To medicate or not?
This decision is stressful for parents who see a child struggling with attention-deficit/hyperactivity disorder but who worry about tampering with brain chemistry.
Websites offer wildly mixed messages about ADHD meds, studies show conflicting data about whether they work, and doctors don’t always agree. Some friends and relatives can’t imagine “how you could drug your child,” while others wonder why you would reject something that might help.
But clinicians who treat ADHD say the decision is often fairly straightforward.
“I recommend medication when something causes a child to be unable to thrive in his environment,” said Glen Elliott, director of the Children’s Center at Langley Porter Psychiatric Institute in San Francisco and author of “Medicating Young Minds: How to Know if Psychiatric Drugs Will Help or Hurt Your Child.”
Elliott is familiar with the dilemma parents face: His son struggled with ADHD in high school and finally opted to use a stimulant occasionally in medical school.
Stimulants such as Ritalin, Adderall and Vyvanse are nearly always the first medication doctors try, Elliott said, because they have a long, solid safety record, they take effect within minutes and they leave the body within hours.
Timothy Wilens, chief of child and adolescent psychiatry at Massachusetts General Hospital, said he weighs factors such as age, severity of symptoms and how the symptoms affect the child’s outlook.
“If I have a child who is relatively younger, with mild symptoms, I am slower to recommend medications. I may first request environmental changes at school, or a different daily structure at school or at home,” he said. “Contrast that with an 11-year-old who is struggling greatly in class, having problems paying attention, getting distracted, and becoming phobic about homework. That child is clearly on a different trajectory... and would probably benefit from medication.”
(Wilens and Elliott received personal funding from pharmaceutical companies in the past but do not do so now.)
Many ADHD groups and both major U.S. child psychiatry organizations (the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association) recommend medication for ADHD, usually in conjunction with therapy that teaches skills such as time management.
Managing expectations is key, however, because no drug can cure ADHD. While some people with ADHD naturally become less symptomatic as their brains mature, Elliott said, about a third of people with ADHD will need treatment their entire lives.
Here are some pros and cons of ADHD medication, according to experts:
▪ In addition to being well-tolerated, approved by the Food and Drug Administration and easy to try out – because they enter and exit the body quickly – stimulants are not addictive in the doses prescribed for ADHD.
▪ Stimulants can be effective even if taken only occasionally.
▪ Drugs may reduce some of the longer-term problems associated with untreated ADHD, such as depression and substance abuse.
▪ Side effects range from mild (and common) – such as irritability, sleep disruption, drowsiness and loss of appetite – to serious (but rare) – such as heart and liver problems and exacerbation of mental health issues.
▪ Clinicians disagree on whether people build up a tolerance for stimulants.
▪ Some can be stolen or resold, which can lead to abuse.
▪ Effects are short-term, in that none can cure ADHD.