Dr. Bob on ADHD: To Medicate or Not to Medicate?
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.
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.