To medicate or not to medicate?

Question

My son is a bright, enthusiastic, caring, extrovert, who also meets the DSM-IV criteria for ADHD. He is social and has good friends. We put him in Montessori because the regular classroom wasn't meeting his needs, not enough challenge and he was being disruptive to the other children. He is a challenge to his teachers because he starts work with enthusiasm but has difficulty finishing it unless they are right there beside him. I have resisted the recommendation to give him medication until now, grade 3. What has changed is that the teachers, who remain objective and do not give an opinion about medication, are telling us he is bright, creative, and a leader with his classmates at recess; it's the writing and projects (which all seem like reasonable expectations to me) that aren't showing the results they know he is capable of. If he were growing up on a farm, I doubt this would be an issue.

If diagnosing ADHD was based on blood tests or something more objective than the opinion of frazzled parents and caregivers, I might be more confident making this decision.

How do you decide whether or not to medicate your child?

Answer 1

Both of my sons (now 12 and 9) are ADHD and both have been taking medication (Concerta) daily for about three years. My older son had behavioural issues since kindergarten, but teachers always told us how bright he was. His marks were fine but he was continually getting in trouble, and was suspended a number of times for violent behaviour. He was as frustrated about this as we were but he felt unable to do anything about it, and he couldn't explain why he had done any of the things he did. Many of his classmates (and some of the teachers) started thinking of him as a troublemaker and he began to get a bit of a negative reputation. Some classmates of his were told by their parents to keep away from him, which was heartbreaking for us and didn't do much for his self-esteem. When the same thing started to happen to my younger son (bright, but continually in trouble for impulsive actions), we took them to a pediatrician.

We started them on Concerta, and they both noticed the difference right away. In the three years since then, neither has been suspended once and they don't get in trouble any more often than any other kid. Both enjoy school and are doing well, and the reputations as troublemakers have since vanished.

This is obviously anecdotal and your mileage may vary and all that, but we feel that the medication gives them a fighting chance. My oldest frequently got frustrated and spent a lot of energy trying to focus on what he needed to do, and now he can just focus on his schoolwork. His confidence level and self-esteem have also increased.

The only real drawback is that we have to remember to pack their medication when we go on vacation or they stay somewhere overnight. Hardly even worth mentioning, given the upside.

Answer 2

Some kids really do need the medication, but others can adapt and do well with some adjustments to their environment and the expectations set on them. While these things aren't information about medicating, you could see if trying some of these options helps enough that you can put off medicating for another year or two or see if you don't need to medicate at all. Then, even if you do medicate in the end, these tactics are still known to be pretty helpful in teacher circles that work especially with kids with learning and behavioral disorders (me having been one of them).

First, it has been shown through various studies that ALL OF US retain more information when we are allowed to get up and move for about 5-10 minutes for every 60 minutes of work. Think about it; do you work efficiently when you are working straight through on something for long periods of time with no breaks? NOW, consider the fact that your child is, well, a child. His attention span is naturally lower anyway! For many kids frequent transitions can be tough, but for the ADHD kid, doing 20 minutes of something and then switching to something else can be a lot more productive than longer blocks of time.

Second, while writing skills are important, our schools tend to forget that writing answers down is not the only way (or always the best way) to assess kids for information retention and/or skills. Classrooms (including montessori) are still classrooms and restrict movement (though less in a montessori environ than others). Can he turn in video projects, art work, collages, presentations (whatever non-traditional idea works for the assignment given. . .) instead of essays at least some of the time?

Can he practice spelling, math facts, and other "memorization" types of things through song and dance, or while rallying a tennis ball or volleyball instead of while sitting in a classroom?

Can he wear headphones to help block out distracting noises? Better yet, when he isn't listening to instructions and is doing practice work can he be allowed to listen to white noise or lyric free music? I did not use this because it is newer, but I've heard (through the teacher pipeline) there is even a special CD available now that has frequencies on it that work especially well to engage the part of the ADHD mind that needs constant stimulation and often creates the distraction. I'm really sorry I can't give you a name, perhaps another community member will know about it and add a comment to help get a hold of it.

