Mom's questioning meds for treating ADHD

Posted by Barbara F. Meltz  August 11, 2011 06:00 AM

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Hi Barbara,

I have 3 boys (7, 5 and 2).

My oldest was recently diagnosed (in June) with ADHD(hyperactivity/impulsivity) and Oppositional Defiant Disorder. He was always a challenge for us to parent. My hope was that his behavior was just a phase and that he would gow out of it. But here I am years later, and his behavior is still a huge concern.

It has become more and more apparent since he is now in school. Peer relationships are difficult for him. He is loud, doesn't get along well with most peers, and sometimes has threatened or hit them. He is bossy with his younger brothers (they do not have ADHD), overreacts to the most minimal situations, swears and talks back to me (tells me he wishes I was dead), etc. Time outs, loss of privileges, you name it, I have tried it.

I did not want to put him on meds, but now it seems like the only option sometimes. I have changed his diet (limit his sugar and dairy intake, colors, and additives) and have him take supplemental vitamins and minerals.

We keep him as active as we possibly can (daily biking, swimming, karate). He gets weekly psychosocial therapy with a social worker (I also see the same social worker for parent training sessions). He will be starting a social skills group soon. Also during school, he will see the school psychologist weekly, and receive speech therapy (social pragmatics).

His behavior just seems so out of control most days (there is always an incident with his siblings everyday), that I can't take it anymore. The child psychiatrist said that this was a mild form of ADHD. It does not seems mild to me. Sometimes, I just want to throw in the towel and go for the meds but will that actually change his behavior or I am just taking the easy way out?

From: At my wits end, Newton, MA


Dear At Wits End,

I'd try the meds and see how it goes. [Reminder: I am neither a psychiatrist nor a psychologist, I'm a reporter who has covered parenting issues for more than 20 years, and interviewed thousands of professionals and parents.]

Here's why:

Meds are not an "easy way out." They are a form of treatment that your doctor is recommending. In fact, it's about the only treatment you haven't yet tired. You owe it to your son to try everything possible because -- and this, to me, is a really critical piece -- the combination of the behaviors you're describing can get him a reputation in school as a kid neither teachers nor peers like. You want to nip this in the bud NOW.

ODD and ADHD diagnoses sometimes go hand in hand, but, often, the ODD is a by-product of ADHD that is not under control. ODD is unlikely to get better on its own, rather it's likely to get more entrenched over time.

Sounds like your family relationships already are somewhat fragile as result of his behaviors. Research shows that parent/child relationships improve when meds are administered. References are here and here. These references were provided courtesy of the National Resource Center on ADHD, which is a program of CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), which, among other things, offers support groups around the country for parents. Check it out if it's not familiar to you.

Readers, what are your experiences with meds and ADHD?

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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10 comments so far...
  1. Like Barbara said, If you have tried everything known to you and your doctor is recommending them.... I will agree that it isn't the "easy way out". You are conscious about this decision. For you to even worry about that speaks volumes of your concern. Have a long conversation with your doctors and seek second opinion if you need extra reassurance. I am sorry that I don't have much advise for you other than to say I wish you luck

    Posted by JD August 11, 11 07:03 AM
  1. I also agree that after exhausting all other options, you may have to consider medication. However, he was only diagnosed in June. So it's been maybe 2 months since you've implemented the alternative therapies (vitamins, diet, therapy)? Why not speak to his doctor and set a reasonable date at which point, if you have seen no improvement, you start him on the lowest dose of medication. I'm also not a doctor, but I feel like you have to give non-drug therapies more than 2 months to be able to see even a small change - maybe 6 months is reasonable?

