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I fully understand the concerns of parents regarding medication for ADHD. My wife and I struggled with this when my son was 5. He had a great response to stimulant medication and remained on medication until he was 14. He suffered no observable side effects. He is a 6’4” guy who completed college with honors and has been employed for 5 years in the film industry and currently is an editor for a top rated cable network show. We were at our wits end and what we called “the small vitamin” was a miracle drug. At home we also used psychosocial interventions from time to time during his formative years.

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During my years as a child psychologist, I have been able to help many children with mild to moderate symptoms of ADHD do well at home and school without medication using psychological interventions. However, children with more severe symptoms benefit greatly from medication. Current guidelines now state that behavioral interventions should be tried first for mild to moderate symptoms and also should be used for more severe manifestations along with medications which may reduce the dose needed to control symptoms and may reduce the length of time required to remain on medication.

With any physical or mental condition, a thorough work-up should be completed by a competent physician or psychologist. All possible physical and mental causes for the symptoms should be considered and ruled out prior to making the diagnosis of ADHD.

Medication should be monitored closely and growth and blood pressure should be monitored periodically as well as routine blood work performed annually. Stimulant medications when used appropriately are the most effective and safe of all psychiatric medications. For complete information on risks versus benefits please see Parent’s Medication Guide and Medline Plus Searchable Drug Data Base.

Probably at least 30% of children on medication would be fine with comprehensive behavioral treatment. Unfortunately, parents often are enticed by advertising to try very expensive supplements and programs using various electronic devices with no scientifically proven benefit. (I am often asked about alternatives, which is why I developed the Total Focus Program.) For more information on psychological interventions please see go to CHADD or ADHD.

Diets seem to help a few kids who react adversely to certain foods and food additives. While these kids may have ADHD-like symptoms, their true diagnosis is food allergy. The manufacture of supplements is not well controlled and while there is no proof of effectiveness for these substances there is, more importantly, NO PROOF OF SAFETY for any of the recommended substances. “Natural” is a poorly defined term and a number of “natural” products in wide distribution have been pulled off the market due to serious side effects including death or for unsubstantiated claims of effectiveness. For a more thorough discussion of alternative treatments please go to the National Resource Center for ADHD.

I hope this information is helpful. I frequently check the scientific and professional literature and will update this post when warranted. For now, parents must make decisions that are well informed and that meet the short-term and long-term needs of their children. These decisions should always be made with the assistance of a trusted healthcare professional.


     

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  • Celine Says:

    Dr. Bob: Thanks for this information!

  • Kirsten Says:

    I have an 11 year old son who has been on Concerta since he was 5 years old. His doctor diagnosed him with the worst case of ADHD he has seen in 20 years! Lucky me! I want to know why Dr. Bob’s son stopped taking stimulant medication at 14? I have already prepared my son that he will most likely need to take it for the rest of his life. A person doesn’t outgrow ADHD. What were the factors that allowed Dr. Bob’s son to go off of it at 14?

  • Dr. Robert Myers Says:

    Kirsten » Good question! Actually about 30% of children diagnosed with ADHD go into complete remission during adolescence. That means 70% will have some symptoms of ADHD as adults. Brain maturity is not complete until the mid 20s for males (somewhat earlier for females). As the brain matures, certain functions fully develop which may enable the ADHD adult to compensate and lead a fairly normal life without the need for medication or assistance. Some will still need medication or benefit from a support group. In adolescence, hyperactivity seems to decrease, while inattentiveness may continue to be a problem. At this point there is no basis for predicting how ADHD will affect a person as they mature.

  • Colleen Says:

    I have a 7 year old son with moderate-severe adhd. he sticks out in a class, although he takes Concerta, 27 mg. Recently his meds have not been working as well in the afternoon, he is disruptive. he is also very skinny (50 lbs) and his meds have been giving him bad headaches after school – he is just miserable until about 7-8 pm. this is ruining his life! I made an appt to talk to his pediatrician. I’m just scared about this.

