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Out of Control Behavior: Should I Medicate My Child?

by James Lehman, MSW
Out of Control Behavior: Should I Medicate My Child?

The recent death of a four-year-old Massachusetts girl from an overdose of medications for ADHD and bipolar disorder has brought the issue of medicating children for behavior problems to the forefront of public consciousness. While this sad case shows the extreme end of the issue, it reminds us of the fork in the road many parents face daily. We have a behavior problem. Should I medicate my child? The question of medication is a complicated one, and many parents have understandable reservations on medical, moral or spiritual grounds. This month in Empowering Parents, James Lehman takes a candid, straight-ahead look at what medication can and cannot do for your child.

James Lehman:
It’s natural for parents to look to the medical system when they are faced with out-of-control behavior. If the child is diagnosed as having some medical condition -- Attention Deficit Hyperactivity Disorder (ADHD), for example, or depression -- the parents may breathe a sigh of relief. "At last! We know what's wrong, and there's medication for it."

Unfortunately, a diagnosis and medication aren’t always a solution. Medications that target behavior problems are at best a shot in the dark and at worst can have many undesirable side effects and alter the child’s personality. Often, the medication that works on one child won't work on the next one, so a period of trial and error may have to take place, requiring patience from the parent and the child. Even the diagnoses can be slippery when it comes to adolescents. Depression, which can be treated medically, can look like Oppositional Defiant Disorder, which cannot be treated medically.

Parents need to know that medications aren't meant to change specific behaviors. What they may do is rebalance some chemicals in the brain to give the child who is taking them a longer fuse or a little more flexibility in thinking about a situation. Kids who are acting out often turn to a fight-or-flight response. If a medication is working well, it won’t change this tendency toward “fight or flight,” but it may give these kids a little extra time to consider the best thing to do.

If you and your doctor determine that medication is the best choice for your child, be observant as your child starts the medication. Look for signs of behavior change. It is possible that they may occur.  More likely what you may find is an increased receptivity to alternate problem-solving techniques. A longer fuse or more patience, for example. Then realize that the pills don't teach the actual problem-solving techniques; it’s up to the adult to teach them and up to the child to learn them.

If a medication is working well, parents should see an increase in ability to focus on tasks such as homework and chores. Conversely, a child who simply becomes lethargic or unemotional is probably not benefiting from the medication, because he is not receptive to learning new problem-solving skills and may need a different medication, a different diagnosis or even a different approach to the problem.

For some young people, psychoactive medications can mean the difference between being functional and doing the work of growing up, and being a constant behavior problem, with all the consequences that implies. I’ve also seen children and teenagers be put on medication who didn’t need it. Their problem didn’t have a medical basis. They needed to learn problem-solving skills, and their parents were not properly trained to teach them these skills.

The key thing to remember is this: With or without medication, many young people who have behavior problems are best treated by creating very structured situations in which to learn appropriate behaviors. Generally, school is a structured environment, so a child may perform better and cooperate better at school where things are more structured. Behavioral change is hardest to measure in the unstructured environment of home. You can teach problem solving skills by starting small and setting limits and offering coaching around one problem you want your child to change at home. Focus in on one thing: doing spelling homework, doing one nightly chore, or talking nicely to your sister. Coach your child toward success with this one thing. Then move on to the next behavioral issue.

As parents, it’s important that we manage our expectations around medication. It can help your child to focus and accept another way to work through is behavioral issue. But it will not solve the problem. Only you and your child, working in a structured, problem-solving environment, can do that.

 

 


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James Lehman, MSW was a renowned child behavioral therapist who worked with struggling teens and children for three decades. He created the Total Transformation Program to help people parent more effectively. James' foremost goal was to help kids and to "empower parents."

READER'S COMMENTS

Thanks for this helpful article...we are in the process of deciding whether our 12 year old son should be medicated or not. This gives us something to think about.

Comment By : Angela501

This is not just about the article but as a teacher it would be helpful to get training to help with these students. I have a small class but all of them are ADHD. They have emotional problems which makes them have problems getting along with anyone.

Comment By : Nan

my 5yr old will throw tantrums in kindergarten, at the teacher & other children, but not at home. He is very smart & does his homework but doesn't transition well at school. help. his violent behavior is disruptive to the class & I don't know how to help him.

Comment By : Lois

* Dear Lois: I am assuming that because you posted your question under "Out of Control Behavior:Should I Medicate My Child?", you are considering having your child evaluated by a professional. I think that anytime a behavior is so severe that you cannot function, then it needs the attention of a professional. In this case, your child is unable to function in kindergarten because of his violent behavior. I would recommend that you ask your pediatrician for a referral to a child psychologist.

