The Decision to Start Our Child on ADHD Meds (Parenting Children with ADHD Series)

One of the questions we get asked the most is about using medication to treat ADHD. I know firsthand what a hard decision this is, as I've had to go through this life-altering decision for myself and for my children. Parenting a child with ADHD is challenging, but it can also be magical.

For our family, medication has been a life saver, but it has not been without a heavy dose of mom guilt and second-guessing, especially given the widely held beliefs that (a) meds are overprescribed and overused, and that (b) child behavioral challenges could be fixed if parents would simply set limits and actually discipline their kids.

Everyone is worried about the unsubstantiated long-term effects of ADHD medication on the developing child, but we should actually be terrified of the very real long-term side effects of untreated ADHD in our children as they enter adolescence and eventually become adults.

Individuals with untreated ADHD are much more likely to:

• Have persisting social challenges (have no or low quality friendships, be teased, bullied, or socially isolated)

• Fail academically (struggle in class, drop out of high school, not enroll in or graduate from college)

• Develop a psychiatric or substance use disorder (experience depression, anxiety, alcoholism, substance addiction, or an antisocial disorder)

• Engage in self-harm (experience self-injurious or suicidal behavior)

• Have physical health problems (experience sleep disorders, high blood pressure, obesity, diabetes)

• Experience more accidents and injuries (drive recklessly or too fast, get into more car accidents, get injured at home)

• Struggle professionally as an adult (be unemployed, have lower performance reviews, be fired or quit a job)

I went my entire childhood without realizing I had ADHD. Because of this, I did not try medication until I was in my late 20s. I remember experiencing medication for the first time and cried because it was also the first time I'd ever felt a sense of calm instead of the chaos inside my mind that I'd experienced my entire life.

It was as though someone found the switch to finally turn on the lights. I didn't even know the lights were off because I'd been living in darkness for so long. Over time, I had adjusted to the darkness and just thought that was the way things were. I found ways to function but was never able to actually make much progress in my life because I wasn't seeing clearly and found it difficult to follow through with tasks and plans.

Medication brought a clarity to my life that I had been longing for.

When my oldest son was about 5 years old, it was already clear to us that he had ADHD. He was extremely active, impulsive, and distractible, much more so than the average young child. However, the thought of using medication to help him was not something I was ready to consider yet. He was my first, and I was still the newish mom who tried to follow all the expectations society thrusts upon us parents, so giving my kid a stimulant drug sounded like I was a drug dealer!

Surely we could help him manage his behavior if we just tried harder as parents. Except that even with access to cutting edge positive behavioral support and the lastest parenting strategies, his ADHD remained. And this made life increasingly hard for him - socially, behaviorally, and academically.

Our son's kindergarten teacher said that he was squirrely and often needed reminders to keep his hands to himself. However, his teacher also shared what a delight he was, noting that every 5-year-old is different and many act similarly as they adjust to the expectations of being in school. So, we did not take action just yet.

Then came first grade. Academic expectations ramped up and friendships began to solidify and deepen a bit. It was only the second week of school when I began to notice a significant shift in my son's excitement for school.

He would come home with the collars of his shirt soaked and stretched from chewing on them and fingernails chewed to the point that they were raw. The angry outbursts at home were off the charts, likely the result of desperately trying to hold it together during the school day.

My boy was struggling and I knew I had to take action.

At the time, I didn't know where to start the process, even though I was married to a child psychologist. I've been humbled by the fact that no matter what your expertise or degree is in, things are much more challenging when it comes to parenting your own kids!

The Meltdown

The final straw for me happened one morning when my son, my little love, had a full blown crying meltdown when we arrived at school. His tiny six year old self clung to my legs, tears streaming down his face, his eyes darting around nervously as if threats were all around him.

The bell had rung, but my little boy fiercely refused to walk into his classroom. So I sat on a nearby bench holding him close and trying to suppress my own ADHD-driven fight-or-flight urge to just take him and run away from the whole situation.

Lucky (or unlucky, depending on how you look at it), this mama also has ADHD, so I knew his fears and feelings were very real and needed to be validated, not dismissed, minimized, or squashed away.

After much coaxing, he confided in me.

In his small raspy voice, he said, "When the teacher is talking and telling us something, I just look at her and see her mouth moving but I don't know what she's saying. It's like she's just saying blah blah blah."

He went on to explain, "And then it feels like I'm dumb because all the other kids will be working on something and I just stare at the paper not knowing what I'm supposed to be doing."

There was one thing in particular that stuck in my head that day which made it impossible for me not to take action. Through tears, my little boy said...

"I thought I was good at things, but now I think I'm bad."

Talk about a punch to the stomach! This of course triggered the Mama Bear in me to wake up and figure out how to help my baby, but unfortunately there was no one to yell at or punch or go all Mama Bear on.

