Ask the Experts

How to Talk to Your Child About ADHD Medicine

If your child is refusing to take his ADHD medication, he could be scared or confused. Here, tips for talking to your child so he’ll cooperate and understand how important the medicine is.

ADHD medication in jar with child's lego toy
ADHD medication in jar with child's lego toy

Janice knows that after her son, Billy, takes his medication for treating attention deficit disorder (ADHD), he can sit and focus in class. But last spring his teachers began to complain that he wasn’t getting his work done and that he was bothering his classmates.

She wondered if his medication had stopped working, or if he needed a higher dose to treat his ADHD.

One day as she cleaned out his drawers, she found his pills. When she confronted him, he snapped, “There’s nothing wrong with me. I don’t need pills to be good.”

Some kids are even more clever. Mary learned to “check” her pills — hiding them between cheek and gum — then to leave the room and flush them down the toilet. There was no evidence that she didn’t take her medication.

Another child decided not to go to his school nurse’s office to get his medication. The nurse reported to his parents that it’s not her responsibility to find him: “He knows he needs to come.” Then the complaints from the afternoon teachers made sense.

What do you do when your child refuses to take his ADHD medication? What if each medication time is a battle, or you find out your child has only been pretending to take his meds? There are no easy answers, but here are some suggestions.

Make it mean something

Children (and adults, too) are more cooperative when they understand the reasons for something. So it’s important to educate your child about why she needs medication, and to let her take an active role in managing it. When your child is prescribed medication, explain why it’s necessary and how it will help her. Tailor your message to your child’s age. Saying “It’s just a vitamin pill” will backfire when she learns the truth. Trust and respect are necessary.

In my books for parents, I suggest how you might explain medication to your child. Use key words that kids can understand, and convey that your child’s brain isn’t damaged, defective, or retarded. I like to say that it’s just wired differently. Here are some sample explanations:

FOR HYPERACTIVITY: “You know that sometimes it’s hard for you to sit still. You might be up and down or fidget in your seat or like to tap things on the table? This is because the brakes in your brain, which slow you down, aren’t working as well as they could. The medicine will help the brakes work more effectively, and help you calm down and move around less.”

FOR DISTRACTIBILITY: “The brain is wonderful. It has filters that can block out unimportant sounds or sights, allowing us to focus on one thing at a time. But sometimes the filters are not working efficiently. The unimportant sounds aren’t blocked, and you become easily distracted. Your medicine helps these filters work more effectively, so you can focus longer and be less distracted.”

FOR IMPULSIVITY: “Our brain is able to reflect on our thoughts before deciding to act on them. This delay helps us decide what to do at any given time. If this reflector isn’t working properly, we don’t stop to think before we act. This is why you might call out or interrupt. (Or why you do things without thinking and feel bad about it.) The medicine will help your reflector work more effectively, so you can think before you talk or act.”

ASK FOR INPUT: “Mary, I need your help. Do you think the medicine is helping your brakes work better? How about your filters? Maybe we need to speak to the doctor about adjusting the amount you take.”

The more your child understands the purpose of medication and how it works, the more likely she is to cooperate. If there are side effects, she will be less upset if you explain them, and assure her that you’ll talk to her doctor about it.

Offer some control

Being actively involved in the decision-making increases a child’s cooperation. So let your child have a role in assessing the effects of his medication. For example, set up a chart for each day of the week, divided into time periods (before school, after lunch, after school). Across the top write brakes, filters, and reflectors. At the end of the day, have your child tell you how his medicine worked during the day. Mark his findings in the chart, and you can see when it’s working and when it isn’t. Your team effort can help determine his medication dose and timing.

Sometimes a child is afraid to swallow pills or doesn’t know how. If he tries to chew (a natural instinct), the taste of the medication can be a turn-off. Rather than assume your child knows how to take pills, teach him. Offer a pill-size piece of candy (he’ll feel safe with this), and explain that there are no taste buds on the top of the tongue, only along the sides. Help him put the candy on the top of the tongue, away from the tip. Explain that a whole pill doesn’t taste bad. Then have him wash down the “pill” with some water. Most children can learn to swallow pills with a little practice. If this doesn’t work, ask your doctor to prescribe an eight-hour capsule (such as Ritalin LA or Adderall XL), which can be opened and sprinkled over food.

Tread lightly with preteens

Most children will learn to take their medicine. They’ll understand that it helps and will cooperate. But problems can arise during the early-adolescent stage. Middle-school kids don’t want to be different. It’s essential that they be accepted as “normal.” Suddenly, at this age, a once-cooperative child will rebel and resist his medication. Pill time becomes a battle, and parents usually lose.

I counsel parents to try again with education. Maybe the family doctor can help. Explain again — but don’t lecture — about brakes, filters, and reflectors. Say that if these areas of the brain are working well, he is more likely to be seen as normal rather than different. Respect an adolescent’s fear that someone might find out about his ADHD. All-day coverage might help. Ask your child’s teacher to refrain from saying publicly, “James, did you take your pill today?” Find some way to elicit understanding and help.

Sometimes family dynamics contribute to medication refusal. A sibling may tease the child who takes medication, calling him a “retard” or “mental.” If this happens, you first handle the sibling. Perhaps one parent doesn’t agree that “my child” should be on medication. He or she might verbally agree to it, while sending a clear, nonverbal message of disapproval. The child sees this and resists taking the medication. If this sounds like your family, consider family counseling. Talking to a therapist — or at least talking with your family doctor — may be in order, if the consequences are significant and if all your other efforts have failed.

Even the best plans flop with middle-school students. Sometimes I advise parents merely to try to minimize the damage caused by being off medication. It may not be until their child is older and more comfortable with himself that he again agrees to take it.

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