Deciding whether or not to give your child medications is a tough decision. And no one can make that decision for you and your child – it is yours (and your child’s) to make. In this article I provide important information to help you decide whether your child should be on medication for ADHD.
Every child and family is different. What is best for your child might be different for another. I knew my daughter had ADHD by the time she was 4. My husband didn’t start to see it until she was 10. We sat on the fence about what to do – she seemed to be doing okay – until we saw her self-esteem drop. And then, one day, she asked what was wrong with her and if there was something we could do to help her. By then her grades were erratic and she started to have friendship drama. That’s when we knew, for her, it was time to start the medications. It was a life changer for her.
The first step to making any decision is to be well informed. Because there is so much contradictory information related to medications, and because parents are exposed to so much negative information from non-healthcare professionals or social media, I wrote this article to help you get educated.
Specifically, I have answered the common questions parents have about medications. As you go through this article, do a cost/benefit analysis using this form. As you read through this article you can add what is important to you in the appropriate column to see whether the costs outweigh the benefits. You will see a green circle at the bottom of each column. When you have filled in your points, assign each column a number to rate the worth of the costs and benefits. They should add to 100. If one column outweighs the other, then that can help make a decision.
The following information is based on children who have ADHD. Before moving ahead, it is critical your child has the right diagnosis. Other difficulties can look like ADHD, so it is imperative that you have a comprehensive assessment done to ensure you know exactly what is going on with your child.
*Please note: I am not a medical doctor. The following information is not meant to replace any medical information from your child’s doctor. You must discuss your decision one way or another with your doctor. Similarly, I am not affiliated with any pharmaceutical company. I am not a proponent for or against medications. My job is to share everything I know about medications to families so they can make the best choice for them.
Does my child need medications?
About 70-80% of children with ADHD need medications to manage symptoms to promote their success across settings. Medications do not cure ADHD, but they certainly help improve kids’ functioning at home, at school, and with friends.
There are some considerations to make before starting medications. If your child exhibits only mild symptoms, you may want to focus on implementing solid behaviour strategies first, such as setting up consistent routines. Same if your child is younger than 6; consider starting behaviour therapy first. Medications may become the next option if you see little progress with those strategies.
If difficulties persist and/or the symptoms are more severe, then medications are likely needed to promote your child’s functioning.
What might happen if my child does not take medications?
The risks of not treating ADHD are significant. There is substantial research done that has confirmed that individuals who are not treated for ADHD are at greater risk of negative outcomes in almost every aspect of life that persist into adulthood, including:
- Low self-esteem
- Depression, anxiety, and other mental health challenges
- School failure and dropout
- Teen pregnancy
- Substance abuse and dependence
- Car accidents
- Being fired
- Less satisfaction in all areas of their life
You also may want to consider the costs of not medicating your child. Consider the difficulties your own child experiences. What are the costs of those difficulties? Of impulsivity? Inattention? Low frustration tolerance? Is your child constantly getting in trouble? Being left out socially? Feeling inadequate? These are important to consider as well.
Are medications effective?
90% of children on medications for ADHD respond positively. ADHD is a neurodevelopmental disorder, meaning it affects how the brain develops. Medications help the brain work properly. When the right medication is found, kids should experience great benefits.
ADHD is the MOST treatable disorder in psychiatry and has the most effective treatment options available that produce the most positive change than any other diagnosis. The effectiveness of medications for ADHD is more than three times better than medications used for other things like anxiety and depression.
Are medications safe?
Before we had all the research we have now on medications, people worried about their effects on the brain over time. However, with long-term and large scale studies conducted over the past several decades, we know that ADHD medications, even when taken every day for 40+ years does not cause any long-term problems. The greatest risk of ADHD is not treating it effectively. The medications themselves are safe and can actually promote brain development.
How do medications affect brain development?
We now know medications can help protect the development the ADHD brain by increasing activity in key areas affected by ADHD. They promote the development of grey matter (brain cells) and strengthen important synapses so the brain can communicate effectively. There are several key findings that highlight medications’ protective role on brain development.
First, researchers demonstrated that certain brain regions are significantly smaller in children with ADHD who have not taken medications compared to those who do.
Additionally, kids who do not take medications for ADHD exhibit decreases in grey matter and faster cortical thinning in certain parts of the brain compared to typically developing kids AND kids who DO take medications.
Although typically developing kids develop grey matter faster than kids with ADHD, they also develop a thicker cortex (i.e., more brain cells). However, over time, the kids with ADHD who took medications have the same cortical thickness than typically developing kids (and significantly more than kids with ADHD who did not take medications).
Researchers have also suggested that medication helps normalize the impaired structures in the brain by strengthening the connections within those structures. So, kids with ADHD who took medications had more white matter (and similar to typically developing peers) than kids with ADHD who did not take medications. White matter plays an important role in communicating to different parts of the brain.
So, why is all of this important? In a nutshell, medications increase brain activity, which promotes the development of both grey matter and white matter in certain parts of the brain. Thus, the brain’s functioning is optimized.
Behaviorually speaking, these improvements in the brain help to normalize goal-directed activity, planning, flexibility, emotion regulation, self-regulation, and attentiveness while decreasing reactivity and impulsivity; many of the things kids with ADHD have trouble with. Working memory is also improved due to the increased blood flow to relevant parts of the brain.
What are the side effects of ADHD medications?
All medications have side effects, even Tylenol. It is therefore important to know what can happen.
When medications for ADHD are optimized (i.e., the right medication at the right dose), there should be essentially little to no side effects. However, everyone is different. While some experience some side effects on some medications, others do not experience any.
There is good news with long-term side-effects: With so much research over the past four decades, we know there are no long-term effects. No, these medications don’t stunt kids’ growth. Nor do they change your child’s personality, though some kids do experience some emotional changes.