There are also tons of great tools available out there now for ADHD kids that help too. Things such as fidgets (link will take you to an article that will tell you what they are and even how to make some at home), and special seats that allow for more "wiggles". You might also try (and have his teachers try) making sure there is a space where he can do his writing while standing like a science lab counter as sometimes the simple act of being allowed to stand (while a stool of the right height is also nearby) can make all the difference in the world. You might also check out Teaching Wiggle Worms for more specific ideas for the classroom. Teaching Wiggle Worms

Answer 3

Maria Montessori as you know was the first woman physician in Italy. In what became her life-work, she accepted children who had been cast off by the public education system at the time and worked what were considered "miracles" when, in reality, all she did was listen, follow, prepare an environment, and mentor.

Of note was her continual examination and refinement of methods. Here was true Science, one that did not rest upon a proclamation that the "answer" has been found.

Contrast to the culture (I can speak of the US) today, where (particularly) medication is seen as not only a solution but a necessary one for issues that you raise. Medicine generally rests its case, as does the one-size-fits-all system of education. If you don't fit (most don't) then you're a failure. If you don't take the pill, you will not succeed. It seems pathetic that we must be in some form medicated to function in this society, and I do not restrict the term to pills in a bottle.

In many ways that last remark is, I think, strikingly telling, for America is a world leader in the intake of antidepressants (alone) and an emerging environmental phenomenon is one concerned with water supply pollution by these excreted drugs.

It may be useful to consider some of the issues Thom Hartmann (author and radio host) has posited regarding AD(H)D. A striking point he makes is that the emergence of this phenomena has been gradually oncoming since the transition from an agrarian to an industrial (and now) and then to a technological society (and we might also consider the environmental and emotional pollution thereof). In each step of this transition we see the cubicles becoming smaller, the flourescent lighting brighter, and the lines which we are told indicate "good" and "bad" behaviour becoming more firm and unwavering. Yet, none of us are wired quite the same and, given the pace of transition, our biological evolution has not quite adapted. Hence the fallout.

So the question on medicating may come down to one of deciding who is really in need of it. My view is that our media-saturated and highly controlled culture is the sick child in the room and the most wonderfully curative and most merciful act of healing that could be brought to bear would be to render every TV set as non-functional. That would be a good start.

So here's an idea. Try, in your own home, to reduce/eliminate the barrage of media, and then watch what happens.

Second, I suggest some physical activity that will help discharge some of the energy.

Third, find more open and expansive spaces in which to be. You may see a remarkable shift, to a more "grounded" state, in a different environment.

All human beings wish to be successful. Coming up against your personal limitations repeatedly can cause one to give up. Mindfulness of the developmental stages and sensitive periods in your own child might also help as you consider a detour around the obstacles until the time (if ever) is right to face them.

Just my few thoughts... /m

Answer 4

"How do you decide whether or not to medicate your child?"

Your gut. Honestly, I think that's the best that any parent can do right now.

If your child can't see the blackboard, you don't question getting them glasses, but when it comes to mental health, it's a much fuzzier, grayer world of diagnosis and treatment options and it's a challenge.

I have ADD and wasn't diagnosed until I was in my 20s. I was good in school, but it was a struggle in terms of things like staying focused and especially getting through homework. So, in hindsight, I wish my parents might have tried some forms of medication. Granted, this was several decades ago so was an even more fuzzier world of options.

Our son has it. We held off for a while, but eventually for him to get through a day of school and homework, we realized medication had to be at least part of the solution. It took us a while to find the right type of medication and the proper dosage, but we seem to be OK now--though readily admit it's going to likely be a lifelong balance going forward. I am also on medication to help as well and have had to go through many different options before finding one that agreed with me.

There are certainly different severities of ADD/ADHD and related imbalances, but for us, it's not to the point of causing disruptive behavior. As such, I think we could get by sans medications if the environment was different. I think Montesorri is a good option for handling the issues by changing the environment, rather than attempting to change the child to fit the environment. But it all depends on so many variables.

There have been studies that those with ADD tend to trend towards careers in the arts and crafts and engineering worlds...creative, hands-on type work more so than purely mentally focused professions (like accounting) so that can aid in future steering of environments as well.

I wish you the best and hope that year-by-year we begin to understand the whole range of mental imbalances and get better at diagnosing and treating them through all available methods and options.

Answer 5

Ask your parents for their input on how they managed to raise children without using powerful mind altering chemicals to change the personality of their children so they behaved in a more convenient way for their teachers/parents.

Also if your son's school is failing him then think about moving schools or alternative forms of education to the state school system such as a private school or home schooling.