To Medicate, or Not to Medicate?
That is the question!
Russel Barkley, a leading PHD in ADHD research says that ADHD is one of the most easily medicated psychological disorders today. So that sounds quite promising as far as disorders go!
There is even research (minimal) supporting medication interventions in children as early as 3 years old! But as a parent, if you’re like me perhaps you are weary of introducing medication to your child too early, especially if it is something they may be on for the rest of their lives. There is much to unpack; the stigma of having a child on medication, the side effects and the personal reflection of you as a bad parent without any control over your child. (Considering that ADHD is still widely misunderstood as a behaviour problem!)
Personally I’ll share some of my journey that is still continuing with medication. As a teenager I was undiagnosed and though many of male friends had ADHD, as well as my brother, it was not something I was aware of for myself. Some of them took Ritalin, amongst other self prescribed drugs like pot, coke, MDMA, ecstasy, mushrooms, alcohol, cigarettes to name a few. Evidently I was one of those kids running wild with the wolves. My theme song at 13 was Madonna’s Where’s the party? By 14 I had tried every drug that was available to me. As a self proclaimed hippy, I gravitated more towards the mood altering effects of acid, mushrooms, marijuana, alcohol and cigarettes as my drugs of choice and from about 13-21 I was almost a daily user of weed and tobacco.
The truth is kids with ADHD are at an increased risk of substance abuse. It ranges between 5-40% depending on early interventions and recognition of ADHD symptoms. They are 4-5 times more likely to escalate to habitual use after trying marijuana or cigarettes once. The desire for novelty and individual identity away from the family, combined with impulsivity and risky behaviours, it is likely your child, especially your ADHD child, will try some kind of substance in their adolescents.
My younger brother, who was the 90’s ADHD poster boy; never sat still, had huge emotional outbursts that highjacked his classroom and our family, learning challenges, violent outbursts and impulse control issues, was not medicated. My parents opted for a smaller classroom environment and specialized learning supports for him. I often wonder if they had medicated him as well if those supports would have been more effective and even possibly prevented him from drug and alcohol addiction that nearly cost him his life in his early 20’s? (Thankfully he is 8 years sober now.) If only I could go back in time and tell us both, STOP, your brain is already smaller than neuro typicals. It’s not worth it! We had the videos in health class (if you were a child of the 90’s you might remember-“Drugs drug drugs, which are good? Which are bad? Drugs drugs drug, ask your mom or ask your dad!) The knowledge was there but the peer pressure, and the experience of weed was far too intoxicating for me. It calmed me, expanded my sense of my creative universe and also helped me to feel more connected with my peers. It gave me an excuse to not feel as shitty about the areas of my life where I felt out of control.
Then around 21, after dropping out of university and trusting my heart to pursue my studies in holistic medicine, I became a total straight edge. I wouldn’t even take an Advil. I swung my pot pendulum all the way to- this is poison! I upped my yoga and meditation practices and connected more deeply to spiritual communities feeling a sense of belonging and purpose that I hadn’t felt before. This filled me, inspired me and supported my growth immensely, giving me a positive hyper focus and some invaluable tools to manage my undiagnosed ADHD symptoms. Like many women, I discovered I had ADHD after my daughter was diagnosed.
When I found out my daughter had ADHD I was determined that she would NOT be medicated. It felt like a crutch or an excuse. I also worried how much do we really know about long term effects on the young brain? But the more I researched and heard other peoples stories I realized that as ADHD is an issue with brain chemistry, there are effective supports that work directly with the brain. There is a neurobiological difference in ADHD brains, just like epilepsy or migraines or bi polar disorder disorder you wouldn’t tell those afflicted to suck it up and work harder or stop eating sugar and they’ll be fine. Medications are available for a reason, because they can be very successful specifically in the school years when most of our day the brain is needed for executive functioning skills and conforming to an outdated system of control….but that’s another article! As they say, pills don’t teach skills. Medication should be used alongside family support, education, therapy, and other management tools.