Nonetheless, there may be some temporary side effects with medications, though they are often much less impairing than the side effects of untreated ADHD (e.g., shame, guilt, self-doubt). Often, these short-term side effects can be helped by changing the dose or time the medication is taken. The side effects only tend to occur when the medication is still working in the body.
The most common short-term side effects include:
Loss of appetite. About 30% of kids have a loss of appetite, though this mostly only affects lunchtime. ( So many kids with ADHD are so busy during lunch they don’t finish their lunches anyway, medications or not.) By the end of the day, their appetite is typically strong.
Sleep. About 10- 15% of kids might have trouble falling asleep. However, if the medication is at a good dose and taken at optimal times, ADHD medications actually help kids get to sleep because they have a calming effect on the brain so kids don’t have the racing thoughts that used to keep them up at night.
It is when meds are taken at the wrong time and kids get too overtired and then ramp up from getting a second wind that makes falling asleep hard.
Physical symptoms. Less than 10% f kids experiences restlessness when the medications wear off. Though not as frequent, sometimes kids may feel dizziness, headaches, or stomachaches. Kids on non-stimulants may also feel drowsy.
What is medication rebound?
Some kids experience medication rebound when the medication wears off, which can result in a flare up of symptoms, irritability, emotionality, or tiredness; all of which can be intense for some kids. Once the medication is completely worn off, symptoms usually go back to normal.
Rebound usually happens when the medication leaves the system too fast. The rate varies from one child to the next and depends on how fast the body processes the medication.
Although medications are meant to wear off evenly over time, some kids process the medications very quickly, which is when the rebounds occur. Sometimes rebounds can happen when the child takes the medication and does not reduce until the medication wears off, in which case the does may be too high. In many cases, adjustments in dose or timing of the medication can help. Sometimes doctors will prescribe a small dose of short acting medication that kids take before their regular medication wears off to help avoid rebounds.
Sometimes kids seem like they are going through a rebound, but it is not due to the medication. Sometimes these kids are more exhausted or irritable at the end of the day because they have had a stressful or tiring day. Kids often feel most comfortable with loved ones so if they have held their cool together all day, frustration and tears usually come out when they feel safe, at home.
Because of the different reasons rebounds may occur, it is important to take note what is going on. Record what behaviours you see, along with the timings they start and stop. This information will be invaluable for your doctor to know.
Is it possible that medications might not work for my child?
Even though medications are largely effective, some kids do not experience any benefit from medications. The problem is often about giving the right dosage.
Approximately 7% of kids do best on low dosages – lower than what is even available. Thus, when they start the lowest dosage that is available, it is already too much for them. As a result, they may present as either over- or under-aroused. The medications would be more effective if they could access lower dosages.
On the other hand, up to 40% of kids do best on high dosages – higher than what is even available. The medications might help some, but perhaps not optimally.
Based on these numbers, it seems that the dosages that are available only optimally help half the ADHD population. They can still be helpful, but perhaps not to the fullest extent for some.
Are there risks of my child misusing the medication?
ADHD medications actually help reduce the risk of substance abuse rather than cause it, especially because their brain is working optimally and they therefore do not feel the need to self-medicate.
Further, most medications prescribed today are designed so that no one can take them in any other form than how they were intended (e.g., slow released and absorbed in the gut), making it impossible to be misused in the first place.
Nonetheless, there are still some medications out there that can be taken in higher dosages so it is important to know how your child’s medication works and potential risks, as well as to monitor your child’s use of the medications.
Can my child take other supplements while on medications?
Children can take other supplements, though there are some things to remember. Things like vitamin C and orange juice (absorbic acid) cannot be taken within an hour window of your child taking the ADHD medications because they can stop the medication from being absorbed in the bloodstream. Caffeine isn’t great for any child, but especially for kids taking stimulant medication.
The following are not side effects caused by medications but are common concerns parents tend to have that need to be addressed.
Tics. If your child is already predisposed to tics, you may notice motor tics as a possible side effect (but medications do not cause tics).
Anxiety. For some kids who experience anxiety, it is the ADHD causing the anxiety because of the amount of effort it takes them to get through their day. This was my experience – I was always an anxious person and had trouble coping. Once I started meds for ADHD, my anxiety went away immediately. Therefore, medications can actually help reduce anxiety.
Nonetheless, for some people, stimulants may contribute to feelings of anxiety. However, they do not cause anxiety.
Personality changes. Medications do not cause personality changes. What you should see is improvements in your child’s alertness and hyperactive behaviours. However, some kids may seem more emotional or irritable if they are not on the optimal medication or dosage. If you do notice a shift in how they are behaving or feeling that is of concern, talk to your doctor. Chances are, the dose is too high.
Heart effects. Some parents are concerned about the effects medications can have on their children’s heart. However, for the past decade, researchers have found that this is not the case. Individuals taking stimulant medications are actually at less risk of heart complications than the general population (0.2-0.5 per 100,000 risk compared to the base population risk of 1.2-1.3 per 100,000)! Your doctor should of course take a practical approach that includes a history of symptoms and family history, along with ongoing monitoring. Routine ECG’s are not needed unless medical/family history warrants it.
Still don’t know if your child should be on medication for ADHD?
If you are still unsure whether your child should be on medication fro ADHD, consider the following chart.
Whether you choose to medicate or not, it is important to visit your child’s doctor. Ask any other questions you have and discuss what the best treatment options for your child are.
At the end of the day, the decision is your and your child’s alone. Weigh out the costs and benefits and consider the role medications can have in your child’s life.
If you do decide to give your child medications, there may be other questions you have. Read more about additional things to consider if your child is going to start medications for ADHD.
A great resource is the CADDRA medication chart outlining information about all the medications for ADHD available in Canada.