Ask: What's the next step after an ADHD diagnosis?

Dr. Brian Eichner
Dr. Brian Eichner

Q. As this past school year went on, my third grader struggled more and more and eventually was diagnosed with attention deficit/hyperactivity disorder after a pretty thorough evaluation. His doctor recommended meetings with a psychologist and also medications. Should I wait to see how fourth grade goes before making a decision on whether or not to start medication?

A. Many parents are concerned for different reasons about starting medications for ADD/ADHD. Some parents are worried about the risk of addiction, others are worried about an association with unlawful behavior, and still others think that their child should try harder and not take a medication to do the work for them. While these are all understandable, they are not, in and of themselves, reasons to not try medication (as they are not actually true) in combination with appointments with psychologists and classroom interventions.

It is quite clear that the combination of medication and non-pharmacologic treatment with appropriate classroom planning and parental support are more effective than either alone, or neither. Of course, the first step is to be certain of the diagnosis, as there certainly is some overdiagnosis, misdiagnosis, and overtreatment of this condition. However, it sounds like your son had an appropriate evaluation.

ADD and ADHD are biologic disorders of the frontal lobe, the “quarterback” of the brain that enables sustained attention and reduces impulsive behavior. Most of us would not expect a diabetic to control his or her blood glucose with either JUST insulin (or other meds) or JUST diet/exercise. Similarly, it is generally unfair to expect a student with ADD or ADHD to succeed (defined by reaching their potential) without both classes of treatments outlined above.

Unfortunately, it is difficult to predict which medication and which dosage will work well for a given child. Unlike most other medications in children, which are dosed solely on weight, these medications are instead started at a low dose and titrated up, with the goal to get maximal effect and minimal side effects. Common side effects include decreased appetite, headaches, stomachaches, sleep disturbance, and feeling “dull” or “funny.”

Given that it takes some time to find the right dose and the right medication, it often does make sense to start these medications over the summer. While taking medication over the summer is not going to have any actual effect once school starts (these types of medication are completely out of the system by the next day), it does provide an opportunity for parents to see how the medications affect their children’s behavior, mood, and appetite and to allow the possibility to find the appropriate dose and medication before falling behind during the next school year! It also allows the child to get used to taking a medication. As an added benefit, it might help your child be able to focus on chores and reading during the summer and, if they attend camp, can assist their ability to get along well with other children and the counselors.

Shorter answer: If you and your doctor are pretty sure of the diagnosis, it makes sense to start figuring out treatment over the summer! Good luck!

If you have a question about your child's health or happiness, ask Dr. Eichner or any of our experts by sending email to

Brian Eichner is a general pediatrician and assistant professor of pediatrics at Duke Children's Primary Care-Roxboro Street in Durham. He enjoys providing care for children who are healthy as well as those with complex medical conditions. Dr. Eichner also serves as the medical director of the Duke Pediatric Diagnostic Clinic. He and his wife have lived in the Triangle since 2006.