- Mental Health
ADHD Medications: Symptom Management and Alternatives
ADHD and parents
I often hear people my age and older questioning Attention Deficit Disorder (or ADHD- Attention Deficit Hyperactivity Disorder) and the fact that so many kids are now on prescription ADHD medications to help them concentrate and focus in school. Most of us can remember a few children from our school days who were often referred to as hyper but the children who could not focus or concentrate were usually just considered less intelligent. Parents these days aren’t so quick to give up on their children and neither are educators and pediatricians. Still, many parents believe that medicating children to help them manage their behavior problems in school is a bad idea. As parents, we are likely to feel very uncomfortable at the thought of relying on ADHD medications to help stimulate parts of the brain so that children can better concentrate and focus.
Many parents have strong feelings about the ADHD diagnosis. Some parents think it is something that is being pushed by doctors and pharmaceutical companies and that it doesn’t really exist: in essence, they believe it is just some type of money making scheme. Other parents believe that the schools just aren’t doing a good enough job of managing children and that it is the fault of teachers and administrators who would rather drug kids than help them learn to better manage themselves in school. Other critics believe there is a problem but that it is the result of lazy and selfish parents who sit their kids in front of video games, movies, and TV all day and don’t take the time to prepare them for school and to help them become learners. All of these criticisms may have some degree of truth to them but for many parents using ADHD medication for their ADHD diagnosed child is something they struggle with greatly.
ADHD medications: Side Effects
Over the years I have worked with some incredibly distracted and impulsive children who really do struggle significantly with their ability to pay attention and focus. The majority of the children I see have also had some type of serious trauma in their lives so the issues are often compounded by post traumatic stress disorder. In many instances, the children also have issues related to fetal alcohol spectrum disorder, which even further complicates the diagnosis. However, one common worry I found among parents and foster parents who are responsible for a child who is prescribed ADHD medication is concern over the side effects. Many believed that the medication seemed to cause too many other problems and so they chose to take a child off the ADHD medication at some point.
The most common side effects that parents complained about were: 1. that the child usually ate much less and they believed the medications were negatively affecting nutrition and food intake, 2. the child’s personality seemed to undergo a drastic change with the child often being described by parents as zombie-like. Most parents would rather have their hyperactive child with their huge easily distractible personality than the emotionless, low energy, often irritable child they began to see when a child began taking ADHD medication.
I recognize that many doctors and pediatricians do monitor these side-effects closely and many are more than willing to try different medications and different dosages of medications to help manage the ADHD medication side effects. However, I have also witnessed these medications being doled out in ten times the recommended amount for children (based on body weight) because some professionals could not come up with better options for a child with serious psychological and behavior problems. However, the fact remains that no matter how conscientious a pediatrician is, some parents will still be unwilling to consent to using ADHD medications to manage the behavior of their children.
ADHD treatment and the consequences of not using treatment
I can also say that I have seen a lot of evidence that ADHD medications do indeed help children focus and concentrate and can therefore help facilitate learning in school. Prior to working in an alternate school program myself I would have been very leery of such claims but when working with certain students I would often notice they would have a very good grasp of certain principles or concepts. Sometimes to a point that seemed completely out of proportion with the rest of their academic skill set. For instance, I would notice a child had a very good grasp of multiplying fractions or maybe they were very good at solving polynomial equations. When I would ask a student why they were so good at that particular task they would inevitably say I learned that the year I was on ADHD medication. When I asked why they stopped they always said the same thing, my parents didn’t like how I was on my ADHD medication.
Children left untreated with ADHD are at risk in a lot of different ways. Children who are not treated for ADHD are more likely to eventually have discipline problems and be expelled from school, they are more likely to have accidents, these children are more likely to get involved with drugs and alcohol, they are more likely to get pregnant (just the girls of course), they are more likely to have employment problems, and they are more likely to end up being involved on the wrong side of the justice system. While parents may have concerns about ADHD medications, they should also be equally concerned about potential problems down the road for their children.
ADHD Medication: Prevalence and Choices for Parents
The prevalence of reported ADHD is quite high. The CDC in the United States reports 5.5% of children 5-10 years old, 8.6% of children 11-14 years old, and 9.3% of young people 15-17 years have been diagnosed with ADHD. Roughly two thirds of these children are being treated with ADHD medications. This means that another third are not taking any medications. I am guessing this is often a decision of parents who don’t want their children medicated for a variety of reasons, some of which have already been discussed. If parents are unwilling to have their children use ADHD medications then it is hoped they are at least considering using alternative methods to help manage the ADHD symptoms of their children.