  • Tammy Rivera Says:

    Thank you for this article. I have a 7yr old son which we have tried Ritalin, Adderall, Concerta and now just started Vyvanse. I am so paranoid of the side effects it is not funny. His ADHD is severe along with ODD and fetal alcohol syndrome. I hope one day that my son will come of all of these medicines. Thank you very much.

  • c Champa Says:

    We have two children who take medadate. My son infirst grade was getting pulled out of class because he was disruptive and the teacher did not know what to do with him. He was on a few different meds he actually had some side effects which was pretty scary. Now he’s on the medadate and oing good. He is in fith grade and he’s less impulsive but does need it.
    My daughter is also on it, more for attention. If a fly flew by it distracted her. Since the meds she has grown accedemically which she really was behind. Pray about it if you feel your child needs meds because they might need it and benefit from it. Dont worry about what other people think.

  • Tammie Says:

    I have a 7 year old who takes Concerta, and has since he was 5. We had tried absolutely everything, counselors, pshychologists, psychiatrists, read every book we could get our hands on, took parenting classes, and implemented every behavior modification that was suggested. We even had one doctor tell us that we just needed to start putting hot sauce on his tongue when he misbehaved! We did not want to medicate him, until we finally got with a doctor that really understood what was going on, and explained the psysiology of ADHD, and why medication was really needed in this extreme case. Medication is not a “magic bullet” that will cure all behavioral problems. It just gives the child a chance to learn from behavior modification without flying into a blind rage, kicking and screaming, when he disagrees.

  • Cynthia Says:

    Our 8 year old grandson came to live with us in December. He had been in foster care for 15 months and had gone through some very awful things. He was in another state, so it took sometime to go through all the hoops to get him to be with us.
    He was on lots of medications but he is now on concerta and what a wonderful gift that has been. He can focus and is doing very well in school and in learning day to day living. We also bought the Total Transformation and I don’t want to sound like an advertisement, but that was a wonderful gift too. Expensive, but worth every penny.
    Good luck to everyone.

  • Suzanne Says:

    My 5 year old son was diagnosed in January of this year. He started on Concerta, which did nothing for him. Now on Adderall, and we are finding that it might not be the right drug for him either. Trial and error is what our doctor says. Since he has started medication I have seen a DRASTIC change in his behavior. He is a very compassionate child, and before the meds he was bouncing off the wall so badly his Dad couldn’t teach him how to play catch. We also purchased the Total Transformation, which we find to be a huge help. We had done everything we knew to do before we medicated my son, but I am so happy we finally did. There is peace in our home now, where there wasn’t before. My brother has ADHD, and growing up with it I learned the signs – and my son shows them all. My brother, now 24 years old, has returned to his medication due to his job – he is a Marine. But he was off of them for nearly 6 years. Knowledge is what got us to where we are now, I am so great full for it too!

  • Roberta Says:

    My son will be turning 18 soon, and he has been medicated since he was 6. We started off with Ritalin, but he experienced headaches and this was in the days before the extended release Ritalin, so he needed a dosage each day while in school to get him through the afternoon. In second grade he went on Adderall XR and it worked so well, and dosing him once a day before school helped take the stigma away of having to visit the nurse daily. A new pediatrican recommended Concerta when he was in sixth grade, as that didn’t interfere with appetite. We found after months of frustration that Concerta didn’t work at all. Our son has been back on Adderall and he still takes it. It was recommended that for evenings where he had lots of high school homework that another dose of Ritalin help him get through the night.

  • nancy martin Says:

    i adopted my 6 year old grandson. he was diagnosed with fas, severe adhd, and behavior disorder. he weights 48 lbs. he is on risperdal twice a day, carbamazepine 3 times a day, and dextroamphet 3 times a day. i cannot really say that any of them work. he is also pretty slow and test out between 3 1/2 and 4 years old. nothing works. he is in a special needs small classroom setting (4 children with 1 teacher and 2 parapros) with the focus on behavior difficulties. the assistant principle has suspended him 3 times this school year. i am at my wits end. by the time he gets home he doesn’t have a clue why i am upset.

