Honestly, this is one of the hardest decisions I think a parent of a child with ADHD must make.  Should I give my child with ADHD, medication?  Firstly, because we are talking about a child, our child.  Secondly, because we are potentially making a life-changing decision for them.  No one wakes up one day and thinks I want to ‘drug’ my child, but what if that is the best decision you could make for them?  It’s such a tough call, especially when they have been diagnosed incredibly young. 

This post is in no way trying to sway you one way or another.  I am NO doctor.  I am a mum too, with two children with ADHD who has been weighing up the pros and cons myself.  Every child is different, every situation is different.  No one should judge someone else’s choice.  This post will purely be about ADHD medication.  I hope it helps.

ADHD and Medication

There is a lot of talk that ADHD medication can be over-used and over-prescribed.  I did find it remarkably interesting, therefore, to read that untreated or undiagnosed psychological and developmental disorders occur far more often than diagnosis, with over a third of children with these issues going untreated.  This is one of the reasons it is so important to find an excellent paediatrician or psychiatrist in this field to ensure you get the correct diagnosis and are offered the correct treatment accordingly.  In my recent blog post ADHD and Autism, their symptoms could seem similar which is why they can so often be misdiagnosed, with ADHD medication doing more harm to an ASD child than good. 

ADHD is a neurobiological disorder that can be treated very successfully with medication in 80% of all cases.  However, just because this is a fact, this does not stop you from feeling torn over whether to medicate your child.  Many parents feel judged for putting their children on medication.  There is still the stigma that you have taken the quick fix; the easy route just to get out of parenting your child with ADHD.  Let me clarify.  You are not selfish if you decide to medicate your child.  ADHD is a hard disorder to live with daily for both you and your child with ADHD.  Add on to that the problems with school and their peers.  No parent is ever judged for allowing their child to wear glasses rather than just saying, ‘See how you get on without them…’ (see being the operative word!).

It is also entirely up to you if you chose to try other methods first: behaviour therapy, CBT; working with your child’s school to ensure the extra support, breaks, target sheets etc; healthy eating; Vitamin supplements such as Omega-3 fatty acids.  Omega-3 (I get commissions for purchases made through links in this post) can be found in oily fish like salmon, walnuts, flaxseeds, leafy veg and other foods, or can be given as a supplement available over the counter or online.  Certain studies have shown that children with ADHD have lower levels of Omega-3 in their blood and therefore it has been suggested that this could help relieve certain symptoms of ADHD.  Either way, it is an extremely healthy supplement to give all your kids!

How ADHD medication works

Medications are not a cure for ADHD but can help some people concentrate and focus, feel calmer and be less impulsive.  Normally your child will be started on a lower dose to ensure they tolerate it and then it will be increased till your paediatrician finds the optimum dose.  Until this occurs you will have to go back to get your child’s height, weight and blood pressure checked.  You will still need to do this every three to six months when the correct dose is found to ensure everything is ok and/or if they have a growth spurt etc in which case the dosage may need to be increased.

ADHD Medication

Three types of medication are currently licensed to treat ADHD in the UK, (I believe in the US there are five). 

Methylphenidate – This is the name of the active ingredient.  The brand names are Concerta XL, Equasym XL, Medikinet, Medikinet XL and Ritalin

Dexamfetamine – Or recently called Elvanse

Atomoxetine – Brand name Strattera

Methylphenidate and dexamfetamine are both stimulant medications.  Stimulant medications have been used to treat children with ADHD for over 30 years now.  If after diagnosis you are offered medication for your child, you will probably initially be offered a stimulant as they have an extremely high response rate for children with ADHD.

Stimulant Medication

I always assumed that as I watched my children zoom around non-stop at top speed, any medication would have to calm them.  I was scared that they would become quiet little zombies with no personality and would take their spark away.  When I realised they stimulate them I was shocked!  Like they need that I thought! 

I had always thought that a cola would tip them over the edge and frantically hid anything at a kid’s party that might have caffeine in, along with any sugar, looking back I was fighting a losing battle!  If only I had known! I might have given them a mid-morning coffee with me when I was flagging (joke!). 

