ADHD: To Medicate or not to Medicate--That is the Question

by Kristyn Crow | More from this Blogger

20 Sep 2006 09:30 AM

Not long ago I received written warnings about my two stepdaughters' ADHD medication in the mail. It was sent to me by Rite Aid pharmacy, where I pick up their meds. I decided to investigate the issue further.

In April of 2006, the New England Journal of Medicine reported that the FDA had voted to issue a "black box warning" for patients taking controlled substances as a treatment for Attention-Deficit Hyperactivity Disorder (ADHD). (The vote had a narrow margin of eight to seven.) What happened was that the FDA had decided to take a closer look at the potential cardiovascular risks associated with these drugs, and prior to making any findings, unexpectedly decided to take action, regardless. They determined that not only would the blackbox warning be issued, but patients, upon their medication being dispensed, would be given written information in "non-technical" language about possible risks.

Cardiovascular Risks

My two stepdaughters' Adderall falls under this blackbox warning. Adderall is an amphetamine. Amphetamines and methylphenidate (Ritalin, Concerta, etc.) are all part of this risk review. The FDA is basically saying that we don't have reliable information about what kinds of long-term affects these drugs will have on children. But it is known they have an immediate stimulant affect on the cardiovascular and central nervous systems. That means that blood pressure is raised and heart rate is increased. These elevated levels, over time, could potentially be hazardous. In fact, studies have shown that long-term increased heart rate and blood pressure are reliable predictors of cardiovascular problems.

One month later, May 25, 2006, the New England Journal of Medicine printed a correction stating,

"We agree that patient safety is paramount and that the long-term benefits and risks of stimulant treatment are not known definitively, yet we are concerned that such a warning will discourage patients and their families from using effective treatment. Untreated ADHD is associated with an elevated risk of substance abuse, academic failure, and motor vehicle accidents and an increased rate of psychiatric disorders."

They went on to say that 70% of patients with ADHD showed improvement with medication, and a similar group who pursued only a psychotherapy-approach had significantly lower improvement.

It appears that even the medical experts are conflicted on this matter. Should we be medicating children with ADHD?

Two Camps

There are two camps furiously debating the issue. With a quick internet search you can find groups who are adamantly opposed to Ritalin, in particular. They claim that some children have died sudden, unexpected deaths when taking it. Others stand up and say that medication transformed their lives. In one particular account I read, a man stated that he was literally "living in a van down by the river," prior to getting medication for ADHD. The medication changed his whole life, and he recently graduated with a medical degree from Brown University.

Important Considerations

In my view, the question of whether or not to medicate must be taken very seriously. As parents we should ask ourselves the following:

1. How serious are my child's ADHD symptoms? Are my child's symptoms causing significant disruptions in his education and social life? Is he headed for academic failure and complete social isolation? Or are his behaviors merely annoying?

2. Is ADHD even the right diagnosis for my child? (Often ADHD can mimic other psychiatric conditions, such as bipolar disorder. Medications typically prescribed for ADHD can make bipolar symptoms even worse.) Could my child be gifted, rather than have ADHD?

3. Could other therapies be explored for my child, such as behavioral therapies or an alternative educational setting?

4. Have I discussed, in detail, the risks of medicating with my child's physician? Have I weighed the pros and cons?

5. Am I willing to be accountable for any possible negative outcome brought about by medicating my child, because without the medication the quality of her life would have been severely limited?

The potential risks associated with medicating are serious enough that we've got to be able to answer these questions before blindly giving pills to our sons and daughters. For now, I will continue to keep myself informed, and be vigilant with medical checks for my stepdaughters. However, prior to their Adderall doses, their academic and social futures were grim. I hesitate to undo what has been a miraculous transformation. For now, I'm keeping an open, yet guarded, mind.

Kristyn Crow is the author of this blog. Visit her website by clicking here. Some links on this blog may have been generated by outside sources are not necessarily endorsed by Kristyn Crow.

Related Articles:

Stimulant Therapy for ADHD

Strategies to Improve Coping for Kids - Stick-to-It ADHD

Learn more about Kristyn Crow

Kristyn Crow is the mother of seven children, and the author of three children's books. Visit her website at www.kristyncrow.com.

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babydawn (7008) 20 Sep 2006 09:49 AM

I think that is wise counsel. Open, yet guarded. My niece is a complete nightmare when she is not on her meds. The medication truely can transform lives. Of course there are risks, there are risks with most medications we take. What we need to ask ourselves is if the medication is really working and if the child really needs it at all. I have a son who just bounces off of the walls at home and often I think he is ADHD, however, this has yet to really interfere with his social life and his school work, so for now, I will let it be. Another option is to talk to your doctor about Strattera, which is a non-stimulant and not a controlled substance and although it doesn't work for everyone, it has worked really well for my brother.

Anna Glendenning (4234) 20 Sep 2006 10:36 AM

How Ironic! As you published this blog I was finishing up on my Blog:

ADHD or Sleep Apnea?

http://special-needs.families.com/blog/adhd-or-sleep-apnea

Our 4 year old had a sleep study done in April and is Dx with Obstructive Sleep Apnea Syndrome, his issue may be sever enlarged tonsils. Before we even consider medication for symptoms which appear to be ADHD his doctor has ordered his tonsils to be removed. The theory is that his Apnea caused sleep deprivation which appears to look like ADHD during the day!

adhderdotcom (6) 26 Sep 2007 12:20 PM

Good article don't medicate. Read "Transforming the Difficult Child" and "Lateral Thinking" by Debono. The first book should be followed to help your child and the second to help you understand how ADHD (right-brain) people think.

More can be found at my blog adhder dot com.

Keep up the good fight. Don't medicate.

Whats worse risk of causing a childs early death or internal problems and a life dependency on medication or maybe they get held back a year in school?