Stimulant medication works by increasing the levels of two brain transmitters- dopamine and norepinephrine, which are very low in ADHD brains. They can be fast acting and start working within the hour of taking and can wear off between 6-10hrs depending on the dose, which can mean 1 pill at the start of the day; or shorter acting meaning you need a few pills in the day. They work directly on the systems the brain (pre frontal cortex and frontal lobes) dealing with executive functioning skills. After stimulant medications parents and teachers have reported handwriting and organizational skills have improved, working memory increased, heightened ability to focus and follow through on instructions, stay on task, complete homework and fewer impulsive and disruptive outbursts.
Let’s be clear medication is not a cure all and they can come with side effects which could include headaches, decreased appetite, stomach aches, trouble sleeping and increased irritability. There is also some research being done now on long term effects of stimulant medication on height and weight of children and in very rare cases can have fatal risks to the heart.
Non stimulant mediations are also an option, specifically for those children who are more hyper-aroused, have anxiety, or responded poorly to stimulant medication. These medications also take more time to see results in children, like 4-6 weeks of consistent use.
Weighing the short term side effects of medication with the long term risks: 30% more likely to have substance abuse issues, high risk of dropping out of high school or college, poor self-esteem and greater risk of accidents- all of these possibilities of course not fact- it isn’t a no brainer! There is also not as much research done that involve girls and medication which can be more complex due to hormone fluctuations. Though one study in 2000 (Safer & Malver) shows marked improvement in girls with more inattentive ADHD symptoms.
As I was opening my mind to the fact that perhaps my daughter might benefit from medication, if it meant she could more easily be in school, retain information, focus and follow through on instructions. She has learning challenges as well and in grade 2 is somewhat oblivious to being so far behind the others but it’s only a matter of time before she starts looking around and possibly wondering, “what’s wrong with me? Why don’t I get it? Why I am I always last to finish and need so much help from the teacher?” These issues of confidence and competence are sure to eat away at a child and for me seemed like more destructive issues long term.
So being the inquisitive scientist I am I decided to try medication myself and see if it made any difference in how I felt. This was a huge leap for me to move past the stigma of taking medication when I saw myself to be someone who was natural and wholistic. Finally, I spoke with my doctor and she prescribed me Adderall.
I held the first pill in my hand taking deep breathes asking to align to the medicine for my highest and greatest good. Excitedly, I felt like I might be Bradly Cooper in Limitless ready to write a best-seller, reach Nirvana or discover the cure for cancer. I poped my pill and started on a huge pile of to do’s. After an hour and a half I felt a bit sweaty, my mouth was dry but I had managed to complete 2 projects from start to finish without distraction! I felt like my mind was slightly more tethered, able to engage and if starting to meander was more easily pull back on task but it was very very subtle. My meditation that day was also seemingly more contained. After a few days I started to feel some stomach stuff and little moments of irritation and clutch in my jaw. I didn’t feel like the subtle positive effects were strong enough to outweigh constant dry mouth and tummy pain. So I will talk to my doctor to try another medication and see if there might be more substantial effects. There is usually a process that occurs to find the right medication, again, not a one pill suits all type of deal so consider that in your journey if you are looking to medicate your child. Having an available and knowledgable doctor, paediatrician or psychiatrist, especially if there are any other underlying issues you are dealing with.
Ultimately as parents we want the best lives for our kids and our family as a whole. If your child has severe ADHD symptoms that are massively impacting their lives and your life as a family then medication might be the answer that you’ve been waiting for. Let yourself be open to the abundant possibilities that are out there.
Sources
Safer, D.J, & Malever, M. (2000) Stimulant treatment in Maryland public Schools. Pediatrics, 106, 533-539.
Nadeau, K (2019) Understanding girls with ADHD: How they feel and why they do what they do.
Kutscher. M.L, (2008) ADHD Living without breaks.
Further Reading
https://chadd.org/continuing-education/medication-management-in-adhd/