    Posted by Q August 11, 11 09:29 AM
  1. This mother sounds like she is doing everything under the sun! I would definitely agree that the meds are worth a try -- and also perhaps some family therapy and an all-girls vacation for mom. I hope she also gets a chance to read my book, "Buzz: A Year of Paying Attention," as our experiences are quite similar. Hang in there! www.katherineellison.com

    Posted by Katherine Ellison August 11, 11 10:58 AM
  1. There are other options!!!! While medicine can help with ADHD it just covers up the symptoms, there is no cure. You are doing the right thing with your child, by allowing him to talk to someone, that will help him a lot as he get older. I encourage you to look into neurofeedback, also known as biofeedback. These new practices are now available for home use and in studies it has been found that they can actually cure ADHD symptoms. Medicine is only a temporary fix, and you will know when the meds wear off after school! Good job so far, you are doing great even though it may not feel like it sometimes! Remember to try and read and learn as much as you can about ADHD, it will help you connect with your son on a new level, also be sure you embrace the things you son does enjoy doing, activities that help him behave and focus his energy. Good luck and keep going!

    I am a graduate psychology student, studying ADHD.

    Posted by Shelby L August 11, 11 05:00 PM
  1. I agree with Q and although IANAD, I would give the current therapies time to actually begin to work. With a child like this, I don't think that 2 months is enough. But you are doing everything in your power which is incredible. And as a parent of a small child who's going through some really bad times, I know how LONG 2 months can feel, especially without improvements. Hang in there!

    Posted by Phe August 12, 11 08:15 AM
  1. There are several different drugs one can take for ADD. Ritalin and Adderall are probably the most common. Although Ritalin and Adderall are stimulants, they have the opposite effect on people with ADD. A person with ADD will feel relaxed and clear-headed on these drugs. (There's a new stimulant called Vyvanse that's supposed to last longer, but your health insurance probably doesn't cover it yet.)

    Ritalin and Adderall are easy-on, easy-off medications. If he tries these drugs and they work, then great! If he tries them and they don't work, he can just stop. It's not the same as with antidepressants where you build them up slowly and then have to wean off just as slowly. These drugs are fast-acting -- your son will notice a difference within an hour of taking it. You can start with a pill that wears off in a few hours, so if he doesn't like the way it makes him feel the duration will be short. If he does feel better, more focused, and less angry, you can move him onto a long-acting pill. A warning: when one first takes Ritalin, the come-down period when it wears off is pretty gnarly -- you get jittery and anxious and your heart races. These withdrawal symptoms lessen greatly as the body becomes accustomed to the medication. If he takes the extended-release version, it may not occur at all (or it will occur while he's sleeping, so he won't notice -- and yes, as odd as it seems, a person with ADD can pop an amphetamine and then go right to sleep).

    I think most people with ADD start on Ritalin. If the side effects are too unpleasant, or if the drug doesn't work as well as one may like, they next try Adderall. I believe that Ritalin also increases seratonin levels, and may result in a more cheerful demeanor than Adderall.

    Ritalin and Adderal can be taken on an as-needed basis. Some people with ADD take meds every day. Others take them when they're having an especially stressful day, or are assigned a complex task, or on weekdays but not weekends, etc. When you make the decision to take Ritalin or Adderall, you're not signing on for a lifestyle. It's more like taking Tylenol for frequent headaches. If you don't feel a headache coming on, don't take the Tylenol.

    An aside on these drugs -- it's well-known among those who take them that they often cause acne -- sometimes severe acne -- in teens and adults. They may also cause hair loss. These side effects are not listed in the official tally on the packaging. But acne can really mess up a teen's life, so it's something to watch out for.

    Wellbutrin is also prescribed for the treatment of ADD. This drug is usually used as an antidepressant or smoking cessation aid. Other antidepressants may also be prescribed for ADD. However, I personally would be very hesitant to give such a prescription to a kid, because they've been shown to cause mood swings, depression, and suicidal thoughts. They're also more of a commitment -- you have to take them every day -- and have lots of side effects.