  • Jennifer Says:

    Hello,

    I have a 7 yr old son whose behavior has affected his academics. He is in 1st grade and I was told by a tutor that he is not at grade level. His behavior at home is disruptive, he gets easily distracted with any little noise. He is constantly hitting his sister for any little thing that does not meet his approval. His behavior in the classroom involves excessive talking, disruptive behavior, and I have been told that the other children in his class do not want to associate with him, because he gets them in trouble. It seems no matter what punishments we give him, speaking to him about the same thing over and over and reminding him that that kind of behavior is not allowed, it just does not seem to register. As his mother, I thought maybe it was his age, but as I research a little more I find that this maybe a ADD or ADHD situation. I have made an appointment for him this summer with a Pediatric Neurologist and it is possible that he may have to repeat the 1st grade again. Sorry this so long, but has anyone else experienced this and if so, what steps did you take that seemed to make a difference?
    Thank You, Jennifer

  • Valerie Says:

    I have a 9yr old boy. He has been on ADD Meds since 2nd grade (now at the end of 3rd grade). I have tried Metadate, Concerta, Stratterra, Focalin XR and Vyvanse. The Metadate and Stratterra calmed him down but did nothing for the focus issue. The Concerta, Focalin Xr and Vyvanse gave him upset stomach, not eating, and no sleep. He just started the Vyvanse but I am now trying to find another Med that does not upset his stomach (it has only been 5 days on this med). I want to find a med that will calm him and help the focus, I just have not found the magic one yet.

    I did purchase the Total Transformation CD w/ADHD CD kit. I love this program, I have alot of changing to do. I think Dr. James Lehman has good points in his training. I hope it works in time. I do recommend the parent support line to get started with the program (I have used it a couple of times). Hopefully with the right Med and changes in the house I will get through parenting.

  • anna hobbs Says:

    Dr. Bob,
    My daughter was diagnosed with very severe adhd at age 5,(she is now 10) at age 7 was hospitalized for three months after behavior that was dangerous to herself, and her emotional state has bounced around ever since then.
    Before hospitalization,she tried almost every stimulant medication and was then given a dual diagnosis of adhd with early onset bipolar disorder,and partial complex seizure disorder which introduced more medications.
    When she was hospitalized, a combination of Dexedrine (that she had never had before) and Trileptal and Amantadine were given. This instantly stabilized her.
    We read many times that stimulants would in the long term increase the mood swings for bipolar patients and could decrease the seizure threshold.
    At our request, over a year later, her psychiatrist took her off the Dexedrine and we went to an anti-psychotic mood stabilizer but everything has worsened, even her superior level academic abilities, and she is on the brink of hospitalization again. In your opinion, did we make a mistake removing the Dexedrine?
    To be less specific, do you have the opionion that stimulant medications worsen the bipolar symptoms if a patient has that too?
    Thank you very much.

  • anna hobbs Says:

    I see that several of you posted that your children had headaches in the afternoon and had a hard time eating when on Concerta. My daughter experienced the very same thing with every stimulant she took, but I was never sure if it was the stimulant.
    She is not on the stimulant any more, and she might return to it, but, seeing that others have the exact situation I’ve described to our psychiatrist is very helpful. (The stimulant may have been too, I’d just like to find one that doesn’t make her feel bad physically)

  • Elisabeth Wilkins, EP Editor Says:

    anna hobbs » I just wanted to jump in here and let you and other readers know that unfortunately, we cannot give specific advice on medicines via EP. It’s actually a matter of medical ethics–a doctor would have to see your daughter as a patient in order to determine whether or not her treatment was appropriate. The important thing is to talk to your doctor and have an ongoing dialogue with him or her about what is best for your child. Thanks Anna, and I’m sorry we couldn’t be of more help with your situation.

  • Jacqui Says:

    Valerie***I may have read your post before, but had no experience with the meds you described. My 7 yr old is now on Concerta. Everything I’ve read states that the stimulants are the way to go for ADHD. It seems that stomach upset/”belly ache” are common side-effects of these meds. Our Dr. has suggestted that if they continue, to try half of a Zantac. If you are still trying the stimulants, please ask your Dr. if this may help. Please be sure to ask how long it can be taken, and ask about any medical reason your child can’t take it…current medical condition, etc. We’ve “run the gammitt” for 5 1/2 yrs now…hang in there!