Stimulants affect the ADHD brain so differently from a neurotypical brain.  This group of medications increases the levels of dopamine in your brain.  Dopamine, (See ADHD Brain), is a neurotransmitter.  This is like a messenger to your brain and plays a huge role in how we feel pleasure.  When a person with ADHD is given a stimulant, Dopamine levels are increased to that of a neurotypical brain.  Not so you hit a ridiculously high or euphoric state.  (If your child appears like this or too placated, then it means the dose is too high and must be adjusted by your paediatrician).  Increasing the activity in the ADHD brain helps them focus, concentrate, and be less impulsive.  Who knew?!  Well, clearly the Doctors because as I said, stimulant medications have been offered to children for over 30 years! 

Methylphenidate

This is the most used and is generally offered to children over 6 years.  They literally start working about 30-60 minutes after they have been taken and will wear off between 3-4 hours of taking them.  However, the different brands mean they can be taken as immediate release in small doses two to three times a day or as a modified release tablet where the dose is released throughout the day.  It is often dependent on the capsule/tablet.  Some must be swallowed whole to allow slow release, others can be halved and crushed etc.  Ask your doctor so you know how to take them correctly. They should not be taken if you want your child to go to bed within four hours therefore as they will hinder sleep.

My daughter has tried Medikinet, one brand of this, but alas, whilst the teachers in her school saw an improvement, she found she could not swallow the capsule.  This is an issue for many of our children because of their sensory issues.  I am quite surprised that this has not been given some thought when creating ADHD medication because it has been quite tough getting her to take them. 

We practised swallowing skittles, but whilst she could swallow these with ease (she practised lots :D), she still could not swallow the capsule.  The paediatrician did tell her she could open this particular capsule and take it with apple sauce but then she could taste it and that was even more of a no go for her!  I am not saying this to put you off, this is just my experience with it with my child.  Just something to be aware of.  As I say the teachers noticed a great improvement in her focus and ability to sit still when she was on it.  She is now on a different brand which is a hard tablet, and she is having no problem with that at all and seeing the same results at school.  Fingers crossed, long may it last!

Side Effects of Methylphenidate

These include:

• a small increase in blood pressure and heart rate
• loss of appetite (can cause weight loss)
• trouble sleeping
• headaches
• mood swings
• stomach ache

My daughter has always had issues with sleep, as many of our children do so is also taking prescription melatonin (melatonin is a natural hormone that is produced in the brain and helps to control your sleep cycle).  Melatonin has been a lifesaver for her, and me, because despite having a great bedtime routine and being in bed early with no electronics, she just could not switch off.  Now she can fall asleep within 20 minutes and wake up at a normal time without feeling groggy.    She did experience loss of appetite when on Medikinet.  I just made sure she ate breakfast first and gave her a big, healthy dinner as she really could not eat lunch.  Again, that is just my personal experience that I am sharing.

Dexamfetamine

This contains something called lisdexamfetamine, which is an inactive form of dexamfetamine that becomes dexamfetamine when in the body. Try saying that as a tongue twister!  The only brand of this currently in the UK is Elvanse and is generally given if methylphenidate has been trialled first and unsuccessful.  Elvanse is normally taken in the morning and will gradually be released during the day lasting up to 13 hours.

Side Effects of Elvanse

• decreased appetite.
• mood swings
• agitation and aggression
• dizziness
• headaches
• diarrhoea, nausea, vomiting

Atomoxetine

Now this one works differently from the above two stimulant varieties.  This increases noradrenaline in the brain and can aid concentration and impulse control.  This is an SNRI, selective noradrenaline reuptake inhibitor, which is also used as an antidepressant drug. 

The only brand of atomoxetine in the UK is Strattera.  This takes longer to work and up to four weeks before it is fully effective.  Your child will normally be started on a low dose and gradually increased till they reach their optimum dose.  Again, it can be taken once in the am or split throughout the day, your paediatrician will advise.

My daughter tried this for a while, purely because she could not swallow the capsules, and this could be given in a liquid, (it comes in capsules also).  However, she hates the taste and as the paediatrician increased her dose, she hated him too!  It was yucky she said!  *Insert eye roll, I told her medicines are not supposed to taste nice!  But no, she refused.  To be honest, this one did not work for her anyhow.

Side effects of Strattera

• small increase in blood pressure and heart rate
• trouble sleeping
• dizziness
• headaches
• stomach aches
• irritability
• serious side effects are notably suicidal thoughts if your child begins to become depressed talk to your doctor immediately.

It is important to note that the first one you trial may not be the one that works for your child.  My daughter is now back on a stimulant but in tablet form and doing so well.  My son is on a different one, a capsule and is positively thriving now, that was the first medication he tried.  He loves the fact that he is shouted at less in school now, bless him!  You just never know. 

