The Decision to Medicate

The Choice to Medicate for ADHD: A Clinician’s Guide to Navigating Parental Concerns

“Should I medicate my child for ADHD?” Clinicians commonly field this question –– and many more –– after making a positive ADHD diagnosis. To best help and support concerned families, clinicians should study these responses to common questions and attitudes about ADHD medication.

An ADHD clinician talking to a family about the pros and cons of ADHD medication

The issue of medication for children with attention deficit hyperactivity disorder (ADHD) — more than with any other condition that I treat — is controversial and murky. For parents, the question of adding medication to their child’s treatment plan is one that weighs heavily. They research the pros and cons of ADHD medication, but their findings are colored by feelings of guilt and fear of judgement from others. It is not a black-and-white decision for most caregivers.

The benefits and side effects of ADHD medications, whether stimulants or nonstimulants, are well documented. While it’s important to educate parents on how medications work and why they might be used, it’s equally critical for clinicians to support parents by being mindful of the concerns that are often present, though not always overtly stated, as they navigate the decision-making process.

“Should I Medicate My Child for ADHD?” Common Medication Concerns

ADHD Medication Concern: Will My Child Become a Zombie?

The most common fear I hear from parents is that ADHD medication will change their child’s personality. They may desire interventions to address some challenging aspects of their child’s behavior, but they are afraid medication will turn their son or daughter into a “zombie.”

Clinicians should assure parents that any medication that appears to mute the child’s positive aspects and core personality is indicative of an unsuccessful medical trial. Another medication should be tried.

At the same time, parents should know that not all personality changes sparked by medication are negative. If a child known for his sense of humor seems “less funny” on medication, it could be that the medication is properly inhibiting them. In other words, it’s not that the child is less funny; it’s that they’re more appropriately funny at the right times.

[Essential Reading: Parent’s Complete Guide to ADHD Medications]

ADHD Medication Concern: Will My Child Will Become Dependent?

Finding ADHD medication useful and helpful is not the same thing as developing an addict-like dependency on it. Clinicians should remind parents of this difference.

If a child finds medication useful, they’re dependent on it in the same way that a person with a broken leg depends on crutches or a wheelchair ramp. A medication is useful if it helps a child execute what they need to do — not if they achieve a high off of it.

Here’s another helpful analogy: Sleep is incredibly important and healthy because that’s what keeps us functioning. If we did not sleep, we would notice the difference, and we would crave sleep it — but that doesn’t mean we’re addicted to it. It’s that our brain and our body need it. That’s what medication aims to do — by buffering the parts of an individual’s neurology that aren’t working in ways that are ultimately helpful.

It’s also important to tell parents who are concerned about addiction that medication does something very different to an ADHD brain than it does to a non-ADHD brain.

[Read: ADHD Medication Side Effects No One Should Tolerate]

ADHD Medication Concern: Aren’t Natural Treatments Better?

It’s helpful for clinicians to frame medication to parents as something that, while unnatural, is not harmful. Prescription lenses — technological medical advancements — are unnatural but extremely necessary and beneficial for so many. At the same time, not everything natural is good. Take cannabis, a natural substance that has high potential for abuse.

Also, remember that how we view medicine is influenced by our cultural attitudes, socioeconomic status, race, and more. Clinicians should consider attitudes about medication stemming from cultural differences and pervasive ethnic and racial disparities. For some, medication is seen as a “quick” fix that Americans are keen on implementing.

Communities of color, according to research, often deal with mixed messaging about medication. Medication is generally less accessible to this group. At the same time, medication is sometimes the first strategy proposed before fully considering any others. Sometimes, for example, parents feel forced by less-than-supportive school systems to place their children on medication when there’s a chance that the school hasn’t provided adequate or appropriate resources to support the child.

ADHD Medication Concern: Does This Mean I’m a Bad or Lazy Parent?

ADHD is not caused by poor parenting. Likewise, giving your child ADHD medication is not an indicator of parental failure. In fact, it’s the opposite. Clinicians should remind parents during the process that their intentions are to help the child and to give them the best chance for success by helping them realize all of their strengths.