  • Kathleen Says:

    It feels good to hear that other parents go through the same things that I have. Sometimes you feel alone in your frustration and desperation. My son is 9 years old and was diagnosed with ADHD and ASperger’s syndrome at the age of 5, although he had behaviors as early as age 2. Of course everyone says at that age that it is ” the terrible two’s but I knew that it was something more. He has been on Adderall, Dexadrine, Zyprexa, Ritalin, Depakote, etc. etc. He is currently on and has been on Concerta for almost two years. It works about as well as the Ritalin but his appetite is much better. He is very small for his age and weights about 55 pounds now. It seemed like he weight right around 40 pounds for about 3 years. We could not get any weight on him. He still has alot of behavior problems such as anger, defiance, impulse and aggression. We are looking into other avenues currently to see if he has a chemical imbalance or neurological disorder. It is hard to know through all of the trial and error whether or not you are doing the right things or not. You have to keep trying though and know that you are doing the best you can for your child or children.

  • EP Year in Review: Top 10 Blog Posts of 2008 | EmpoweringParents.com Says:

    [...] ADHD: To Medicate or Not or Not Medicate? by Dr. Bob [...]

  • Kris Says:

    Medications are a mixed blessing. They do help, I see a huge difference in both my sons. However, there are side effects and we’ve been on almost every one of them. What I have also noticed is the coming down or withdrawl. At the end of the day, the mornings, and weekend medicine breaks, my boys are much more miserable than in the summer when they just don’t take the meds. I think this is withdrawl, just as the first week of summer when we take them off. The meds do help and we have decided that it would be impossible or near impossible for them to succeed in school without the meds. However, I sure wish they could find a way to teach these boys without having to medicate them. It seems to me that there are resources available for every other type of learning difference from giftedness to retardation. Why do they leave out our ADD kids? Especially when on any given day, 5-10% of each classroom is ADD, on medication or not. It seems to me that children with ADD would better learn to manage their differences given a supportive school environment. They would better learn coping skills than when we medicate their differences out of them. On meds they’re ok, off meds they’re in withdrawl which is worse than if they didn’t take the meds at all? Are the meds keeping them from growing mentally as well as physically? On meds they are learning all the academics they need, but are they really learning to manage their differences? It seems that we are just setting them up to be on meds forever. THIS IS THE DILEMMA WE FACE AS PARENTS OF ADD CHILDREN! It’s so frustrating. In summary, we chose to do meds simply because we believe that they would be left behind in school and that the teachers in a mainstream classroom would not have the time or want to give extra attention to them, this has been our experience. SO, darned if you do and darned if you don’t, this is my opinion of meds. As parents, weigh the pros and cons and do what is best for your child. After all, they are what its all about!

  • Marianne Says:

    I found the forum helpful;in that I no longer feel alone in coping with an 8 year old on meds who has F.A.S.D and A.D.H.D.

  • ADHD to medicate or not - Netmums Coffeehouse Says:

    [...] topic from Dr. Bob, he is the father of an ADHD child and the creator of the Total Focus program. Dr. Bob on ADHD: To Medicate or Not to Medicate? Reply « Previous Thread | Next Thread » addthis_pub = ‘netmums’; [...]

  • Offia/Chicago Says:

    I am the mother of a 12 year old Africian American child who is bright in so many ways and knowledgable in so many things, but it seems that his brain will not connect to the actual writting that is necessary for academic achievement. He has been taking Concerta and Risperdol for 2 years now. My concern is I am subjecting him to weight loss and it seems to not be working so well. I feel bad because he know that school is important and I feel like I have exhausted my resourses and the school doesn’t understand this condition. I don’t know if removing him will help him but what else can be done? The school says he doesn’t qualify for an IEP plan because he scores so high on the state exams but the daily school work is the problem, especially in social science and reading work not reading itself but writting. HELP SOMEONE!

