Does my child need ADHD medication?
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 to make. In this article, we provide important information to help you decide whether your child should be on medication for ADHD.
The first step to making any decision is to be well informed. Because there is so much contradictory information related to medications, we wrote this article to help you get educated. The truth is that medication does not help everyone. For that reason— you should gather as much background knowledge as you can before agreeing to a trial of medication for your child or teen.
Next, it's important to note that we are not medical doctors or affiliated with any pharmaceutical company. The following information is not meant to replace any medical information from your child’s doctor. We are happy to connect you to our network of trusted psychiatrists and psychiatric nurse practitioners for a consultation, if interested.
Before reading any further, be sure your child has received a proper diagnosis. Many disorders can mimic ADHD symptoms (as well as typical child development); therefore, a comprehensive ADHD evaluation is critical from the start.
Does my child need ADHD medication?
For many children with ADHD, medication is a life-changing tool in managing symptoms and enhancing their success. About 70-80% of children with ADHD need medication to manage their symptoms across settings. Stimulant medications do not cure ADHD, but can significantly promote your child’s functioning.
There are some considerations to make before starting any medication. If your child exhibits only mild symptoms, you may want to focus on implementing an evidence-based behavioral intervention first, such as setting up consistent routines. Similarly, if your child is younger than 6 years old, it’s appropriate to start with parent training as a first line of treatment for ADHD. Stimulant medication may become the next option if you see little progress with those strategies. Medication may be necessary from the start for more severe or persistent symptoms of ADHD.
What might happen if my child does not take ADHD medications?
The risks of not treating ADHD are significant. There is substantial research 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 social relationships, self-esteem, mental health, low life satisfaction, teen pregnancy, school failure and dropout, substance use and dependence, car accidents, arrests, and being fired from jobs. The research is clear: if you choose to not use medication as a form of treatment for ADHD, you must use alternative treatments and consider the actual effectiveness of those treatments. Medication is significantly more effective than no treatment at all.
Are ADHD medications effective?
Stimulant medications have been shown to be effective in improving behavior, academic performance, and social adjustment in anywhere from 50% to 95% of children with ADHD. As a whole, hundreds of studies indicate that ADHD medications are effective and can be of great help to those with ADHD.
Are ADHD medications safe?
Medications for children with ADHD continues to be controversial in the public’s mind despite there being absolutely no controversy among the scientific community as to the safety and effectiveness of these medications. Extensive research over several decades has shown that ADHD medications are safe for long-term use and do not cause any lasting harm to the brain — even when taken every day for 40+ years, these medications do 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 healthy brain development.
How do ADHD medications affect brain development?
Medications for ADHD support brain development by increasing activity in key areas affected by ADHD. These areas are responsible for inhibiting behavior, maintaining effort or attention to tasks and goals, and more generally creating self-regulation. By increasing brain activity in the self-regulation centers, these medicines allow children to demonstrate more control over their behavior, more focused behavior, and less random restlessness and activity or off-task behavior.
How do ADHD medications help academic performance?
ADHD medications do not directly increase a child’s knowledge. A child struggling to learn their multiplication facts will not become a multiplication star overnight after taking one dose of ADHD medication. There is no pill that can directly insert ‘knowledge’ into our brain in this way. The way ADHD medications improve academic performance is by improving a child’s holistic school functioning. Medication allows children to show what they know on assignments and tests by improving their attention span, concentration, resistance to distraction, and thoughtful, reflective behavior. They also make children more available to learn what is being taught by reducing their off-task, disruptive behavior and improving their self-regulation, thereby getting along better with peers, following classroom rules and teacher directions more effectively, and completing assignments more timely.
Such changes not only can boost self-confidence and self-esteem in the classroom setting, but can make children more likable to the peer group and therefore give them more opportunities to make or keep classmates as friends. They can also reduce the amount of punishment and rejection children with ADHD often experience at school from both peers and teachers.
What are the side effects of ADHD medications?
While all medications have potential side effects, ADHD medications are generally well-tolerated when taken at the right dose and have no long-term side effects. Stimulant medication does not stunt a child’s growth nor do they change a child’s personalty, though a child may have improved emotion regulation thereby experiencing emotional changes.
Short-term side effects can occur, although they are often much less impairing than the side effects of untreated ADHD (e.g., shame, guilt, self-doubt), and include loss of appetite, trouble falling asleep, and mild physical symptoms such as restlessness when medication wears off, all of which can often be managed with dosage adjustments. Most of these side effects are clearly related to the dose: higher doses produce more side effects. It has been estimated, however, that 1 to 3% of children with ADHD cannot tolerate any dose of any stimulant medication. Other non-stimulant medications are considered in these children.
Will ADHD medication lead my child to use other substances?
We have research to show that ADHD medications actually reduce the risk of substance abuse by reducing the need for self-medication. Proper monitoring and education can further minimize any potential risks.
Parents should know that the most important factors in determining a child’s risk for adolescent substance use or abuse are (1) early onset of conduct disorder or antisocial behavior in the child, (2) poor monitoring by parents of the child’s or teen’s whereabouts in the community, (3) the affiliation of the child or teen with other teens who are using or abusing illegal substances, and (4) the degree to which the parents may also be using alcohol, tobacco products, or illegal substances.
What is medication rebound?
Some children may experience rebound symptoms as the medication wears off, leading to irritability or fatigue. Children taking ‘immediate release’ pills twice per day may experience this rebound twice per day. Adjusting dosage and timing or switching to ‘extended release’ capsules can reduce these effects. It's crucial to communicate any observations to your healthcare provider.
Do ADHD medications cause tics or anxiety?
If your child is already predisposed to tics, you may notice motor tics as a possible side effect, but stimulant medications themselves do not cause tics. Always consult with a neurologist if you are unsure if your child experiences tics or not. If you do notice an increase in tics, in my experience the tics return to their normal level within a week or so after medication is stopped. On the other hand, about 20–25% of children with pre-existing motor tics actually improve tics on medication. Your child’s physician will help you weigh the risk vs benefit of this side effect and whether or not it makes sense to continue.
Similarly, stimulant medication may contribute to feelings of anxiety in children predisposed to anxiety disorders, however they do not cause anxiety disorders. For many children with ADHD, anxiety is a secondary disorder as they spend a great deal of time “holding it together” to avoid the shame and embarrassment that can come from their symptoms such as forgetting appointments or arriving somewhere late. Once starting medication for ADHD, many children notice a reduction in their anxiety because they no longer have the need to keep a tight control on their day-to-day tasks.
Additional ADHD Resources
With any decision regarding medication, it's important to consult your child's doctor (you have to speak with them either way). Take all the time you need to ask questions and gather the information you need to make an informed decision. Many developmental pediatricians are well-trained on ADHD and feel comfortable prescribing stimulant medication; however, some pediatricians will refer you to a child psychiatry specialist such as a psychiatrist (M.D.) or a psychiatric nurse practitioner (PMHNP) and that is ok. I tend to recommend these providers first since they quite literally specialize in psychiatric medication. Just because you are handed a script, does not mean to need to fill it. Consulting with a medical doctor can fill the missing gaps in knowledge to help you make an informed decision.
At Tampa Pediatric Psychology, we offer a comprehensive range of ADHD services including ADHD evaluations and ADHD testing, parent behavior training for ADHD, parent workshops, individual therapy for teens with ADHD, and ADHD and executive functioning coaching to high school and college students.
Visit our informational page to learn more about ADHD.