Comment By : Carole Banks, Parental Support Line Advisor

My 15 year old takes Adderol and it does significantly alter his personality, but without it he is near impossible to deal with. He is unable to focus even on the simplest of tasks. I often wonder whether or not his being medicated is the best course of action.

Comment By : fryeikat

My 8 year old son has ADHD. He routinely caused trouble in the classroom, hit and kicked us when angry, kicked holes in the wall and broke furniture before we started him on Adderall. He has much better impulse control now that he is taking medication. It has been a lifesaver for our family, although it never feels good giving your child medication.

Comment By : Lisa

My son is 6 almost 7 years old and has been hyper since he was 18 months old. I handled it until he started Kindergarten last year and the teachers didn't know what to do with him but I could talk to him on the phone and they wouldn't have anymore problems with him that day. This happened several times in the beginning of the year and we had to pick him up at least 3 times within the first 9 weeks. I had him evaluated by his pediatrian per the schools request and they diagnosed him as ADHD. He went through 18 medication changes that school year. We got married this past summer and I had taken him off of his meds because they just simply did no good you couldn't tell if he took them or not. My husband and I had him cognatively tested by a psychologist and educationally tested by a professional tester. We learned that he also has a learning disability. He was "placed in first grade and the principle, who is no longer there, said and I quote "I believe C would be a productive first grader if he would just straighten up and do better." I let him know that 2 professionals disagreed with him and we had him repeat kindergarten, now he is at grade level and hopefully with practice and dedication he will stay that way. Now his meds are managed by a child psychiatrist and we all see a family counselor and of course we are appling The Total Transformation techniques this is our second week and he is really enjoying earning his Sunday toy from the Dollar Tree which he thinks is the toy store. You guys are great and have already helped me and my family so very much. Finally after almost 7 years there's light at the end of the tunnel. Thank you!!

Comment By : croberts

My son has ADHD and is on adderol. I can always tell when he has not taken his medication because he is more affectionate. However, he is much more argumentive as well. I struggle daily with the decision to medicate him simply because it does effect his demeanor, but the consequences for both of us when he does not take it are dire. He is 15 and I realize his age plays a part in how we interact, but I see a huge difference with him medicated.

Comment By : fryeikat

I have a 13-year old son with ADHD, who does not have 504 eligibility, but is on meds (adderall). He is doing very well in school and participates in gifted programs. My 11-year old daughter, on the other hand, who is also diagnosed with ADHD, does not take any meds but has, unlike her brother, 504 eligibility. Even so, she does not perform at school as well as her brother. She is very smart too, but her problem is forgetfulness, disorganization, and lack of focus. My husband and I are trying to keep her without meds hoping that she can learn ways around it. Her lack of discipline and forgetfulness, and especially lack of organizational skills are not getting any better. I also have ADHD I am not fully able to help her even with my best efforts. I try to work hard with her but if she forgets to write down her homework assignments my efforts are worthless. How can we best help my daughter without medication? Is medication the only way? I hope not. Desperate Mom

Comment By : desperateMom

every day my son will get first warning in school for talking to his friend or interupting the teacher.The nurse in school told me that he had ADHD and need medication.I talked to my son about it and this is what he said 'mom iam not that bad compare to other student i only got one warning i do not need medication they just have to warn me and i'll stop'.is he right?He gets As and Bs grades in school and is 9 years and 8 months.

Comment By : jose

I have a 9 1/2 yr old son who acts like he is boss. He yells throws things cusses at me and I am beyond myself in knowing how to handle him. I am a single stay home mo with 4 little girls ages 8, 3 1/2 and twins 2. It is very hard for me to deal with my son and the girls at the same time. Please Help.