  • Dr. Bob Says:

    Dear Offia/Chicago:
    Scoring high on a state exam does not necessarily mean a child will not qualify for an IEP. It is based on a discrepancy between his academic ability (usually IQ) and his academic achievement (reading, math, written language scores). Even if a child is gifted he may qualify for an IEP if there is a significant difference between the standard scores on ability versus achievement (usually must be 23 points or more). Even if a child does not meet the criteria for classification as Learning Handicapped, a child with ADHD should qualify for what is called a 504 accommodation. (Be sure to check out the US Department of Education Q&A on 504s and IEPs. You can find it online.) Unfortunately, parents often have to be forceful advocates to get help from our schools due to their tight budgets.

  • nikki/lansing Says:

    I always knew something wasn’t right when I kept receiving statements from my 7 year old daughter’s teachers about focusing and paying attention. My husband and I have done everything I could think of to help understand the importance of focusing and paying attention. I truly believe she has either ADD or ADHD. I still haven’t garsp the difference between the two. I need to know where can i take her to have a tested and what type of test. Please help a concerned mom!

  • Carole Banks, Parental Support Line Advisor Says:

    Dear Nikki:

    The best place to start is your pediatrician. They are usually able to do this testing but they also need to rule out any underlying medical problems. Or you could go directly to a child psychiatrist, who is a medical doctor and can do this physical exam. Child psychiatrists specializes in behavioral issues. The third option is a child psychologist. These highly trained PhD’s frequently specialize in ADD and ADHD, but they are not medical doctors so you would need that physical exam first.

    The usual practice is for the doctor to ask you what you have observed regarding your son’s behaviors. They will then send a questionnaire to the school and ask your son’s teachers to fill it out and return it to the doctor. The teachers will report what behaviors they observe in the classroom.

    There is a difference between ADHD and ADD as they are currently characterized. ADHD includes hyperactivity and difficulties with impulse control in addition to inattention. ADD is primarily inattention that looks like daydreaming, passiveness, sluggishness or social quietness.

  • Nikki Says:

    Our son is 7 and has ADHD. He has had various special needs assessments which all show his intelligence is that of a 12 year old. He is performing at national average in most subjects but falls below for literacy as he also has dyslexia. We chose not to medicate as he was performing to national averages but then on taking part in a ADHD parenting empowerment and skills course it was pointed out to me that he is not performing to his ability – obviously he is abouve average the tests have pointed out, so we shouldnt be happy with the ‘average’.

    We manage his behaviour at home as best we can as we also have 3 other children.

    It is only when i realised that ADHD is not a behavioural disorder but a communication disorder that I realise now the benefits of medication.

    My dilema is now he eats and sleeps and if i go down the medication route this is most likely to stop.

    I wonder if i am more worried about losing my own sleep as having the other kids its noce to get respite, or am i worried about my son not getting sleep….obviously its both.

    I just dont know what to do. He is moderate ADHD i think on the scale so I feel we are managing but i wonder am i holding him back if i dont medicate as he is about to step up to junior school and required to sit for longer and he is growing up so the obstacles in his way will get tougher.

    Can anyone offer any advice?

  • D. Rowden, Parental Support Advisor Says:

    To “Nikki”: Thank you for sharing your story with us. You ask some excellent questions. There definitely is a lot to think about when considering whether or not to use medication. We would recommend talking with his primary care doctor and/or counselor about the pros and cons of medications and making the most informed decision you can. There is no definite right or wrong answer; it’s what’s going to be best for your son. You are the one who is in the best position to make that choice. We wish you and your family the best while you work through this decision. Take care.

  • zenny Says:

    I have a 11 year old son who has add. I started with concerta when he was 7 because he was 1 grade level behind. He had terrible headaches and insomnia that he would stay up until midnight. He then would fall asleep during class. He did improove on his grades but the side effects scared me. I then tried ritalin, he had excessive vomitting and I had to stop. I then just gave up on meds. He was doing average in school without meds. I was ok. Not all kids need to be above average. Now, he is 11 without meds and he is having behavior issues and is getting into legal trouble. The school psychologist has told me that he had Add and some adhd. I am now scared and totally confused. If I give meds, I have to see him suffer the side effects. If I don’t, He and I can get into legal issues. I feel totally devastated and feel like a failure as a parent. How should I resolve this? Please help! Also if anyone can tell me is his behavior due to his condition or normal age related.

