The Decision to Treat ADHD

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Many people have strong opinions about whether the disorder really exists.

Parents report to me still being told, by family and so-called friends, that it’s “their fault,” and that all these children need is discipline, sometimes defined as “a swift kick in the rear.”  This may be the case in some children, but the truth is that ADHD does exist and often requires a multipronged approach to treatment. As a parent, it is important to know that you should know that the diagnosis of ADHD should only be made by more than just one doctor’s visit or just one report/phone call from their teacher. The American Academy of Pediatrics has a set of guidelines available for the diagnosis, evaluation, and treatment of ADHD that your child’s physician should refer to.  According to the CDC, 6.4 million children ages 4–17 have been diagnosed with ADHD in the U.S., which is an increase from 7.8 percent in 2003 to 11 percent in 2011.

If you are the parent of a child with ADHD, you have probably faced the dilemma of whether or not your child should take medicine. Perhaps the recommendation comes from the teacher, or after hearing that your friend’s child has benefited from medicine. You are left to wonder whether your child would also benefit. Perplexed, you are unsure how to decide. In my opinion, the decision to treat has to be a mutual agreement between you as a parent and the physician and should include more than just medicine.

Physicians normally use a risk/benefit ratio to decide on the course of any treatment. If the benefits outweigh the risks, you proceed with that treatment, and if the risks outweigh the benefits, you don’t. However, the formula can get more complicated. In weighing the risks and benefits of medicine, or any treatment for that matter, one weighs them against the risks and benefits of all other treatments. Whether the alternative treatment you consider is cognitive behavior therapy or biofeedback or removing sugar from your child’s diet, each costs time, money, and effort, and each should have a measurable benefit.

To complicate this one more, all these treatments must be weighed against the risks and benefits of not treating. That is, choosing to do nothing.

Deciding not to treat is also a treatment decision and also has consequences.

As more information is gleaned from research, doctors have a better idea, although not always a clear one, of the outcomes of ADHD.

Parents need to also challenge themselves. What am I trying to accomplish? How will my child benefit from taking medicine? ADHD has many faces that are each associated with risks. Some can be lessened by medicine and others cannot. For example, children with ADHD visit the hospital emergency room more frequently than their peers. If medicine decreases the likelihood that a child will grab the hot frying pan that’s sitting on the stove, then his parents would most likely jump to use medicine, because they value that outcome highly. Children with ADHD also have more difficulty with schoolwork, with chronic academic failure being associated with demoralization and perhaps depression. If medicine will help improve grades and prevent this progression, parents might choose to use medicine because of that high value. Parents are perhaps in a tougher situation when considering using medicine to treat a child who is doing fairly well in school, but is not reaching his or her potential. Every parent wants their child to do well, but each has their own judgment of what is good enough.

So, I will leave you with five things to consider when deciding whether to use medicine:

  1. Start with a good evaluation by a trusted professional.

    Many other difficulties can imitate ADHD, including learning disabilities, anxiety disorders, or transient reactions to the stresses of life. Before concluding that your child requires treatment with medicine, let a trained professional make the correct diagnosis.

  2. Consider how your child might benefit from medicine.

    Does the problem you want to treat merit treatment with medicine, or will other treatments, such as behavioral interventions, suffice? Will it help the child academically? Will your child benefit socially? Will the medicine decrease the risk for danger? Will the benefit be immediate or long-term?

  3. Get accurate information regarding side effects.

    The Internet is full of information, some accurate and some not. Your healthcare professional should be able to give you a list of side effects. The “zombie” side effect concern most parents have is easily avoided with appropriate dosing of medication and a good line of communication with the treating physician.

  4. Don’t feel rushed to make a decision.

    Treating ADHD is not a medical emergency. You have time to do your research and make your decision.

  5. Know that your decision is not permanent.

    You can change your decision at any time. If your child does not benefit from a trial of medicine, you may stop the medication. If your child experiences intolerable side effects, you may stop the medication.

Few decisions challenge the parent of a child with ADHD like the decision to medicate. Calmly evaluating the risks and benefits of medicine and weighing them against those of other treatments and of leaving ADHD untreated allows one to make the best decision for their child.