Comment By : momofjsimm

This is a great article that touches on alot of sad truths about adhd. I have 3 children, all different, 1 with adhd. My oldest, now 15, was diagnosed with adhd in early elementary school. The public school system took him off of his IEP when he was in 2nd grade because he was "doing grade level work, academically". He was bright but they consistently complained about his disruptiveness in the classroom and had little tolerance for his learning differences and needs,despite the fact that they took him off the IEP. We didn't know our rights at that time and were naive. Had we known our rights back then, we may have taken a different path. Instead we went along with their recommendation to take him off the IEP and then found ourselves dissatisfied with how they treated him in school. Fortunately and unfortunately we had the means to send him to private school. Because they were more willing to work with his adhd and were more nurturing and creative, a treatment plan never followed him as it would have in the public school system. We looked at him from many angles over the years with neuropsych testing, medication(which was very helpful at times) and on and off therapy as well as behavioral management at home. Our son is bright, articulate, very athletic and is truly a very charming kid. He is not disrespectful to teachers or adults, he saves that just for us at home with defiant behavior, very sneaky defiant behavior. These are many reasons why he was overlooked along the way by everyone but us. It is true that no one knows your kid or cares about your kid like you do as his/her parent. You must be a strong advocate for your child early on. Even when you try to acquire all the right tools and activate all the right professionals, as we think we did, things still may not go your childs way. We feel like we truly did everything we knew was right for our son. During the past 12 months we've seen him decline, sabotaging himself and engaging in risk behaviors that we feel are rooted in his learning deficiencies that have chipped away at his self esteem over many years. Our son was sent to a theraputic wilderness program last month because we saw things becoming very dangerous for him. It is a lonely place as a parent to have a child with adhd which often later manifests itself into other different disorders. The loving extended family that we have does not really understand. It is not an easy road. You must advocate for your child, and not worry about what others think, one mistake we made along the way. Intervene as early as possible. There is so much more information out there today(like TT and others) than there was 10 years ago when we began our journey. Know your rights and get your child the support he needs at home and at school, pray and read alot and love him unconditionally even if it means ultimately sending him away to get the professional support and treatment that he/she needs. james lehman makes a very excellent point that once he/she reaches 18, help drastically diminishes. Good luck.

Comment By : mom4life

I HAVE A 6YR GIRL SHE IS VERY SMART BUT SHE HAS A LOT OF PROBLEM GET ALONE WITH OTHER KID SHE ONCE TO GET ALL THE ATTEN IF NOT SHE DOES STUFF TO GET YOUR ATTEN SHE HAS BEEN ON MED SENCE SHE WAS 2YR OLD FOR ADHD .I TRY TO SPEED A LOT OF TIME WITH HER BUT WHEN THE GRADDAUGHT COME SHE WIL NOT HAVE MUCH TO DO WITH ME AS LONG AS IT IS ME AND HER ,SHE FIND THERE IS ONLY 3YR DIFFERT IN THEM TEL ME WHAT I CAN DO TO HELP WITH HER FEEL THE WAY SHE DOES

Comment By : E.HUBBARD

mom4life's comments really hit home for me as a mom of a 14 year old boy with adhd. I too see the clock ticking down to his 18th birthday. So much of what you said rings true for me.....the loneliness, the family not really getting it, working with therapists, doctors, trying different meds, having an IEP that really is ineffective, completely different behaviors inside vs. outside the home with the ugly ones reserved for the safety of the family scenario. It's all so exhausting. We are struggling with trying to work the Total Transformation System ourselves. Would really like info on special camps that help boys focus on their futures before it's too late. Everyday is a new day with our son.....we'll keep trying but it's taking its toll.

Comment By : Can'tGiveUp

Both my kids are on the Australian 'Failsafe' diet [it's mainly for ADHD, but also learning disabilities and asperger syndrome]. My elder son is now at university getting A's - I never thought I'd get him through school! I believe Australia are world leaders in this diet. Sue Dengate helped me free of charge - I got her book from the library for free. But she's just a parent - not someone out to make money. If you think food and drink don't affect behaviour, look at what alcohol does to behaviour. My teenage son wants to stay on the diet because he says he can concentrate on it and then can do well at his work and gets good comments not bad ones. To the person who's son is argumentive - you do know that most teens want to argue over anything and everything at 14/15 etc. Just let them go and argue with them - just don't take it personally! It's still important to maintain good boundaries and consequences for behaviour however. Good luck to everyone!

Comment By : Vida

* Dear 'Shannon': It can be challenging to find a school placement. Expect that it will take some time and some research on your part. Begin by clearly assessing your child’s needs so that you are able to match him with a school that offers that type of assistance. This will help narrow your search. What is he doing or not doing and why? For example, if he struggles with ADHD, there are schools that specialize in working with those needs. If he has mental health issues, make sure he has an accurate diagnosis. If he is currently working with a counselor and you are considering a ‘boot camp’ setting, ask his therapist if this would be a good placement or if it would be therapeutically counterproductive. School guidance counselors and juvenile court officials in your area may maintain lists of schools. There are some web sites that maintain listings such as National Association of Therapeutic Schools and Programs http://www.natsap.org/search.asp. As you are deciding on a placement, check the placements academic accreditation and the credentials of the staff. It’s a good idea to visit the placements you are considering, inspecting the eating, sleeping and medical facilities in addition to the classrooms. Ask the placements for references from parents whose children have completed their programs. There is quite a bit of leg work involved but it’s important to place your son in a program that will address his specific needs. We wish your family the best.