  • D. Rowden, Parental Support Advisor Says:

    To “zenny”: Thank you for taking the time to share your story with us. Your situation is a difficult one. It is normal that you are worried what will happen if this behavior continues. Do your best not to personalize what is going on with your son. I understand this may be easier said than done. What’s going on with your son does not point to you being a failure as a parent. Rather, it points to your son having difficulties he may not have the skills to solve right now. You ask some really good questions. We would encourage you to speak with his primary care provider regarding any questions associated with medication or concerns you have. I want to reassure you that there are behavior modification techniques out there that could help your son learn how to manage his behavior. Dr. Myers discusses some of these in his article ADHD: Disorder or Difference? Good luck to you and your family as you work through these decisions. Take care.

  • Carlie Says:

    I saw in your one response there is no right answer to medicate or not. Then how do you know what to do. My son is 8 he has been off medicine for a year. He dreads it. He obviosly does better in school – especially handwriting – when on Ritalin or Metadate – however he says he hates the taste and how it makes him feel – he was on for a year. I have put it in all of his favorite foods – no luck. And he won’t try Concerta because he will not swallow a pill. He is open and tries all the behavorial techniques (he’s always pleasant/happy) but they only work to a point and now the other children are starting to notice how loud he really is. When do you push the child as parent to take the medicine. The pediatrition says I’m only hurting myself by not medicating him. The reports from psychologists and occupational therapists recommend medicine so he can function to his potential. But I’m so scared to go against his wishes and make him take it because I think it’s only a short term improvement that will lead to “trouble” in his future.

  • D. Rowden, Parental Support Advisor Says:

    To “Carlie”: Thank you for taking the time to post a great question. It can be difficult to know exactly what the best course of action is in situations such as this. On the one hand, you want your son to be able to live up to his potential; on the other, you don’t want to force your son to take medication for fear that it’s not going to be an effective solution. It’s understandable why you are struggling with coming to a decision that you’re confident with. You share in your comment the concern that having your son take medication could lead to “trouble” in the future. It might be helpful to make an appointment with his pediatrician and possibly the other treatment professionals involved to discuss any specific concerns or questions that you may have. Knowledge is power and they are going to be the most informed parties to address your questions. Ultimately, you will have to decide what works best for your family based on the information you gather from these different sources. We would also suggest continuing with the behavioral techniques. Keep in mind that children with ADHD develop at a different rate than children who don’t have ADHD, so, it may take longer for the skills to be fully developed. We wish you luck as you and your family work through this challenge. Take care.

  • Stephanie Says:

    I am so gld to feel I am not alone .my son is 8 years old and is just finishing 2nd grade and one of the hardest years of his life. He has problems focusing,staying on task he’s always getting in trouble for being
    Disruptive.at home he’s very angry easily everything seems like a fight.some days I feel like we can’t have quality time cause I feel like its always a battle.i don’t kow where to start?im really thinking in to medication. But wondering if it’s the bes thing?but I know I’ve got to do something cause his grades dropped and he’s suffering making and keeping friends.some days he seems happy and respectful but others days are always a challenge.i want him to succeed in life and also I want hi. To be happy with I’m self me and my husband love him so much it’s hard to go thru some days.

  • Denise Rowden Says:

    To “Stephanie”: Thank you for sharing your concerns with us. Deciding whether or not to medicate is a difficult decision for many parents. We would suggest making an appointment with your son’s pediatrician and discussing the many possible options with him or her. Your son’s doctor is in a much better position to determine what the best course of action will be for your son. We wish you and your family the best as you address this. Take care.

  • Jess Says:

    My son who is 7 years old was diagnoised a few months ago with moderate ADHD combined type (mothers instict knew something wasnt right since age of 3) well because his academics are great some above grade level no doctor will put him on any meds?? his behaviors unbelieveable and even when doing something he loves/enjoys (sports,computer educational games)he can’t keep his focus on what he is doing. Has anyone else had this problem??? I’ve done all the research on meds and think it is whats best for my son he is becoming a socially awakward child :(