    The important thing is for you and your son to sit down with a psychiatrist (a prescribing mental health professional) who can evaluate his needs thoroughly and involve him in the decision-making process. He may feel that there is a stigma attached to taking medication. He may feel that nothing can be done to help him. He's probably sick of everyone trying to fix him. Involving him in the process is the first step to helping him take charge of his condition. You're catching it at an early age, which is great! You may find that his Oppositional Defiant Disorder disappears completely when he starts taking medication. Imagine how you'd feel if you woke up every day with a crushing hangover and then drank six cups of coffee on an empty stomach-- that's what it's like to have ADD. Now imagine that scenario, but you're forced to sit through the most boring meeting ever and then bike to a karate class. Torture!

    I'm not saying you've done anything wrong -- you sound like an amazing parent! -- I just want you to see what it's like from your son's perspective. You'd probably be feeling pretty oppositional too.

    Anyway, I wish you all the best of luck. Just remember that there's no shame in taking medication to treat a real problem. If your son had frequent migraines, you'd get him medication. This is just another brain problem that can be fixed pretty easily with a pill. When you think of it that way, don't you feel pretty lucky?

    Posted by Emily August 12, 11 10:21 AM
  1. Shelby, your comment that "These new practices are now available for home use and in studies it has been found that they can actually cure ADHD symptoms" is not correct and, I think, more than a little irresponsible. There is NO "cure" for ADHD; there are merely different ways of coping and different strategies to mitigate the issues associated with ADHD. Neurofeedback is one possible intervention but it can't just be used at home by any random person, something you ought to know. Further, modulating brain activity through NFT is not much different than modulating brain activity through medication. And frankly, IMHO, as medication has been tested more thoroughly than NFT at this point, it seems to me that someone who is hesitant to medicate would *certainly* be hesitant to resort to the less-thoroughly-vetted NFT.

    Medications for ADHD have this going for them: if you decide you don't like using them, you can simply stop. Any side effects will go away, and your child will return to his or her regular, ADHD-self. There is little harm in trying it. One of my kids, who has ADHD, recently began medication. After 2 years of trying cognitive and behavioral therapies, and getting feedback from his teachers that he was having just as much difficulty as ever in the school setting, we decided to try medication. It made an immediate but subtle difference -- he is still the same boy, but has better impulse control and is a bit less fidgety and disruptive. Too soon to say whether we will keep him on it, but I do feel that these medications get a bad rap lately. As much as we'd all love to just "fix" ADHD with therapy, it doesn't always work. As Emily points out, you'd take medication for a migraine. Taking it for a mental health issue that can't be solved through therapy is not much different.

    Posted by jjlen August 13, 11 12:00 PM
  1. It's true -- CBT doesn't help for ADD. But CBT and DBT (cognitive behavioral therapy and dialectical behavioral therapy) can help with the depression and feelings of inadequacy that come from having ADD. And a good therapist can also help one organize her thoughts and create an organized lifestyle. It's important for people with ADD to have structure and schedules, neat rooms, clean closets, to-do lists, etc. It's very easy for a person with ADD to become overwhelmed by too many variables or tasks at once. So if you find a good therapist, it's probably a good idea to check in with them on a regular basis to keep things on track.

    Posted by emily August 13, 11 08:01 PM
  1. I hope that a competent family therapist can be involved as soon as possible.

    I am not a therapist, but I have been confided in by many men who ALL identified the birth of a sibling when they were 2-3 years old as a massive trauma in their lives. The fathers of these men became disengaged from active parenting almost exactly at the time that the second child was born. In many cases, the fathers openly admitted to making a habit of coming home from work, eating supper, and then returning to work for several hours every weekday evening. Some of the mothers served their men with divorce papers citing this "abandonment" of the second child.

    These children exhibited symptoms that are now generally interpreted as "ADHD" before the time when drugs were commonplace. They also ALL exhibited ODD into adulthood, and NEVER formed strong relationships with other men.

    So I would like to know if the father of this "problem" child disengaged (either physically or emotionally) when the second child was born. You see, the younger children never knew any different, but the oldest child certainly can remember a time when he had two active parents. I consider that the "ADHD" is probably intensive attention-getting activity to compensate for the loss of active one-on-one with the father.

