The Difficult Decision to Medicate My Child

This is my son, Conrad. He recently turned 10 years old and like any other boy, he loves Legos, animals, football and Minecraft. He is smart, creative, happy-go-lucky and an overall great kid with an amazing sense of humor. He also has ADHD – so he can be impulsive, absent-minded and sometimes difficult to handle. He is hyperactive and has a hard time sustaining attention on anything for more than a few minutes. To use a common analogy, he has a Ferrari brain, with bicycle brakes.

My son has ADHD but I will not let him be defined by it.

If I was sitting in a circle at one of ‘those meetings,’ I would tell you ‘Hi, my name is Karri and my son is taking Ritalin.’ But we aren’t in a circle and this is not confession time. Instead I’m going to envision that we are at a coffee shop and I’m just telling a friend or two (or 3,000) about the tortuous decision my husband and I have made to put our son on stimulant medication.

Arriving at this decision has not been easy.

Despite being my first, I knew in my heart Conrad was different than other babies. He had colic, difficulty nursing, and never slept. Even though I breastfed him for 13 months, he was sick a lot and had multiple ear infections that led to several surgeries. He was an inquisitive baby, always aware of his surroundings and very observant. He crawled at 6 months, cruised at 8 months and walked at 10 months. Calculator was his first word, spoken at 12 months. By age 2, he was talking in full sentences. But he would not could not sit still. The distinction between would not and could not is very important and I will get to that in a minute.

I know some of you are thinking, oh he was just a busy boy. Boys are wild. No kid likes to sit still. She was just an over-reacting first time mom (as if all first-time moms’ concerns are exaggerated and invalid). The definition of ADHD is hyperacitivity and impulsivity to a degree that is greater than other children of the same age. So yes, most preschool-aged boys are active, but Conrad was characteristically more active, inattentive and impulsive than his typical peers.

Around the age of 3, we brought up our concerns to our pediatrician. ADHD has a genetic predisposition, and since it runs in my husband’s family, it was on my mommy radar from the beginning. She agreed that he seemed to fit the description, but said he was too young to make a formal diagnosis. The next year was rough for us, but even rougher for Conrad. He had to navigate the world with a younger brother. He did not respond to the typical discipline tactics like time out and redirection that worked for other kids. He was like the Energizer Bunny, always on the go. My husband and I felt very alone, often misunderstood, and a little bit helpless.

When Conrad turned 5, we turned to a developmental pediatrician for help. His testing and evaluation confirmed what I knew in my heart all along, that Conrad met all of the diagnostic criteria for ADHD. He quickly helped us understand the difference between would not and could not. It wasn’t that Conrad would not sit still, it was that he could not sit still. Kids with ADHD have brains with structural size differences. Their brains exhibit less activation from the regions that control attention, impulses, organization, and planning. My mother’s intuition told me that Conrad was not being naughty. In fact, he was trying very hard to do the best he could to function in this world.

When we shared the diagnosis with friends and family, most were supportive. Some were skeptical, and even a few were downright hurtful. There is always someone who will tell you that ADHD is not a real diagnosis or that it’s kids just being lazy. We had a few friends tell us that essential oils would cure him, or that a dye-free/gluten free/organic diet is the answer. I wish it was that easy. ADHD was in my son’s genes long before organic farming practices were even invented. The worst is when someone criticizes your parenting skills and says you need to be a better disciplinarian or thinks he is just acting out and not listening because he is a brat.

ADHD was (and is) a part of who Conrad is so we made it our mission to learn as much about the disorder as possible. In the beginning we were hopeful to manage it without medication and we tried valiantly. Things like giving him clear 1-step directions and using little timer clocks for time management. We had a routine with structure to make it through the day. We gave him breaks and down-time regularly. We found ways for him to use up all that energy. We bought a mini-trampoline and visited every indoor and outdoor park in the metro area so he could run free. We spent hours outside, getting fresh air and sunshine which seemed to help, if only a little.

We stumbled through the next few years, doing our best to control his behaviors and hoping that he would improve with the formality of school. Preschool and Kindergarten are set up in such a way that they allow for a variety of activities to grasp young ones’ attention. Kids usually sit at tables for a short period of time rather than at a desk. Learning through movement and activities is a big part of those years. But first grade and beyond is a different story. Each school year, the demands for attention and sitting quietly get greater and greater. We met with his first grade teacher at the beginning of the year and developed a strategy. Conrad would sit at the front of the classroom. He would get extra sensory breaks as needed. The teacher would use visual prompts whenever possible. All of these helped, but by his first conference that fall, it was apparent that he needed more help. One could argue that the traditional school model does not lend itself well to many boys, let alone one with ADHD, but that is a whole different blog post.

