of course, a standard classroom is exactly the opposite of this in most cases. The children have very little choice of activity, and the teacher decides when to start and stop everything. In my view, this kind of classroom is generally a bad environment for an ADHD-type of child. So we figured, why expose them to a bad environment where both they and the teachers will be frustrated? That’s why we chose to use the alternative educational plans we did.

This is not to say that every ADHD child will do well in an open classroom. It is something that has to be examined for each child and decided by each family with their child’s needs in mind. I can tell you from personal experience that it IS possible to raise an ADHD child without medication. It’s a lot of work, requiring creativity and patience and perseverance, but it can be done, and the results have been great for us. There are no easy solutions, but whatever you decide, I encourage you to think about the educational environment that will work best for your child. And it is good to know what others’ experiences are with meds, but the fact is, every child reacts differently, and you are the only ones in a position to decide if the benefits are worth the costs. We decided they were not, and survived pretty well. Others make a different decision, and their families survive, too. The bottom line is, you have to do what works for your family, no matter what the doctor, the teacher, the school psychologist, your friends, or anyone else says. Follow your gut about what is right, and be willing to experiment with new ideas - you will make it, one way or the other!

Good luck!

Our paediatrician finds that kids can do with lower doses of stimulant medication if they are also taking Omega 3. He says that others find this as well.

We have just started with Adderall for our inattentive ADD son, a low dose with Omega—no troublesome side effects.

We tried all or most of the non medical interventions first and have a paediatrician who is very good—starts with a dose on the low end rather than the high end and plays with it, suggests non medical interventions like biofeedback and omega first.

Tough decision. The first weekend he was on it I was a wreck. First sign of a serious side effect like anxiety and I was ready to bail. I’m glad we have a doctor who got the amount right the first time!

Jan, do you see any differences in your son on medication?

Beth

Beth,
Yes. First day (a Sat.) he was playing video games with his brother and buddies and won every game. Off the meds he would lose most multiplayer games due to distraction. Naturally he was pleased.

At school, he reports that he does not zone out/drift off. Also, although he forgot to tell me about a grammar/punctuation test he was having (we are still working on organizational skills!) and so failed to study, he came home and gleefully reported that he got a Level 4 (A)—inserting end punctuation, commas and identifying nouns and verbs. I asked if he had needed extra time (as he normally would) and he said, no, he was done before several others in the class. Last June he needed extra time and much prior study and ended up with a lower mark on a similar test.

On a writing assignment he had to do in a hurry at home (because I had been partial homeschooling for Neuronet and then stopped the teacher wanted another quick evaluation for the Nov. report cards) he decided, after I’d identified a few spelling errors for him to correct, that he wanted to redo the whole thing for a Level 4. He did this quickly and more ably than usual, with better organization and use of compound-complex sentence structures and parenthetical expressions I would not have seen in his writing previously. My take is that writing is easier and requires less energy because of the added ability to focus. Now, he still spells phonetically and habitually disgregards the need for end punctuation, but on proofreading he seems to catch more of his mistakes.

On the whole, I am thinking it was a good idea to take this route, and I am kind of wishing we’d done it earlier! I am waiting to hear teacher feedback at the coming interviews.

Tonight we are resuming Neuronet, and I am waiting to see the impact.

Our paediatrician, after hearing my report of the above, says he feels he is definitely inattentive ADD. (Or it could be NLD-inattentive type—amounts to the same thing.) We are to return in February for another follow-up. Despite gaining 9 pounds and just over an inch, we were okay with the dose he prescribed last May (10 mg. xr—at his weight the full dosage would be 30 mg.)

Wow, Jan, that’s great!

My son yesterday came home with a 37 and a 57 on English homework. He really has no clue and was resistant last week to having me help him. I guess I am seeing that when it is “boring” in his eyes he does seem to zone out. He told me the other day that he can’t pay attention if it is boring. However, that fact does not seem to bother him in the least.

A couple years ago I used to joke that my son’s only academic strength is that he is interested in everything. And he is—to a much greater extent than most kids. He is the only kid I know who used to have us read his social studies and science books to him as bedtime stories! I see now though that his interest is helping him compenstate in school.

English is not one of those topics though. I sat with him and worked with him on a four page review for a test tomorrow. Seriously, you would have thought he never had any of the material taught to him at all for as much as he seemed to recall.