    I have also seen how karate usually adds a positive sense of discipline to children--but I wonder if this specific father has dumped his kid onto karate class as a substitute for parenting. I find it troubling that the MOTHER is attending parenting classes without describing any positive activities that the father of these children is undertaking for the emotional health of his children.

    I believe that a half-hour of one-on-one from the father of this seven-year-old boy EVERY DAY will solve the real issues that are causing this intense hostility towards his mother and siblings--primary competitors for the father's attention at home. It is very clear that the father is doing nothing at all in terms of modelling respect for his wife in front of his chilidren.

    Posted by Irene August 16, 11 01:30 PM
  1. I think that Irene's comment is wrong-headed. She blames the father without any basis -- how does she know whether the letter-writer is a mother or a father? -- and throws out some really wild accusations. How does she know that the father is not "modeling respect for his wife?"

    ADD is not caused by inattentive parents. It is not a purely male disorder. And the symptoms are not limited to general surliness and "acting out." It is a neuropsychiatric condition that runs in families, and the main symptom is an inability to concentrate. The oppositional behavior usually stems from frustration and feelings of inadequacy, as well as the lack of impulse control that is a symptom of ADD.

    Anyone who thinks that ADD can be cured by a half-hour of parent time every night is totally off. The parents of this kid have done everything they can to help him. To turn around and accuse them of neglect and lack of respect is offensive. It also places a huge burden on the kid with ADD.

    Posted by Emily August 22, 11 09:22 AM
 
10 comments so far...
  1. Like Barbara said, If you have tried everything known to you and your doctor is recommending them.... I will agree that it isn't the "easy way out". You are conscious about this decision. For you to even worry about that speaks volumes of your concern. Have a long conversation with your doctors and seek second opinion if you need extra reassurance. I am sorry that I don't have much advise for you other than to say I wish you luck

    Posted by JD August 11, 11 07:03 AM
  1. I also agree that after exhausting all other options, you may have to consider medication. However, he was only diagnosed in June. So it's been maybe 2 months since you've implemented the alternative therapies (vitamins, diet, therapy)? Why not speak to his doctor and set a reasonable date at which point, if you have seen no improvement, you start him on the lowest dose of medication. I'm also not a doctor, but I feel like you have to give non-drug therapies more than 2 months to be able to see even a small change - maybe 6 months is reasonable?

    Posted by Q August 11, 11 09:29 AM
  1. This mother sounds like she is doing everything under the sun! I would definitely agree that the meds are worth a try -- and also perhaps some family therapy and an all-girls vacation for mom. I hope she also gets a chance to read my book, "Buzz: A Year of Paying Attention," as our experiences are quite similar. Hang in there! www.katherineellison.com

    Posted by Katherine Ellison August 11, 11 10:58 AM
  1. There are other options!!!! While medicine can help with ADHD it just covers up the symptoms, there is no cure. You are doing the right thing with your child, by allowing him to talk to someone, that will help him a lot as he get older. I encourage you to look into neurofeedback, also known as biofeedback. These new practices are now available for home use and in studies it has been found that they can actually cure ADHD symptoms. Medicine is only a temporary fix, and you will know when the meds wear off after school! Good job so far, you are doing great even though it may not feel like it sometimes! Remember to try and read and learn as much as you can about ADHD, it will help you connect with your son on a new level, also be sure you embrace the things you son does enjoy doing, activities that help him behave and focus his energy. Good luck and keep going!

    I am a graduate psychology student, studying ADHD.

    Posted by Shelby L August 11, 11 05:00 PM
  1. I agree with Q and although IANAD, I would give the current therapies time to actually begin to work. With a child like this, I don't think that 2 months is enough. But you are doing everything in your power which is incredible. And as a parent of a small child who's going through some really bad times, I know how LONG 2 months can feel, especially without improvements. Hang in there!

    Posted by Phe August 12, 11 08:15 AM
  1. There are several different drugs one can take for ADD. Ritalin and Adderall are probably the most common. Although Ritalin and Adderall are stimulants, they have the opposite effect on people with ADD. A person with ADD will feel relaxed and clear-headed on these drugs. (There's a new stimulant called Vyvanse that's supposed to last longer, but your health insurance probably doesn't cover it yet.)