Together with our developmental pediatrician and after much deliberation with my husband (some discussions were intense, many ended with me in tears), we agreed to try Conrad on a stimulant medication. It seemed odd at first to give a stimulant to someone who is hyperactive, but the medication actually stimulates the brain to focus. Once the brain can better concentrate on the task at hand, the body doesn’t act so impulsively and hyperactively to stay engaged. Understanding this was another “lightbulb moment” for me.

We waited until winter break to start. I wanted to be there to watch him closely. Yes, there are side effects, scary side effects that we hope and pray never happen to our son while taking medication. The incidence is very low for these and we feel he has a greater risk of getting hurt because he impulsively runs in front of a moving car chasing a runaway ball or makes a poor decision while riding his bike. After he takes his first pill, there is a notable difference in his behavior. That week, despite being a chaotic and busy holiday, we were able to play an entire game of Monopoly with his full attention. He was not bouncing off the walls with his activity level. He was able to slow down enough to actually read and do his homework packet without getting up to move around. The difference was astonishing. The positive impact on his self-esteem was equally as amazing. Thankfully, the results carried over into the school environment. It took several different medication trials and dosage changes to find the right fit for our son. Supposedly, this is normal and we are thankful for a physician who provided great guidance and care.

Funny thing is, even though he has responded so well to the medication, it still feels really weird to me. Even if it’s just in my head, I already feel like an outsider at my son’s school because I am not a SAHM and I don’t drive a black Honda Pilot while wearing Lululemon pants when I drop my kids off in the morning. But now I am THAT mom. It also feels odd because I am usually so anti-medication. I gave birth without drugs. I can’t remember the last Advil I took – we don’t even have it in the house. This may be controversial, but I don’t treat my kids’ fevers with Tylenol if it’s under 102 degrees. I figure the fever is there for a reason and my kids will get better sooner if the fever can fight off whatever bug they may have. Now Conrad also takes Melatonin before bed since a side effect of the medication is difficulty sleeping. Adding to the emotional complexity of my feelings, some days I feel guilty that we didn’t start the medication sooner. We would never expect a child who failed a vision test to squint for months before getting prescription eye glasses, would we?

Friends, one important thing I want you to understand is that medication is not the end of the story. We didn’t just stop doing all the behavior management because the medication was working, and we don’t intend to. It’s not like the medication makes him perfect, it just makes it a little easier for him to focus. He still struggles to pay attention, but less than his pre-medication days. No parent ever says, “I’m going to give this pill and then stop all other interventions.” The medication actually enhances the behavior management and allows Conrad to learn better, both in academics and general life skills. We kept him enrolled in occupational therapy and now he takes social skills classes to help him engage better with his peers. He meets weekly with an ADHD coach who helps him follow through with some of these behavior strategies in real-life situations, especially as he transitions to middle school soon. These therapies are time intensive and exhausting (for him and for us), not to mention expensive. Our goal is to teach Conrad the necessary tools to manage his impulsivity and inattentiveness so that he does not need to take medication forever, however we understand he may need it long term. ADHD improves for some in adulthood, but many struggle with certain aspects of it forever.

Some people with ADHD consider it a gift, a blessing. I am not there yet. I have yet to see the benefit it has given my son, as it has been a difficult journey thus far. I hope that someday I will be able to look back on our experiences and feel that way, to be thankful. But I will say this, it has taught me to celebrate the small achievements that perhaps I would have overlooked before. And I recognize that it is these common traits that have paved the way for much creativity, innovation and ingenuity in this world. Dr. Ned Hallowell, a world-reknowned ADHD expert who lives with the disorder, has this to say: “These are the people who colonized our country…just think, who in the world would get on a boat in the 1600’s and come over here? You had to be some kind of a nut. You had to be a visionary, a dreamer, an entrepreneur – you know, a risk-taker…this country is absolutely full of ADHD.”

So there you have it…maybe none of us would be here, because America wouldn’t even be here, if it weren’t for some person with Attention Deficit Hyperactivity Disorder. I guess that is cause for great celebration, and certainly even some thankfulness.

Shine On-

Karri

**ADHD is one of the most common childhood brain disorders. While it is more prevalent in boys, it can also affect girls. If you suspect your child may have it, please consult with a physician or visit here for more information.