My son has trouble with basic punctuation and grammar still and he is 11. Your post did make me wonder if medication would help with all of this. I think his attention is too divided and he certainly isn’t detail oriented. He finds proofreading “boring” too and is really bad at it. It is a really tough call really because the rest of his papers were all A’s, including a 100 on a reading test (I never though I’d see that day a few years ago!).

A’s and F’s—now if that isn’t an LD kid!

Beth

the meds really help with the details and the zoning when they are bored syndrome. However, even with meds my daughter zones out in math 2nd period of the day because the teacher is BORING :roll: So guess which class she is having problems in…Math…because of her willful inattentive behavior.

My daughter didn’t start meds until she was in 5th grade which would have been 10 or 11 years of age. The difference in her skills was remarkable, especially in her writing organization and attention to details that was missing prior to meds.

Meds was a good thing for her and yeah, I wish I had done it a lot sooner… She is also active in a Water Sport which has helped her focus, keeps her mentally alert, teaches her endurance, teamwork and patience.

Patti,

I think I am finally getting to the point that I can begin to sort out what is ADD versus what is LD. My son has integration difficulties so he has tired easily and zoned out easily. It was very difficult to separate that from ADD. We have had trouble until last summer with any type of tutoring we’ve done with reading.

For example, he did a PG intensive in Orlando last December and had difficulty sustaining attention for the three hour tutoring sessions. The tutor told me he did get better as his skills improved but that he still had issues with attention at the end. She really was unsure whether it was ADD or difficulty with skills. But by the time he did Seeing Stars last summer, his attention was not an issue. He went four hours a day for four weeks and there were no attention issues. He made great progress—went through the entire program in that four weeks. We still need to get his reading speed increased and are working on that now.

So I think we have resolved a lot of the LD issues with him.

I do think that a lot of his difficulties with English grammar—on worksheets—is attention. He finds it boring and zones out. I did some diagrams for him which did seem to help–he was finding it to be a lot of unrelated rules. Still, this is only one subject.

Writing is a different issue. He has real difficulty here also. He is good with ideas but grammar is dreadful. He still doesn’t automatically put a period at the end of a sentence and he is in fifth grade. This is not a problem with learning of the rules—he knows this. Of course, difficulties with integration may be a contributing cause here (like in reading). His fine motor skills, for example, still are not where they should be and if you add the cognitive demands of writing it may be just too much still.

I spoke to his teacher about him getting some resource room help with his English (he is elgible but has received no services this year). And we’re back to working on his motor skills. If automaticity here either doesn’t happen or doesn’t improve the quality of his writing, I think I will consider medication. I am concerned about the demands of middle school—right now he won’t be able to keep up.

I appreciate you sharing again how medication helped your daughter’s attention. I had remembered that she was unable to respond appropriately to reading therapy without it. That has not been true of my son so I had thought we were beyond considering medication. Now I am beginning to wonder again.

Beth

Beth,
I heard brain expert Kathie Nunley speak at a conference last year and recall something she said that we all intuitively know but need to keep up front, and that is that learning requires a huge energy output (I forget the science part of her presentation that related to this but no matter.). Until it is automaticized (and fairly often even when it is automatic) humans are naturally inclined not to spend the energy, unless the situation is novel or critical or it’s structured so as to reduce the energy output.

Now when kids say, “This is boring” I translate that as meaning, “This requires more energy than I can put out right now. Do something.” The something could be, for punctuation, doing 2 sentences a day instead of 6, colour coding or slowly reading the sentence out loud, having the child listen for pauses and bang the table loudly with a palm to signal the need for a comma etc.

I know what you mean about fear regarding the writing challenge—my chief reason for trying Adderall (as well as the failure to make much headway with other approaches for concentration that have worked for you).

The plague of boring work is that there is no novelty attached to make it worthwhile so it’s not worth the energy output for kids for whom the many subparts of the process are not yet near automatic. It’s very hard to make grammar intriguing!

My son loves to write when he can put his own slant on a topic. That fires him up, makes him care a little more about punctuation. Right now his class is doing procedural writing—define a task, set requirements, devise a plan with steps and describe outcome. After doing a conventional one (design a game), he is coming up with odd topics, like how to subvert people in the use of the English language (give one word nonsense answers to routine questions and see how people respond etc.) What he will do with the routine 5-paragraph high school essay though is anyone’s guess.