    Ritalin and Adderall are easy-on, easy-off medications. If he tries these drugs and they work, then great! If he tries them and they don't work, he can just stop. It's not the same as with antidepressants where you build them up slowly and then have to wean off just as slowly. These drugs are fast-acting -- your son will notice a difference within an hour of taking it. You can start with a pill that wears off in a few hours, so if he doesn't like the way it makes him feel the duration will be short. If he does feel better, more focused, and less angry, you can move him onto a long-acting pill. A warning: when one first takes Ritalin, the come-down period when it wears off is pretty gnarly -- you get jittery and anxious and your heart races. These withdrawal symptoms lessen greatly as the body becomes accustomed to the medication. If he takes the extended-release version, it may not occur at all (or it will occur while he's sleeping, so he won't notice -- and yes, as odd as it seems, a person with ADD can pop an amphetamine and then go right to sleep).

    I think most people with ADD start on Ritalin. If the side effects are too unpleasant, or if the drug doesn't work as well as one may like, they next try Adderall. I believe that Ritalin also increases seratonin levels, and may result in a more cheerful demeanor than Adderall.

    Ritalin and Adderal can be taken on an as-needed basis. Some people with ADD take meds every day. Others take them when they're having an especially stressful day, or are assigned a complex task, or on weekdays but not weekends, etc. When you make the decision to take Ritalin or Adderall, you're not signing on for a lifestyle. It's more like taking Tylenol for frequent headaches. If you don't feel a headache coming on, don't take the Tylenol.

    An aside on these drugs -- it's well-known among those who take them that they often cause acne -- sometimes severe acne -- in teens and adults. They may also cause hair loss. These side effects are not listed in the official tally on the packaging. But acne can really mess up a teen's life, so it's something to watch out for.

    Wellbutrin is also prescribed for the treatment of ADD. This drug is usually used as an antidepressant or smoking cessation aid. Other antidepressants may also be prescribed for ADD. However, I personally would be very hesitant to give such a prescription to a kid, because they've been shown to cause mood swings, depression, and suicidal thoughts. They're also more of a commitment -- you have to take them every day -- and have lots of side effects.

    The important thing is for you and your son to sit down with a psychiatrist (a prescribing mental health professional) who can evaluate his needs thoroughly and involve him in the decision-making process. He may feel that there is a stigma attached to taking medication. He may feel that nothing can be done to help him. He's probably sick of everyone trying to fix him. Involving him in the process is the first step to helping him take charge of his condition. You're catching it at an early age, which is great! You may find that his Oppositional Defiant Disorder disappears completely when he starts taking medication. Imagine how you'd feel if you woke up every day with a crushing hangover and then drank six cups of coffee on an empty stomach-- that's what it's like to have ADD. Now imagine that scenario, but you're forced to sit through the most boring meeting ever and then bike to a karate class. Torture!

    I'm not saying you've done anything wrong -- you sound like an amazing parent! -- I just want you to see what it's like from your son's perspective. You'd probably be feeling pretty oppositional too.

    Anyway, I wish you all the best of luck. Just remember that there's no shame in taking medication to treat a real problem. If your son had frequent migraines, you'd get him medication. This is just another brain problem that can be fixed pretty easily with a pill. When you think of it that way, don't you feel pretty lucky?

    Posted by Emily August 12, 11 10:21 AM
  1. Shelby, your comment that "These new practices are now available for home use and in studies it has been found that they can actually cure ADHD symptoms" is not correct and, I think, more than a little irresponsible. There is NO "cure" for ADHD; there are merely different ways of coping and different strategies to mitigate the issues associated with ADHD. Neurofeedback is one possible intervention but it can't just be used at home by any random person, something you ought to know. Further, modulating brain activity through NFT is not much different than modulating brain activity through medication. And frankly, IMHO, as medication has been tested more thoroughly than NFT at this point, it seems to me that someone who is hesitant to medicate would *certainly* be hesitant to resort to the less-thoroughly-vetted NFT.