So the issue for parents becomes one of two possible choices for parents of children who have an ADHD diagnosis. The first is to allow the child to take ADHD medication but to manage the dosage and the use of ADHD medication in consultation with the prescribing physician, so that the benefit of the medication can be utilized with the least amount of side effects for the child. The second is for the parent to try to find ways to address the problem by trying to find natural remedies for ADHD. Either way parents should create a plan that can be monitored and evaluated to see if they are helping their child manage the symptoms of ADHD.
Managing children taking ADHD medication.
If a parent decides to go with their doctors recommendation to give their child ADHD medication, it is still a good idea for parents to do a little homework and find out what options they have. The most common type of ADHD medications are stimulant medications and, without getting into too much science here, let’s just say they help children by making the connections in the brain work more effectively. Certain chemicals in the brain that are associated with brain functioning are more efficient when stimulant ADHD medications are used. The name of the stimulant is methylphenidate but it is more often known by the common brand names Ritalin, Concerta, and Metadate. These ADHD medications only help reduce the symptoms of ADHD while they are being taken by a child. ADHD medications do not act as a cure for the disorder.
Children who take stimulant ADHD medications are often referred to by their parents as zombie-like. If a parents notices this they should discuss it with the prescribing doctor. The prescribed dosage may be too high. Another issue for parents is loss of apatite. Some parents try to manage this by having the child take one long lasting pill in the morning and no other ADHD medications for the rest of the day. This way the child will usually be hungry by the time they get home from school. Some parents will also only use the stimulant for school so that the rest of the time (in the evening and on weekends) the child will have their normal apatite. High calorie nutritious supplements like PediaSure or similar nutritional drinks are often a good substitute when a child refuses to eat during the day. Any meal replacement drink or bar the child will eat is better than not eating at all. However, discuss any use of supplements with your pediatrician. It is also a good idea to let children taking ADHD medication eat when they are hungry, even if it is late at night and they are suddenly ravenous. It may interfere somewhat with their bedtime routine but if parents don’t allow them to eat they will likely end up hording food because the hunger they experience is very real and very strong.
Parents can also try to supplement ADHD medications by implementing some of the suggestions for treating children with natural remedies for ADHD. Ideally we would like our children to function as well as they can without the use of stimulant ADHD medications. However, if we do choose to have our children take meds, there are still other ways we can to try to help your child manage the symptoms of ADHD during the times when they are not taking their ADHD medication. While these suggestions are not intended to be considered a cure, I have personally seen improvements in many children who made some of the changes that are suggested below.
Alternatives to ADHD medication: Diet
Parents often ask for natural remedies for ADHD. However, remedy is probably the wrong word as ADHD symptoms are something children and parents can learn to manage, but there does not appear to be an actual remedy.There are a number of alternatives that have been suggested as an alternative to the prescription drug approach. These alternatives usually require a significant commitment on the part of parents but in some cases they do allow children to function better without having taken ADHD medication.
The most frequent suggestion is to make changes to the ADHD child’s diet. Over the last thirty plus years the amount of foods containing preservatives, food coloring, additives and other unhealthy substances has skyrocketed. The removal of these foods along with some other less healthy products like those containing sugar and other simple carbohydrates can make a difference. The amount of caffeine kids often ingest is also a big problem. Natural foods like nuts, fruits, and vegetables can make a massive difference. It is also good to add fish or fish oil as a supplement. The omega three in fish oil has been shown to stimulate the brain and help build better connection in the brain. I have personally noticed significant improvement in some children who were given healthy amounts of omega three in their diet.
ADHD treatment alternatives: "Natural Remedies for ADHD"
As I have already stated the term remedy is probably misplaced with regard to treatment for ADHD. As much as parents would like a pill to fix the problem, ADHD is not something that children catch. However, there are other supplements besides omega three that may also be of benefit. Zinc, iron and magnesium have also been suggested as being helpful along with herbal remedies like gingko biloba, valerian, and skullcap. I have not seen any noticeable difference in children who were given these types of herbal remedies but they may have some benefit. The zinc supplement, in particular, has been shown in other instances to improve brain functioning so it is definitely something parents should consider. However, the omega three supplements should probably be a top priority, unless a child has some type of allergy to fish oil or plant seeds like flax. There are a lot of different sources of omega three though so parents should be able to find something that works.