Sometimes, parents feel a sense of guilt or selfishness about medication. They wonder if they’re putting their child on medication to make their own lives easier. But parents should use their own feelings and responses to challenges as data, and refrain from judging themselves. Inform parents that if they are losing patience with the child, whom they love unconditionally, imagine how classmates, coworkers, and others may see and interact with the child. Ultimately, parents must know that ADHD medication will absolutely make a difference in parenting, but it’s because it’s also making their child more successful at better managing himself or herself.

ADHD Medication Concern: Why Now After All These Years?

Some parents question the benefits of putting their child on medication at a given time, especially when they’ve done OK without it for years.

Medication might not be necessary in early childhood if the right internal resources and supports are available to the patient at the time. As the child moves on to middle and high school, though, executive function demands exponentially increase. Clinicians should drive home the point to parents that expectations in second grade are significantly different than tenth grade expectations — not only in terms of materials, but also in terms of independence and self-management.

Parents must understand that, though it is a lifelong condition, ADHD will show itself in different aspects of life and in different ways over time. What wasn’t a challenge when the child was younger may be one later on, and vice versa.

ADHD Medication Concern: Treatment is Too Much Work

ADHD medication is a large commitment and investment. Apart from refilling tightly controlled prescriptions for stimulant medication, a parent must bring their child for many medical appointments and endure several medication trials even before finding the right drug and dosage.

Clinicians should prepare parents and patients for the possibility that the first medication won’t work — an outcome more common than not.

If parents are particularly struggling with investing resources, remind them that one long month of appointments and trials can yield a solution that ends up working for years, or a lifetime.

Putting it All Together: Helping Parents Weigh the Decision

Though we hear all of the above concerns frequently, parents also worry that choosing not to medicate means their child will do poorly in school, fail to regulate emotions and impulsivity, grow to resent them, or face judgement from others.

Parents should understand that an ADHD diagnosis for a child does not always necessitate treatment with medication. In weighing the decision to medicate, parents should consider the purpose of the medication — Is it to bolster the child’s executive function skills? To manage impulsivity? To aid emotional regulation? Do they have a complicating comorbid condition? If a parent does decide to put their child on medication, even for a trial run, stress that you can’t measure progress without clearly detailed target outcomes.

If parents decide not to medicate right away, they should likewise establish a threshold that will indicate when it’s time to consider adding medication to non-medication therapies. There is no common threshold; those indicators depend on the child and parents. Parents should also know that medication isn’t a “last resort” option.

Clinicians should assess and manage prevailing attitudes on medication. Do the parents trust the medical community and mental providers? Does the family view these providers as mere pill-pushers? Or as people who truly want to help the child? Exploring existing attitudes and expectations as early as possible can help clinicians deliver their treatment recommendations effectively.

Medication or not, clinicians should remind parents of the myriad available ADHD treatments and interventions, which includes behavioral therapy, executive function coaches, support at school and home, and maintaining healthy habits.

[Read This Next: The Top 10 Questions About ADHD Medication for Children — Answered!]

 

The content for this article is based on Roberto Olivardia’s ADDitude webinar, “Medicating Your Child with ADHD: How to Manage the Feelings of Guilt and Judgment, and Make Peace with Your Decision,” which broadcasted live on April 15, 2020.

Updated on May 21, 2020

1 Related Link

  1. I have to strongly disagree with the 1st problem of the “Zombie” effect is a medication trial failure and another medication should be tried. I am board certified in both Neurodevelopmental Pediatrics and Developmental/Behavioral Pediatrics. The stimulants should not be used to manage hyperactivity. They are used to improve attention. The hyperactivity control is a frequent benefit, but not the target. Unfortunately dose increases are frequently related to teacher reports with the ‘focus’ being the child’s hyperkinesis. There is a very narrow therapeutic window between dosing to manage hyperactivity and ‘overdosing’ to a ‘HYPERFOCUS’ effect. The “Zombie” effect should first be considered to be a dose which is too high, not a medication trial failure. A reduction of the dose is the next step. Monitoring attention and hyperactivity with a standardized instrument like a Vanderbilt from home and teacher (and also other outside activity like sports, scouts, church) is very important.

Leave a Reply