    Medications for ADHD have this going for them: if you decide you don't like using them, you can simply stop. Any side effects will go away, and your child will return to his or her regular, ADHD-self. There is little harm in trying it. One of my kids, who has ADHD, recently began medication. After 2 years of trying cognitive and behavioral therapies, and getting feedback from his teachers that he was having just as much difficulty as ever in the school setting, we decided to try medication. It made an immediate but subtle difference -- he is still the same boy, but has better impulse control and is a bit less fidgety and disruptive. Too soon to say whether we will keep him on it, but I do feel that these medications get a bad rap lately. As much as we'd all love to just "fix" ADHD with therapy, it doesn't always work. As Emily points out, you'd take medication for a migraine. Taking it for a mental health issue that can't be solved through therapy is not much different.

    Posted by jjlen August 13, 11 12:00 PM
  1. It's true -- CBT doesn't help for ADD. But CBT and DBT (cognitive behavioral therapy and dialectical behavioral therapy) can help with the depression and feelings of inadequacy that come from having ADD. And a good therapist can also help one organize her thoughts and create an organized lifestyle. It's important for people with ADD to have structure and schedules, neat rooms, clean closets, to-do lists, etc. It's very easy for a person with ADD to become overwhelmed by too many variables or tasks at once. So if you find a good therapist, it's probably a good idea to check in with them on a regular basis to keep things on track.

    Posted by emily August 13, 11 08:01 PM
  1. I hope that a competent family therapist can be involved as soon as possible.

    I am not a therapist, but I have been confided in by many men who ALL identified the birth of a sibling when they were 2-3 years old as a massive trauma in their lives. The fathers of these men became disengaged from active parenting almost exactly at the time that the second child was born. In many cases, the fathers openly admitted to making a habit of coming home from work, eating supper, and then returning to work for several hours every weekday evening. Some of the mothers served their men with divorce papers citing this "abandonment" of the second child.

    These children exhibited symptoms that are now generally interpreted as "ADHD" before the time when drugs were commonplace. They also ALL exhibited ODD into adulthood, and NEVER formed strong relationships with other men.

    So I would like to know if the father of this "problem" child disengaged (either physically or emotionally) when the second child was born. You see, the younger children never knew any different, but the oldest child certainly can remember a time when he had two active parents. I consider that the "ADHD" is probably intensive attention-getting activity to compensate for the loss of active one-on-one with the father.

    I have also seen how karate usually adds a positive sense of discipline to children--but I wonder if this specific father has dumped his kid onto karate class as a substitute for parenting. I find it troubling that the MOTHER is attending parenting classes without describing any positive activities that the father of these children is undertaking for the emotional health of his children.

    I believe that a half-hour of one-on-one from the father of this seven-year-old boy EVERY DAY will solve the real issues that are causing this intense hostility towards his mother and siblings--primary competitors for the father's attention at home. It is very clear that the father is doing nothing at all in terms of modelling respect for his wife in front of his chilidren.

    Posted by Irene August 16, 11 01:30 PM
  1. I think that Irene's comment is wrong-headed. She blames the father without any basis -- how does she know whether the letter-writer is a mother or a father? -- and throws out some really wild accusations. How does she know that the father is not "modeling respect for his wife?"

    ADD is not caused by inattentive parents. It is not a purely male disorder. And the symptoms are not limited to general surliness and "acting out." It is a neuropsychiatric condition that runs in families, and the main symptom is an inability to concentrate. The oppositional behavior usually stems from frustration and feelings of inadequacy, as well as the lack of impulse control that is a symptom of ADD.

    Anyone who thinks that ADD can be cured by a half-hour of parent time every night is totally off. The parents of this kid have done everything they can to help him. To turn around and accuse them of neglect and lack of respect is offensive. It also places a huge burden on the kid with ADD.

    Posted by Emily August 22, 11 09:22 AM
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About the author

Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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