The topic of medication and ADHD is controversial and emotional. It seems like everyone has an opinion. But what are the facts?
Myth: Medication will make everything normal.
Fact: Medication usually does not make all the symptoms completely go away all the time. Most medications are effective in about 70% of patients, which means that its not unusual to have to try more than 2 medications before finding one that works.
Also, almost all medications wear off at some point during the day, usually after school and before bedtime. The only major exceptions are Strattera and Intuniv, which usually do not wear off. If your child’s major struggles are before and after school, you will likely still have struggles on medication.
If you begin medicating after the patient has developed significant social symptoms, medication may treat the ADHD but not the consequences of the behaviors. For example, if your child has gotten a grade level behind due to inattention, the medication may successfully treat the inattention, but your child may still need to work extra hard to catch up on the academic skills he hasn’t learned yet. Adults who have ADHD often benefit from coaching or talk therapy to unlearn unproductive coping habits, even after they are medicated.
Myth: If I medicate my child, they won’t learn how to cope with their symptoms in other ways.
Fact: Medication is an aid to get your child through the hardest part of the day (usually school) until they develop coping skills in environments where failure to pay attention or keep still doesn’t carry such significant consequences. Whether they learn those coping skills is probably more a function of how much you teach them at home on how to deal with homework, chores, friendships, and other issues.
Myth: Medication just makes kids zombies.
Fact: Most people who take medication for ADHD do not feel like zombies, or even unlike themselves. They just feel a little more able to stop, listen, and consider consequences. Some medications can make a person feel sleepy. However, these medications are effective even if the person taking them does not feel sedated. If your child is like a zombie on medication, the dose or the type of medication needs to be adjusted.
Myth: A regular pediatrician or family doctor is not qualified to manage ADHD medications.
Fact: This is highly dependent on the community you are located in, the individual doctor’s expertise, and the complexity of the case. You should always start with your primary care doctor to get a diagnosis. This is because other health problems, such as hearing and vision problems, need to be ruled out. Some primary doctors feel very comfortable with ADHD medication management, and some do not. Your first step is to ask how comfortable they feel. Your second step is to ask how comfortable you feel. Does your primary doctor take the time to listen to your concerns, answer your questions, and explain his answers? Will she answer your phone call questions promptly? Are there other problems that might make the patient’s ADHD management complicated, such as other medications or other neurological or psychiatric conditions? Have you already been through several medications without success? How long will you have to wait for a specialist appointment (in some communities it can be as long as 6 months)?
Myth: Some medications are only for inattentive/hyperactive ADHD.
Fact: At the present time, all medications approved by the FDA for ADHD are for use with both inattentive and hyperactive ADHD. Clinical studies typically do not differentiate between the subtypes or include both subtypes. Non-stimulants, while particularly useful for hyperactive ADHD or ADHD combined with ODD, can also be used for inattentive ADHD.
In the future, therapies may be targeted for one or more subtypes. For example, metadoxine, an experimental therapy for ADHD, has shown to only be effective in adults with the inattentive subtype.
The author is a family doctor comfortable managing ADHD medications. She has written extensively about ADHD and is also the parent of a child with ADHD.
Reference:
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics128.5 (2011): 1007-022. Print.
