ADHD medication quandary

Q: My 9-year-old has been diagnosed with ADHD. I am struggling with the recommendation that he be put on medication. What are the best alternative treatments?

In my opinion, when a child has been appropriately diagnosed with ADHD after a good evaluation, he or she deserves medication treatment. I believe medication is usually an important part of a treatment program. I prefer to think of the other components of treatment not as alternatives to medication, but other components of a good treatment program.

Before I return to medication, I want to list some of the other components of treatment that are usually needed and, sadly, often neglected. I believe a person diagnosed with ADHD — including a child — needs to understand the disorder. Parents need education to help them thoroughly understand the disorder. Related to that, parents need help and support in developing and implementing a good behavioral program at home. Finally, but just as important, is the complex matter of trying to help the child get the help he or she needs at school. From their doctors, from their parents and from their teachers, these children need a lot of help and support. I fear many — maybe most — do not get close to getting all they need.

Medications for ADHD have always been controversial among the public and the press but, frankly, far less controversial among the professionals who research and treat these children. The medications have probably been researched more than any medications given for any purpose. I think an honest review of that research, and the experience of physicians, is that the medications for ADHD are largely safe and largely effective.

I say “largely” safe and effective because there is no such thing, as far as I know, as a completely safe or a completely effective medication. All medications — and all treatments — have to be evaluated in terms of the potential benefits against the potential risks.

But, as part of that consideration, I believe parents should know that there are very real and very serious potential problems with having ADHD and not getting appropriately treated. There are short-term and long-term problems. As a group, individuals with ADHD who do not receive appropriate treatment tend not to do well. They have more academic failures. They are far less likely to graduate from college. They have more arrests, more divorces, more job changes, and many more short- and long-term problems.

All that said, it is completely understandable and appropriate for parents to have reservations about any medication. Share your concerns with your child’s physician and give the doctor a chance to address them.

Dr. Dale Wisely is Director of Student Services at Mountain Brook Schools and has been a child and adolescent psychologist for 30 years.