ADHD medication concerns

Of course, there are so many concerns when you are thing about trialling ADHD medication. But here were my Top 3 concerns:

Will my kids change on ADHD medication? 

I was so worried that ADHD medication would wipe out all that made my child unique.  That their spirit would be dulled.  Both my children with ADHD have brilliant senses of humour and are cheeky. Would this be taken from them? This was probably my main concern.  I have to say that they are still the same little cheeky characters.  The only difference with my son is probably that he is more appropriate with it!  A little less impulsive at blurting out inappropriate funny things!  In fact, let me share with you the note that came home from his teacher the other day.

“We have seen an incredible difference in ***** since commencing his medication.  He is much calmer in class and does not need reminding to stay in his chair.  He retains his lovely personality and is active at break times and during PE lessons but is able to contain his focus in ‘sit down’ lessons.  Last week we began our end of year assessments and ***** completed the Maths papers to the best of his ability because he was able to remain focused and concentrate for the entire period.  We did not have to remind him to stay quiet during the assessment and he has become an example to his peers of what ‘positive and ready to learn’ looks like.”

I mean for me; I could not be happier than to read that! 😊

Will my child become dependent on ADHD medication?

I found an especially useful article on this that made me feel better when I first started my children on medication.  It basically said that if a child finds their ADHD medication useful then it is the same as saying a person with a broken leg is dependent on crutches or a person with diabetes is dependent on insulin.  Are they regarded as a dependency?  I wish I could find the article to link because it even went so far as to say, humans, need sleep to function.  If we do not get sleep, we crave it, does that mean we are addicted to it, or does it mean we simply need it for our brain to keep functioning. 

Does giving my child with ADHD medication mean I am a lazy or bad parent?

NO!  No one would say that to the parent of a diabetic!  ADHD is not caused by bad parenting and in the same vein medicating your child with ADHD does not make you a bad parent.  If you choose to medicate your child, then you are doing what is best for your child.  Does it make your life easier?  Hopefully yes!  I mean I get fewer calls from the school now!  But my daughter’s medication has worn off before she gets home, and I chose not to medicate her again or at weekends.  She needs it for school, it is a must, but generally, I do not give it at weekends or school holidays.  I would give it if we had a day out somewhere that might involve queues, or if we are going on a long journey or a flight to keep her calm. 

This is all very personal to your child and to you and what you can deal with and how your child’s behaviour is out of school.  Your choice.

Also, another thing I read.  We love our children unconditionally, and we still have breaking points with them.  Imagine the people in their everyday lives that do not love them as we do.  Their teachers, peers, dinner ladies etc.  They are more likely to snap at them with less tolerance than we give.  That is human.  As my son said, he loves not being shouted at school anymore since he started the medication.  How much better for his self-esteem must that be?

To be honest, I remember writing down the pros and cons of medicating my daughter.  I almost felt as guilty for not medicating as I did for medicating.  I was worried that if I did not medicate how would she ever stay in class and learn anything.  She was already behind academically.  Honestly, parenting throws so many things at us and we always feel guilty, about whatever we do!

But, to summarise once more, choosing to medicate your child is a personal and individual decision.  It should not be considered a last resort by any means.  Having done all my research, I decided to medicate my daughter.  I then had to rely on her school telling me how she was doing as, as I say, it has worn off by the time she gets home.  Now she is on the correct meds and correct dose, third time lucky, she is doing so much better at school.  It was a much quicker decision for my son because I had already done the research and had seen the benefits my daughter had experienced.  Also, my son was extremely fidgety, very impulsive, and easily distracted.  He is also very clever, and it was affecting his schoolwork severely.  It has been so good for him.

So, my final advice would be to do your research; work out what behaviours you would like to see improved; would these benefit from medication; would you like to try something else first until you are ready to go down that route or would you prefer to trial medication first and see what happens there.   Medication is never a replacement for a parent.  That is a given.  I hope this has been useful.  I tried to share my story without being biased toward medication.  This is my particular journey, with my two children who have ADHD.  I weighed it all up just like you probably are if you are reading this.  For me, this was my decision, and I am happy with it.  I wish you all the best of luck with yours.

I have started a private support group on Facebook for parents and carers who need support with their child with ADHD. It’s a friendly place to chat with others. Please do click this link ADHDinchildren to join. And for anyone on Instagram, I’m there too ADHD Mum.

Vicki x