Reply To: To Medicate or Not Medicate?

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I’m a pediatrician. I have ADHD and use pharmacological treatment. I was diagnosed while in medical school, but in retrospect, had symptoms way before.

Here is my approach when it comes to children & teenagers.

1) Are the ADHD/ADD symptoms causing a dysfunction? At school, and/or in home life?

By dysfunction I mean impairment. People think dysfunction = handicap. So if the child does well at school, but you can’t go out in public with the child out of fear he will slip away from you and get lost, there is a dysfunction, period.

The standard tests (such as the Vanderbilt surveys) essentially measure what I call dysfunction. If he is doing well at school, gets along with teachers and peers, is not an overly anxious child – he likely doesn’t need medications.

2) Let’s flip your question. How does the child/teenager feel about his life? These forums are mostly based on parent’s responses.

The mother may think the child is OK, but when I ask the patient… the answers change. I ask the siblings too and obtain great responses!

If these symptoms start earlier in life, I rather treat so the child can actually focus on learning some of these coping mechanisms and strategies. Teenagers that were previously well often feel overwhelmed when challenged with new skills (such as oral reports, more homework, etc) and that’s when a cycle of anxiety forms.

Awareness, organization, repetition, and structure DOES help. As an adult, it is what gets me through the day!

Some children, teenagers and even adults can cope quite well with the symptoms but ONLY when they’re AWARE of ADHD. Cope = deal with difficulties. ADHD is like jogging with a group, only you have a heavy backpack! Medication takes the load off initially and helps with the brunt of symptoms. But trust me, these symptoms won’t go away. Awareness, organization, repetition, and structure are needed to cope.

Phrasing this as a child with “mild ADHD symptoms” is a misnomer, because what I look for is dysfunction. Everyone can be anxious, fidgety and forgetful, especially when stressed. That’s not ADHD. These symptoms have to persist AND cause a dysfunction in more than one setting. If you have people convincing you that your child doesn’t need ADHD medication – he likely needs it.

Lastly, let a trained clinician (pediatrician, psychologist, psychiatrist) ask questions to the child directly, and you’ll be surprised at the responses.