I resisted meds-thought it was an LD problem, couldn’t see the ADD(I). We did the reading tutoring and broke through, did the vision therapy and broke through and then could see the ADD(I) more clearly. It didn’t help that we did not have a good diagnosis initially and our first med trial with Ritalin had side effects.

My daughter’s life is much better with meds - she is 13 and can verbalize that very clealry. She is better able to manage herself. She has a social life. She has self esteem. Its not just school. We used to not give her meds on the weekend or holidays. But it became evident that certain tasks are much less stressful if she has meds. She will ask for them if she has a day planned that needs them. I am not wild about stimulant meds and we did try Strattera. We are back to Adderall. I have come a long,long way. I am very thankful that meds work for my child.

Meds are not an easy decision. It is a very personal decision made on an individual basis. There has been a strong anti-meds lobby on this board that has become ugly in the past. Its tough to seek information and keep a perspective.

I do not advocate meds for everyone but those that need it, simply need it.

that the ‘anti-meds lobby’ was really only TROLLS? I can’t think of a single regular poster on these boards (I’ve been here since early 2001) who is ‘anti meds’. Some of us may be ‘anti-meds for our OWN kids’… but that is totally different from being ‘anti meds’!!!

I am totally against meds for MY KID, in MY SITUATION…but have no problem with them for the children of others, who choose to use meds, whether I would use them if it was ‘my kid’ or not! I actually try to even avoid thinking that sort of thing, though I must admit I have done so in the early stages of my parenting journey.

Hope you will reconsider your poor impression, especially since your participation has been very welcome around here, IMO…I know trolls are hard to take, but they should be ignored, not regarded as if their opinions were meaningful…

I tend to agree with Elizabeth that absence the trolls there is a pretty thoughtful discussion about medication. I have gained parenting tricks to use with my youngest who is ADHD like, although never diagnosed. My older boy is ADD-inattentive, if he is anything, and kids who do not have the hyperactivity are difficult to figure out, especially if they also have significant learning issues. I have read all the posts with interests, posted my two cents about the progress we’ve made without meds, but in the end still am not sure whether I will end up posting like Jan and MMM or Elizabeth. One thing I have appreciated is the perspective that some children appear to be ADD but the same behavior can have have multiple causes. I certainly didn’t get that balanced perspective from the neurologist who initially diagnosed my son as ADD-inattentive. He basically told me that kids who have severe learning disabilities like my son are almost always ADD!

Beth

Hi Beth,

I have an inkling that when things get harder for your son in middle school, when he has to work at a faster pace you are going to see more of the ADD symptoms popping up and maybe at that time you may think about trying meds.

I work with middle school kids and it is hard for them, the faster pace, 6 different teachers and classes and keeping everything organized and turning in assignments on time. It takes a lot of organizational skills to keep things on an even keel even for kids without ADD :-D

Hi Patti,

You may very well be right. We are doing three things that may make a difference, however.

1. He is in a parochial school where they have only two teachers in sixth grade for academic subjects. He will have one teacher for Math and Science and another for English, Social studies, and Religion (along with the “specials” they have had all along for spanish, PE, art, computer, and music) This is actually one of the main reasons we switched him from public school last year. I could not see him navigating public middle school here (3000 students). In his school, there are two classes of 60 per grade and less than 600 kids in the whole school. They keep close tabs on the kids (I had his art teacher stop me in the office and tell me he had not brought back a project he had taken home to finish!).

2. His teacher this year is very organized and has told both Nathan and me that his main issue is organization. She sat down with him and me and together we agreed on some simple goals for him. She is keeping a chart for him and he will get some reward for progress. To me, this is an indication of how come we’ve come when organization is his main issue. He writes down all his homework, does it, and turns it in so he isn’t horrid but he is messy and tends to stick everything into his agenda rather than the separate folders ect. His desk is a scary place!!

3. We have returned to therapy with our Neuronet provider. I am hoping to increase his reading speed and to do that she is working on general speed of processing first. It is interesting to me how different my two boys are. The young one who is impulsive and hyper has a difficult time doing the exercises which are slow (to a metronome) while Nathan finds the fast exercises much more challenging. We have only been back at it for a couple weeks and already there is marked change with the exercises so I am hopeful that we may see some positive changes in classroom/life processing too.

