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"Will my child need to take ADHD medication for the rest of his life?"
I recently diagnosed eight-year-old Aidan with ADHD. When I met with his parents to explain the disorder, each time I described a symptom, his mother exclaimed, “That’s me!” or “I’ve been like that all my life, too.” At the end of the appointment, she asked me if she should be evaluated, as well.
As an adult, Aidan’s mother had jumped from job to job, and had difficulty meeting household demands. As a child, she had struggled through school, often getting into trouble and getting poor grades. After a thorough evaluation of her chronic and pervasive history of hyperactivity and distractibility, she was diagnosed by a psychiatrist who works with adults.
Aidan and his mother both started on medication. Aidan’s grades and behavior improved. His mom reported being more relaxed and efficient at work and at home. On a follow-up visit, she remarked, “If only I had been on medication as a child. I could have finished college, I could....” Then she paused: “Oh, my gosh, does this mean that Aidan will take medication for the rest of his life?”
Good question. The best answer I could give was, “Possibly.” Why can’t I be more specific? Didn’t she deserve a clearer answer?
Until the early 1990s, the medical community considered ADHD a “childhood disorder.” Believing that children “outgrew” the condition, physicians routinely took them off medication before high school. In many cases, however, the teens struggled socially and academically, making it clear that ADHD symptoms had not gone away. And, as greater efforts were made to educate parents about ADHD, more and more of them, like Aidan’s mother, began to recognize their own ADHD symptoms.
Clinically, we have seen that some individuals do show enough improvement after puberty that they no longer need medication. But the American Academy of Family Physicians reports that two-thirds of children with ADHD continue to grapple with the condition throughout adulthood.
How do I determine whether a particular child still needs medication? I advise taking children and adolescents off medication once a year. If the symptoms of hyperactivity, inattention, and/or impulsivity are no longer noticeable, they stay off. Should these behaviors return, medication should be restarted. This process teaches adolescents about the challenges ADHD presents in their lives, and how to determine themselves whether medication is needed in school, at home, with friends, and so on. Medication should be used whenever symptoms interfere with the demands and expectations of a specific task or activity. It is not necessarily needed all day, every day.
For example, a college student may learn that she benefits from an eight-hour capsule to cover morning and afternoon classes, but can be off medication while she relaxes, exercises, or socializes later in the day. On evenings when she needs to study, she can take a four-hour tablet at about 6 p.m. An adult may find that he needs medication at work but not at home, or for some social functions, but not others.
Will your child need medication for the rest of his life? Possibly. You can find out one year at a time. And, if medication is needed, you can teach him to use it for specific times and situations. In the future, I hope that fewer adults will tell me, “If only I had been on medication as a child....”
Larry Silver, M.D., is clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C. and director of training in child and adolescent psychiatry at Georgetown University School of Medicine. He is a former acting director and deputy director of the National Institute of Mental Health, as well as the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities.