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Dance of the ADHD Meds, Part I

September 12, 2011

How We Got to the Point of Trying Meds

Until now, I’ve tried not to name the medications we’re trialling with Hope because children are so different neurologically –even those with common underlying issues like FASD –that there is no such thing as a “best” drug for ADHD. Many kids eventually will find a med that normalizes their unique neurochemistry. But what works for Hope may not work for someone else and vice versa.

However, several people lately have asked if I’d name names with meds we’ve tried. After considering it, I think there is some value in that. Not because I can recommend one for anybody else’s child. But because it seems that many of us trial many meds before finding the right one at the right dose, in a form our kids can ingest. Maybe there are some broad principles in our journey that will encourage someone else.

First common thing I’ve observed: I have not yet met any family who was eager to try medication. Almost all of us have tried coping with the ADHD behaviors many different ways –from waiting for the child to mature, to occupational and sensory integration therapy, to specialized parenting techniques. In the end, we consider medication because the other things we’ve tried make little or no difference. Or in the case of therapies that seem promising (we’re still using iLs), it may take so long to finish the whole program (in our case, over a year) that we feel like we don’t have the luxury of waiting any longer.

A second common theme surprises me. Many young kids with ADHD seem to have a rougher time in their home environment than anywhere else. That may simply be a factor of my friends and their friends tending to stay home with their children while they are young. So maybe the pool of people I talk to is skewed. But pretty routinely, other moms tell me they finally start considering medication when the burden of the ADHD symptoms becomes too great on the whole family.

That observation raises a problem for diagnosis. Kids are now being diagnosed with ADHD at much younger ages. But the diagnostic criteria were developed in the days when ADHD was not routinely diagnosed until elementary school, when a teacher typically observed the behavior. So the diagnosis, as far as I know, still includes a “in two or more environments” criterion. The teacher would say: “I notice these symptoms at school…” and parents would be asked to complete an inventory of behaviors at home.

I actually sent Hope out to preschool in part because I was sure her teacher would back me up. Nope. Each year when I raised the possibility of ADHD, they assured me she was a sweet, well-behaved child with an age-typical attention span. (My other reason for sending her out to preschool: I needed a break.)

So Hope basically held herself together for 2.5 hours of preschool three mornings a week and 1.5 hours of Sunday School. But the stress of working so hard when she was out of the house meant her behavior was even worse at home. Here, it was safe to fall apart and she did. We did not get Hope’s magic “second environment” until her FASD evaluation, during which her psychiatrist noted ADHD symptoms. (Hallelujah!) She referred us to a psychiatrist specializing in ADHD.

It is a measure of how much the ADHD symptoms were weighing on our family that I was not depressed to get a formal diagnosis of ADHD. By that time, I’d educated myself about the neurochemistry of ADHD and was convinced that in Hope’s case, it was a “righteous” diagnosis –the real thing, not other things mimicking ADHD. I felt like her diagnosis was a golden ticket to trying to balance out some of her neurochemical deficits.

I was right. But I had no idea how wild a ride it was going to be.

9/13 edited to add: Dorothy just made a great post on the subject of how to know if it is the right time to consider trialing meds. If you’re thinking about it, click over and read.

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