And if he still does struggle in middle school, I will try medication.

As always, I appreciate your comments.

Beth

Interestingly, I think for my ADD-inattentive (maybe!) son the switch to a middle school model has helped in some ways. The novelty of switching classes excites him. And he is learning some good organizational skills (because he’s ina special school that is actually teaching them.) Were he in a mainstream setting however, it might all be too overwhelming.

I find it interesting that Neuronet seems to be like exercises he needs to do to maintain focus, attention and processing speed. But organization is one thing that some ADDer’s struggle with, they are either organizational freaks like me who need to be hyper organized to deal with life or they are super disorganized and don’t care about the chaos. I need to be organized so I can function and if I am not organized that is when my ADD is out of control.

What is really interesting to me about doing Neuronet with two kids is how different they are. My youngest, who is hyper and impulsive, has a hard time with the exercises which involve slow metronome but not when it is fast. My other son who is not hyper at all has a hard time with the exercises that require fast processing but no trouble with the slower exercises.

So does medication change how organized people are? Nathan is one of these people who have no need for organization. A few years ago he was incapable of cleaning his room when it was a disaster. Now he can do it but never will unless I insist. In contrast, his siblings will get in “neat moods” where they will clean and organize their rooms. Nathan has never had a neat mood and I doubt he ever will!!!!

Beth

We are still praying for the “bar mitzvah effect”, which I think you told me about Beth. (where they get more organized around age 13?…..)

ADD is thought to be a disorder of performance(vs LD’s which are problems with academic abilities…)-so if at times the child is organized and can do the task, but forgets, or is implusive about it, yes, medication will help the performance of whatever…medication won’t magically give the skills of organization, athletic abilities or social competencies where they didn’t exist before.

yes, but it is tough to learn social competenties, etc, when you have little control over impulsiveness or inattention. Its hard to be a member of a sports tema when you forget you are in the 2nd half ahd have switched goals, or that the play is at third. Its hard to be considered a friend when you can’t stop yourself from talking over top someone else. or not be considered weird when the notion ot bunny hop across teh room strikes you as a good idea-and the rest of 6th grade doesn’t think so.

No, you don’t want a robot for a child but a little control goes a long way in lots of situations. Meds won’t cure anything esp. LD’s but it sure makes it easier to deal with the problems.

yes, but it is tough to learn social competenties, etc, when you have little control over impulsiveness or inattention. Its hard to be a member of a sports tema when you forget you are in the 2nd half and have switched goals, or that the play is at third base. Its hard to be considered a friend when you can’t stop yourself from talking over top someone else. or not be considered weird when the notion to bunny hop across the room strikes you as a good idea-and the rest of 6th grade doesn’t think so.

No, you don’t want a robot for a child but a little control goes a long way in lots of situations. Meds won’t cure anything, esp. LD’s, but it sure can make it easier to learn strategies to work around some of the problem areas. My daughter isn’t more organized but she is able to complete her homewrok in a reasonable amount of time. She able to remember to put the homework in her binder.

ADD affects everything my child does. It has been a relief to be able to turn it down or tame it for awhile. She takes a tiny dose compared to many - upped to 15 mg once a day at age 13. But the difference is amazing even to her. She is a much happier person. Is it a happy pill? I don’t think so. I think the happy is the side effect of being productive, of being able to accomplish her goals, of having friends

I agree with MMM. Medication allows my child to focus so that she is able to become organized. I am so proud of how well my 13 year old daughter is doing this year!

yes, but it is tough to learn social competenties, etc, when you have little control over impulsiveness or inattention. Its hard to be a member of a sports tema when you forget you are in the 2nd half and have switched goals, or that the play is at third base. Its hard to be considered a friend when you can’t stop yourself from talking over top someone else. or not be considered weird when the notion to bunny hop across the room strikes you as a good idea-and the rest of 6th grade doesn’t think so.

No, you don’t want a robot for a child but a little control goes a long way in lots of situations. Meds won’t cure anything, esp. LD’s, but it sure can make it easier to learn strategies to work around some of the problem areas. My daughter isn’t more organized but she is able to complete her homewrok in a reasonable amount of time. She able to remember to put the homework in her binder.

