Tuesday, December 6, 2011

ADHD: To medicate or not? That is the question

My son is autistic, ADHD with a little OCD for flavor. We found all of this out between the ages of 3 and 4. And since he turned 5 he has taken medication to help with the ADHD.

Now hear my story before jumping to self righteous conclusions. We sit and we judge and we think we have all the answers because we read some article about how ALL kids should be X, Y, and Z and ALL parents should do A, B, and C. But the truth is, when it is your child, those lines and rules are a lot grayer. Sometimes, no matter how hard we try, our kids do not fit into the world’s little boxes. A LOT of study and research went into starting him on stimulant medication so young. If you follow my blog at all, you know that I am the QUEEN of research, and nothing makes me happier than immersing myself in it. So we tried EVERYTHING for him to avoid meds. Diet, supplements, behavior modifications, "all natural" remedies, yoga...and while each of these things helped a little- we knew that once he started school we were going to be in for trouble.

The autism for instance made it extremely difficult to distinguish behaviors- well, not for us, but for teachers it would. The meds we grudgingly started giving him did NOTHING for the autistic behaviors-they weren't supposed to and we knew that. BUT- what they DID do was Slow.Him.Down. He was seriously like the Tasmanian Devil- he NEVER stopped- and I am not talking fidgeting either.. I am talking RUNNING. CONSTANTLY. Zero impulse control. ALWAYS moving....even in his sleep.
 Now- check out these similarities between Autism and ADHD:

Autism Behavioral Checklist

Difficulty mixing with other children;
No real fear of danger;
Tantrums: displays extreme distress for no apparent reason,
Inappropriate giggling or laughing,
May not want cuddling or act cuddly,
Noticeable physical overactivity or extreme underactivity;
Little or no eye contact,
Works impulsively; often makes careless mistakes: work is sloppy,
Uneven gross/fine motor skills

ADHD Behavioral ChecklistCannot talk or play quietly; disrupts others with talk or actions,
Difficult awaiting turn in games or activities,
Engages in potentially dangerous activities,
Plays without normal caution or consideration of consequences,
Severe temper tantrums,
Interrupts, disrupts, talks and acts inappropriately,
When younger, difficulty accepting soothing or holding,
Always on the move, overactive, even during sleep,
Often does not seem to listen when spoken to directly,
Often does not give close attention to details or makes careless mistakes in school work or other activities,
Uneven gross/fine motor skills.

Kind of scary isn't it? Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. LIKE AUTISM. We were told by the school initially that The Boy was simply ADHD- something I questioned immediately- because last I checked you are a school NOT A DAMN DOCTOR. This is after two neurologists told us it WAS autism AND ADHD.  Hmmmm..... interesting. Then there was the fight for the DOCTOR's diagnosis not to be trumped by the SCHOOL.... yes that was an issue- but a blog for another day.

Back to the decision to medicate The Boy. When we saw a HUGE improvement in his ability to sit and focus, it was a no brainer. We didn't do it to make OUR lives easier,although that was a by product,  and we certainly didn't do it because the teacher wanted little robots that never misbehaved- we did it because we SAW that it improved his QUALITY OF LIFE. Being able to focus made it easier for him to LEARN, kept him from being "in trouble" all the time, and made a difference in his social interactions- which due to his Autism were already difficult enough. 

I currently work with a child who is EXTREMELY ADHD, very immature for his age, and most likely dealing with some emotional impairments as well. It is clear he is NOT medicated at all- and I wish I knew why. I know there are some other conditions , such as Bipolar Disorder that make taking a stimulant drug impossible. Allergic reactions also prohibit taking the stimulant drugs. I don't know if this is the case with this child, but he breaks my heart. He screams, he can't focus, he can't sit still, he drives his peers nuts. He is a target for bullies. Even his parents don't act happy to see him. This poor kid has it rough- because this is not his fault. I know and understand.   

This could be my kid- if we chose not to medicate. Now, medication isn't a cure- we also do behavioral therapy as well, this is VERY important. Meds alone will NOT help LONG TERM. They treat the SYMPTOMS - not the disorder itself. Teaching a child how to cope with life in general is crucial.  

I do know this: ADHD does exist. It is both over-diagnosed by parents and pediatricians who want kids to sit down and shut up AND under-diagnosed by parents who are scared to death of labeling their child.There is no shame in a diagnosis. While labels are scary, understanding what is going on with your child is your first step in knowing how to help them.

Our hope is that The Boy will not need the meds some day. We are VERY aware of the dangers, side effects, and long term dependence concerns. We also take a very proactive stance in his schooling, and he has very clear guidelines for behavior. He is autistic first and foremost, but the behavioral modification strategies work with both conditions with some tweaking here or there.

In the mean time- I stand firmly behind out decision to medicate The Boy. But- I also understand parents who do not want to go down that road- we all try and do what we feel is best for our kids. But- speaking as a proponent for ADHD medications ( where appropriate!) I say PLEASE- if you have a concern, and if you have a child diagnosed with ADHD- consider all the options- medication included- and always ALWAYS take your child's quality of life into consideration. They are the most important.