ADHD treatment alternatives: Exercise
The amount of exercise and strenuous activity children engage in has also decreased significantly over the past thirty years. Schools have cut back on P.E. classes and more and more children spend time playing indoors and living a sedentary lifestyle. Sitting in front of a television or computer watching shows or playing video games is not likely to stimulate the body and brain the way nature meant them to be stimulated. However, a good exercise routine can help make a significant improvement for ADHD children. Like some supplements, exercise has been linked in many studies with improved brain functioning. If kids have to play video games then parents should at least consider a Nintendo Wii as some of their games do involve exercise and physical activity.
ADHD treatment alternatives: Parenting ADHD children differently
Parents who yell and scream and generally react strobgly when their ADHD child is misbehaving can help their child by learning to use a
more consistent and calmer approach to parenting. When children are yelled at it
often releases chemicals in the brain that reduce the child’s ability to focus
and think straight. When cortisol is released children often experience a sense
of disorientation. By using timeouts and calm assertive discipline, parents can
help their child better control their impulses and focus. The more parents
are able to incorporate predictable rituals and routines (like a bed time routine) into their daily schedule, the better
their kids will be at organizing themselves for daily events. ADHD children almost demand routine and structure and it definitely helps them and those who are parenting ADHD children.
ADHD treatment alternatives: Reducing stimulation
Lastly, parents can reduce the amount of stimulation in the environment. The bedrooms of children and other play spaces need to be cleared of unnecessary toys and clutter. The less distractions, the better. Children with ADHD need to find ways to learn to cope with the everyday reality that is not over stimulating and entertaining. Reducing stimulation in the environment helps these children learn to better focus on tasks without being distracted. This is especially true when they are doing homework. Children with ADHD symptoms also seem to benefit when parents provide them with limited choices such as choose this shirt or that shirt, or this fruit or that fruit. Keeping things simple and not overwhelming them with too many choices will help these children learn to cope better.
In some studies, videogames have also been associated with exacerbating some of the symptoms of ADHD. While kids with ADHD symptoms can often hyperfocus on very stimulating video games, their ability to focus on the everyday mundane tasks of daily living become more and more of a struggle. ADHD children who frequently play videogames can also tend to become easily agitated and antisocial. It seems only logical that they are not learning to cope with less stimulation if they are allowed to continually overload their brains.
ADHD medications and treatment: A few final thoughts
The suggestions listed above can often help children taking ADHD medications as well as those who don’t want to rely on prescription drugs. Parents may not be able to cure their child of the symptoms of ADHD but they can certainly do some things that will hopefully allow their child to be a little more organized and focused and a little less impulsive. There is no magic pill. Even stimulant medications are only there to alleviate some of the symptoms of ADHD.
It is important to remember our children are not disorders. In the case of ADHD they are merely young people who struggle with being able to focus and concentrate and control their impulses in certain environments. These symptoms present differently in different children. While much of the literature focuses on what children with ADHD supposedly cannot do and on what their deficits are, as parents we owe it to our kids to focus on their strengths and while helping manage those areas that may need improvement. Thinking of our kids as works in progress and knowing there are ways to help them better manage and cope is part of our job as parents. I have come across to many parents who refer to their child as their ADHD child but we need to remember the label is not the child. In fact, it isn't even close.
One last caveat. More and more doctors are suggesting that
children take ADHD medications at home in the evening and weekends in order to help keep children
more stable and to prevent potential involvement with drugs, alcohol, or other dangerous
and antisocial activities. To many parents, this may seem like too much
and that is a decision each parent should make for their child. Personally, I
would want to use as many non medicinal methods as possible. Still, ADHD medication can be of great help those
kids who really need them, especially for school. No child in this generation needs to be considered less than because they are experiencing symptoms of a disorder that makes focusing and concentrating more difficult. Unlike the generation I grew up with in school, these children do not need to feel less intelligent because they suffer from these symptoms. As parents though, we still want to find that balance by helping our children who are experiencing ADHD symptoms learn to manage their symptoms in a variety of ways and not become convinced that the only way for them to manage is by using ADHD medications.