Comment By : Carole Banks, Parental Support Line Advisor

I'd like to comment to mom4life, my daughter who is now 20 and finally diagnosed w/ ADD about 2 yrs ago is going through similar issues. She believes getting high calms her down enough so she refuses to take her adderall, is "classified" as "gifted" yet, she can't get organized and focused to achieve what her Godgifted talents can do for her community. I urge all parents to keep up with these issues throughout their teen and college years. I pray that it isn't to late for my daughter to really succeed.

Comment By : Lori

I was a bit disappointed, but not surprised to see no mention at all in the article about dietary interventions. I say this because, they carry no risk, are low cost and have to potential to help many children without using medications. I see so many parents who do not want to medicate, but do not have quality information about any safe, effective alternatives. My family has used the Feingold program (feingold.org) instead of medications for the last 11 years. The short version is elimination of synthetic additives (dyes, flavorings, sweeteners, and preservatives BHA, BHT and TBHQ) as well as possibly some foods. I would highly suggest it to any parent who does not want to use medications. BTW, this program has been around since the 1970s.

Comment By : mbcsMom

my son is 8yrs old he is adha and learning we are trying our level best to change his behaviour with the help of behaviour therapist but northing much has happened still the same thing is continuing is it safe to start the medicine with the help of neurologist.

Comment By : hemashankar

* To ‘hemashankar’: Thank you for your question. The best way to know if it is safe to start any medication is to talk with a doctor—a pediatrician, psychiatrist, or neurologist should all be knowledgeable about the different kinds of medications that might help your son. It might be helpful for you to make a list of your questions and concerns and take it to the appointment with you so you can make sure they are all addressed to your satisfaction.

Comment By : Sara Bean, M.Ed., Parental Support Advisor

I have a 8 year old son, whom I love dearly. He is very smart and makes the A, B honor roll. It just his behavior in class. He is out of control in the school settling. He have spoke with 2 physicans that both tld me he will grow out of it, but i am to the point I think some additonal help is needed. He gets into it with his classmates, runs out the classroom,refuse to do his work, dont like anyone looking at him and throws things in class. He had the princpal running behind him because he did not want them to call me. This behavior is just at school, at home he is so charming. Please help. I am a single mother seeking for assistance for my only child I know who is destined for greatness.

Comment By : scmom

* Hi scmom: It is troubling when you see your son acting out in school when you don’t see these kinds of behaviors at home. We recommend having a meeting with your son’s teacher, and possibly also the principal and/or the school social worker or counselor to discuss your son’s difficulties in the classroom. It might be helpful to see if there are any patterns to his behavior; for example, if he acts out more when seated next to certain students, or after lunchtime. At home with your son, you can do some problem solving with him about his behavior at school. You might say “When the teacher asked you to do your math worksheet today, you decided to throw it at her and run out of the classroom. That’s not OK; it’s your job to get your work done while you’re at school. What can you do differently tomorrow when your teacher asks you to do your worksheet?” I am attaching some articles that you might find helpful: When Your Child Has Problems at School: 6 Tips for Parents & Acting Out in School: When Your Child is the Class Troublemaker. Good luck to you and your family as you continue to work through this.

Comment By : Rebecca Wolfenden, Parental Support Advisor

HELP! My 5 year old daughter is out of control she is perfect in school but the moment she gets home shes hitting screaming sealing lieing she doesnt listen to anythng i say she kicks the ways and yells so loud police come . I have taken her to her doctor and they tell me its normal its not!

Comment By : T_Newman

* To 'T_Newman': It is understandably frustrating when your child appears to know how to behave in school, and seems to forget when she walks in the door! It is great that you have taken the step of having her seen by her doctor. As tough as this is, it’s actually a good sign that she is behaving appropriately at school, as this shows that she does know the correct way to act in certain situations and environments. It might help to focus on one or two behaviors she is showing at home, such as the hitting and kicking, rather than all the behaviors. We advise talking with your daughter in a calmer time, and asking her “What is going on for you when you get home and you’re hitting and kicking?” Once she answers, reinforce that this behavior is not OK, and ask what she can do differently when that is going on. For example, she can do something active when she gets home, or have some quiet time to transition from school to home-whatever will work best for her and your family. One strategy that many parents find helpful when trying to change behavior with younger children is to develop a behavior chart. With this, she can earn something extra by choosing to do something else other than hitting and kicking. I am including a link to some articles I think you might find helpful: Hitting, Biting and Kicking: How to Stop Aggressive Behavior in Young Children & Child Behavior Charts: How to Use Behavior Charts Effectively Good luck to you and your daughter as you continue to work through this.

Comment By : Rebecca Wolfenden, Parental Support Advisor

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