ADD affects everything my child does. It has been a relief to be able to turn it down or tame it for awhile. She takes a tiny dose compared to many - upped to 15 mg once a day at age 13. But the difference is amazing even to her. She is a much happier person. Is it a happy pill? I don’t think so. I think the happy is the side effect of being productive, of being able to accomplish her goals, of having friends.

sorry about that I kept getting invalid session messages. Whoops. I meant it but not so emphatically as to say four times.

we were on our way to a meeting and she was leaving one of her children to stay with mine. Hers went down to the playroom, and mine was sent (we had just finished supper) to do his homework, which with a bit of trying to get me to allow him to ‘do it downstairs’ (HAH! yeah, right!) he sat right down to it. I had already gone over the tasks with him and made sure he was OK on his own…and he ‘got right at it’. Of course, he knew his Dad had been instructed to check for completion before he’d be allowed to join his friend on the PS2!

Her kids are both severely adhd and she was marvelling at my son, since she knows we have many times where this is not possible and I have to ‘sit on him’ as she does hers. (and I have done HW with hers, too!) This was obviously an ‘eyeopener for her — you see, I suspect that all my friends whose children ‘seem’ similar to mine and are ADD/ADHD (on meds) have trouble fully believing that meds would not help my child, at least not enough to warrant their use in MY opinion — but they love me and don’t say it out loud!

The difference in the children is marked — but only if you know them well and work with them. If my son CAN do the work — after the usual attempt at avoidance/procrastination, he will get at it and get it done, whether I am in the room or not. If he CAN’T — or if the task does not come easily — you’d think he was as ADD/ADHD as they come. Her kids have much better academic skills, tho they are also LD — but the difference is the attention. They are NEVER able to ‘just do their HW’ except with an adult in the room, and often with much struggle even so — the meds just don’t last that long. (and there are enough sleep issues — they are finding HW should be reduced rather than add PM stims.) With my LD but not ADD son — if he is capable of the work, he can focus and bang it out as if he had no issues at all…an essential distinction, IMO.

mmm, when I first came here I was facing much opposition from the school on this issue. They were sure he was ADD, but I had been told by a private tutor and LD teacher of much experience that he WAS LD, not ADD, and all I had read and seen with him supported this. He had ‘seemed’ ADD based on teacher observations in Gr. 1 and did not progress at all, except with some sped work on learning the letter forms in multi-sensory ways — yet when he got to small group teaching using direct, specific phonics instruction, he was reading beginner books in 4 weeks - and we’ve never looked back. This was also his tutor’s basis for ruling out ADD — and his test scores, once we got them and I learned enough to have an opinion, provide further evidence.

It is my opinion that if you ARE truly ‘ADD/ADHD, all the one-on-one in the world will probably not be effective — until the attention piece is corrected. I learned that first from Patti but it has been illustrated over and over on this board.

I think this is exactly what you are saying in your post — if a kid is ADD, they need meds FIRST — then tutoring! And, as SAR says, just because they get the meds doesn’t mean they will suddenly be organized (or reading, for that matter!) — they may still need teaching, and lots of it, especially if they are LD on top of the ADD/ADHD!

I think whether you need to do meds first before dealing with the LD depends on the relative contribution of the two deficits to your child’s difficulties. This can be difficult to figure out, like in the case of my son, where he had severe learning disabilities. In other words, he wasn’t good at reading, math, or writing and so teasing it all out was difficult. He was diagnosed early on with APD and Fast Forward helped his attention. I think it was that experience as much as anything that has kept me chipping away at his LD and not trying meds (he was actually diagnosed with ADD-inattentive several years after the APD). I knew we had improved his attention by remediating his LD and I wanted to see how far this could take him.

I have a neighbor’s child who is having trouble in K. I gave her some books and then offerred to do some informal tests on him when she seemed a bit overwhelmed by it all. He has more severe phonological processing deficits than my son ever had. But he seems just fine in terms of visual/spatial numbers kinds of things. He had a difficult time concentrating during the little testing I did with him that was language based. But eagerly did anything that wasn’t letters/sounds. He even found a puzzle in the next room that my older son was putting together and worked on it when I went upstairs to write a few notes for his mom. This is a child who I would guess is LD but not ADD. His attention difficulties seem to be limited to what he has trouble on.

On the other hand, I have a friend whose child was labeled LD in first and ADHD in third. Once they started medication, his LD was a nonissue.

Children can be such a puzzle.

Beth