Every morning, Henry takes a Claritin and a multivitamin. In the evening, he takes two Benadryl and two fish oil capsules. Occasionally, if he has a headache, he takes a couple of Tylenol.
Barring an illness, that’s the extent of his medication.
You’d think a kid like Henry would be a good candidate for medication, both for his ADHD and his anxiety. Unfortunately, he’s not; he falls into a very small percentage of kids, almost all with Aspergers, who don’t respond well to the available meds. We’ve tried virtually every ADHD med on the market, both stimulants and non-stimulants. Each time, the doctor lists the side effects and reassures us that odds were we won’t see any of them. Each time, often within days, we’re calling to ask if we can stop the meds because we’re seeing all the side effects.
The first medication Henry took was Adderall, and honestly, the change was amazing. My formerly disorganized, unfocused kid could suddenly stay on task and keep track of his things. This meant that he was less frustrated, which meant that he was happier and less stressed. It was remarkable.
Until we noticed the tic.
Henry has a couple of small tics — he scrunches his face in an odd way and makes little humming noises. The tics aren’t particularly bad or noticeable, but they’re worse when he’s tired or anxious. On the Adderall, the tics, particularly the scrunchy face, became pronounced. I called my pediatrician, hoping she would say it was nothing. Instead, she said, “You need to stop the medication right now.”
So we did.
Other medications had other side effects; the most common were an inability to sleep and a kind of generalized rage. Instead of helping my son to focus, the meds made him angry and wired.
So you might expect me to say that I am 100% opposed to ADHD medication, right? Because they’re bad! And dangerous!
You’d be wrong. I still wish, with all my heart, that we could find a medication that works for Henry. But I am painfully aware of how complex and complicated these drugs are. Prescribed and taken in the right way, they can be tremendously helpful. But more and more these days, we’re hearing about kids who are diagnosed on the fly and given prescriptions for medication that they most likely don’t really need — prescriptions for highly addictive medications, in fact. And that makes me sad.
This week, the New York Times ran a long piece titled “The Selling of Attention Deficit Disorder,” which looked at the marketing of drugs like Adderall. The take away? That drug companies are more interested in selling their products than in helping your child. “Even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication…Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits.”
Unlike other medications, ADHD drugs are prescribed based on symptoms, not height or weight or age. In an ideal situation — which ours was — patients are thoroughly evaluated, using a variety of tests and questionnaires. When we initially had Henry diagnosed, Wade and I filled out pages and pages of questions about his behavior and sleep and eating habits; he teachers filled out similar questionnaires that focused on his school day. He underwent a long day of testing at the psychologist’s office, which included an IQ test and a detailed ADHD evaluation. For us, diagnosis took weeks, not five minutes in a doctor’s office.
That’s not necessarily the case any more. Over and over, I hear stories of doctors who listen to a parent’s complaints about a child being disorganized or unfocused and send them away with a prescription. I’ll tell you a secret: my non-ADHD 11-year-old is disorganized and unfocused sometimes. Not because he needs medication but because he’s 11. There’s a big difference between a kid who cannot focus because of the way his brain is wired and a kid who just has a lot on his mind (like NBA stats and what’s for lunch and which girl he likes this week).
In our case, the testing revealed that yes, Henry most certainly had all the characteristics of a person with ADHD. But even then, the first recommendation wasn’t for medication. There were other things we could try first, like behavior modification therapy.
Studies show that for kids with ADHD, medication works best when it is used n combination with some type of therapy. This seems logical to me, but every time I say it out loud, I get blank stares, even from parents of other kids with ADHD. Medication is sold as a solution to all the child’s problems — give him a pill and he’ll be fine!
This is funny to me because I cannot think of another drug that works that way. I have high blood pressure; I take medication daily for it. But every doctor I’ve ever seen has reminded me that I also need to watch what I eat and keep exercising regularly. The meds help to manage my condition, but they’re not a cure-all. ADHD medication works the same way.
Of course, therapy is a lot of work; it requires not only getting your child (and yourself or the entire family, sometimes) to the therapist but also arranging your life around your child’s disability. Kids with ADHD need structure — consistent mealtimes and bedtimes, consistent rules, consistent strategies for dealing with homework and chores and social commitments. Behavior modification therapy isn’t a thing that your kid does once a week with the doctor; it’s a lifestyle, something that the adults in the house have to commit to. And that’s hard. A pill is so much easier!
Kids with ADHD who receive a mix of behavior modification therapy and medication do well because they learn to manage their symptoms in a variety of ways. For this to work, though, a child actually has to have ADHD. A surprising percentage of middle school boys diagnosed with ADHD are really just sleep deprived. Once they get enough rest, their symptoms vanish. Giving those kids medication is ridiculous, but it’s also incredibly easy.
There’s nothing easy about diagnosing ADHD, and absolutely nothing easy about living with it — or with a kid who has it. Medication can be an important and useful tool for families dealing with ADHD, but it is not a cure-all. Like any other health condition, ADHD requires effort and commitment to manage; medication is just one component of that. I wish it were something we could add to Henry’s treatment plan, not because I think a pill will fix him but because I believe that these meds can be a useful part of the bigger picture.
Is your ADHD kid on medication? Why or why not? What’s your experience been with meds and other forms of treatment?