The threat was invisible, just like many other disabilities, so I had to go on a covert mission with stealthiness. Being a former teacher, I knew the uphill battle I was embarking on. I saw several children be denied services and supports in classrooms because they didn't quite qualify for district level support.

Fortunately, our school was very supportive. Our principal at the time saw us struggling and offered to help. She took my child's hand and walked him around the grassy field to quell his anxiety and eventually walk him into his classroom.

Once I knew he was safe, I immediately phoned our pediatrician. I must have sounded like a crazy woman on a mission (which in fact, I was) as I left a frantic voicemail to please call me back immediately! Since I also have ADHD, events such as this can become all consuming and tunnel vision takes over. I became hyperfocused on the task of figuring out how to help my son. It took on an urgency in my mind that sounded like a loud beeping alarm. It would not be turned off until all the threats were addressed and a plan was in place.

Looking back, I am a little embarrassed at my behavior that day, but I don't regret it because I got the results I wanted! Sometimes my ADHD grants me the gift of temporary assertiveness and courage needed to get things done. When the pediatrician finally called me back, I bombarded her with a barrage of questions and information.

We set up an appointment for the following day.

Ty and I went together as a united force. We knew asking for medication was the right choice, but a decision that was rightfully going to be scrutinized. Our pediatrician would likely be very hesitant to prescribe a 6-year-old Ritalin, which was to be expected. Medication is a big decision that should be taken seriously and prescribed only after careful consideration between parents and a medical professional.

We were rightfully met with a lot of cautious reluctance as the doctor reported her general preference to adopt a "Wait and See" approach with young children. We described the persisting challenges that remained despite the behavioral techniques we already had in place at home and at school. Fortunately, she acknowledged and respected our professional backgrounds in education and psychology.

An Ounce of Prevention...

We stayed adamant in our belief that we wanted to start medication before he failed. The "Wait and See" approach seemed more like a strategy to "Flail and Fail". In our experience as parents and as professionals, it is a lot more stressful and challenging to address and fix problems after they have happened rather than proactively preventing them from happening in the first place. I'll be the first to admit that I spend the majority of my days "fixing" the problems I failed to prevent!

In this situation, I could foresee the social, academic, and behavioral consequences if we waited instead of proactively addressing it. In fact, it was already beginning to unfold in a downward spiral.

Other kids were starting to getting annoyed with him, which was making it hard to form deeper friendships. He was quickly falling behind academically because sustained focusing was challenging, and I even got a phone call from a mom saying that her son no longer wanted to invite my son over for playdates because he could be too out of control. Behavioral challenges persisted at both home and school, but we got the brunt of it since he tried so hard to keep it together while in class.

I'd seen enough kids flail and fail in a school setting to know that I did NOT want that happening to my child. Up until this point, we had tried behavior plans and ensuring he had ample opportunities to move his body. I sought out every single sport I could sign him up for, bought swings galore so he could get all his sensory needs met, and ensured his teachers were aware of his needs.

The hard truth I had to swallow was that all of this was still not enough. If I truly wanted my son to thrive and succeed in a society that isn't set up for neurodivergent people, we needed backup.

This meant accepting medication into our son's life with cautious optimism.

It was decided that we'd start him on the lowest dose of slow release methylphenidate (Ritalin).

Ty will explain the science behind how and why ADHD medications work in another post, but my Momsplation is that it allows us to better use the existing neurochemicals in the front part of our brains that regulate attention, emotion, and behavior. It calms the storm and provides an alternative to the random scrambly pathways an ADHD brain typically creates.

So, with a mix of emotions and an influx of worries, we began our medication journey. As I'm writing this, my eyes are welling up with tears, as they do every time I tell this story. The first time he took Ritalin, I remember picking him up from school so curious and eager to see if it made an impact.

I peppered him with questions about his day, as all parents tend to do. I could hardly believe what I was hearing and he could hardly wait to tell me!

In his sweet raspy voice, he said "Mommy, you know how before my brain usually goes all like wild?" He says this while swinging his arms around to show me a visual of what his "wild" brain feels like.

"Well today my brain was just not wild, it was just like this" and made a calming, controlled hand motion to describe his mental state.

Today, our son is thriving. He has a great group of friends, experiences some level of academic success, and remains a very gifted athlete. He continues to have his struggles socially, academically, and behaviorally, but these are tempered by his current combination of medication, household expectations, and physical outlets. We still clash on a regular basis (as two strong-willed individuals with ADHD are prone to do), but medication has been instrumental in helping him experience success and build self-confidence.

Our son continues to be one of the most stubborn and spirited kids we know, and we love him dearly and unconditionally. When parenting a child with ADHD, medication was probably one of the best decisions we made. We get confirmation of that decision every day.

Disclosure: Prior to writing and publishing this post, I talked with my oldest son and obtained his permission to tell his story. Throughout the process, I asked for his input and feedback.