To Medicate, Or Not To Medicate

[Anonymous]

Our nearly 14 year old son has recently been diagnosed with ADHD-PI and we now have to make the decision whether or not to trial medication. The psychologist who diagnosed him said she believed it probably wouldn’t be necessary, as he his case is on the mild end, rather than severe, and she thinks behavioural therapy will do just fine. BUT the issue I have is that I was exactly like him at my age (not diagnosed though), and learnt coping strategies as I got older, but I still struggle to function at times. I cannot sleep easily due to racing thoughts, and I have lots of great ideas about organising my house but as soon as I get up to put them into action it is like someone turns off my brain and I lose all motivation. I hate it. And I can see the same traits in him. Obviously good habits learned young can stick well, as I have rarely been late for anything due to habits developed during my life, but getting into a good habit/routine can be difficult.

So I guess what I am asking is whether medication is likely to assist with

a) his racing thoughts keeping him awake at night, and distracting him in the day

b) his ability to focus on learning new habits to improve organisation

c) anything else??

Has anyone been in my son’s situation? What’s your thoughts. It’s all very well to read about meds and how they work and so forth, but getting info from someone who has experienced what the medications actually do will be so much more helpful.

Interestingly, his ADHD showed up on an intelligence test. The areas of the test which required executive functions (working memory, attention, etc) showed our son to be three years behind the rest of the test (which put him 18 months ahead of his chronological age – the reason he has flown under the radar for so long). We also had to give his history and answer lots of questions, so it was a thorough process all up!

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[dspicelady]

Just my two cents here, but ask your son what he wants to do. You stated that he’s intelligent so answer all of the questions together and then let him decide. Too often we make these decisions for our children with little or no input from them. If he chooses not to medicate, he’s at the very least aware of his situation, and when he’s ready to deal with it and develope coping strategies on his own, you’ll both be prepared.

Also remember, he is not you. No matter the similarity. Just support what he wants to do.

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[Anonymous]

My nephew was also diagnosed in his mid-teens and although he had medication, he didn’t like taking it. So his teen years were a bit out of control (or a lot), as far as I know. But as he got older, he realized that his friends who also had ADD and were taking their meds were a lot more successful than he was. So he started taking his meds and things settled down for him. He successfully completed a golf management program at a community college and is out on his own in the world now. I don’t know if he is continuing to take his meds but it definitely got him through what might have been one of the most important periods in his life, deciding what he wanted to do and following through on it.

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[Bibliophile]

As he is 14, I think he has the right to make the decision after being informed of the options. Behavioural modification/counseling may benefit him for task completion. But, medication may be the right route for him also. Try and see. If it helps, continue. If not, look for something else. So much of treatment is trial and error.

My own experience with stimulant withdrawal saw a drastic reduction in school performance for many years until I was able to develop coping strategies and even they are not foolproof. I stopped taking meds in Grade 7, having been diagnosed in Grade 4, and went from B+ to D student overnight. My decision to stop taking meds was to assert personal control over my situation and I am not comfortable taking medication. I made it through two university degrees with a LOT of difficulty and shifts in focus. I should note that I am a combined type and not inattentive type, which some view as completely different disorders from one another, e.g. Dr. Russell Barkley. The stimulants help with my need to move about and ability to continue with a task for a longer period of time, but that is it. They don’t help me start tasks or stay on topic/task.

I read somewhere that stimulant treatment of the ADHD-PI subtype has a lower likelihood of being beneficial than for the combined type with other treatment options seeing higher rates of improvement, but I can’t remember the source.

The good news is that the should be little to no impulsivity from the disorder, which can cause quite a bit of havoc for developing ad keeping social bonds, spending limits and other responsibilities, as this is not usually an associated impairment with that subtype.

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[Anonymous]

Thanks guys. I did talk to my son about meds, and I know he is happy to try them, but he also is very inquisitive and likes to be informed, hence my post. I was hoping to be able to give him some viewpoints of others who have been there, so he can better make an informed decision. We have time up our sleeve, as we are yet to get the psychologist’s report thst we will need to take to a doctor if we want to go down the medication path.

I guess I compare him to me because I am the only person I know who seems to understand how he functions and what he feels, and I experience many of the things he complains about. I know what irritates him, and I’d like to be able to tell him what things the medications might help, and what they probably won’t. I suppose that I also see the potential for him ending up with similar issues to me later in life, so if medication might just help get things under control then it would be worth a try (if that is what road he wishes to take).

Speaking of which, he has just walked into the room and brought the subject up. He wants to try meds as he is feeling a bit desparate. He wants to be able to concentrate on a book because he is getting into strife at school because he finds reading difficult (despite a good reading comprehension level, he finds he cannot remember what he has read by the time he has finished the page and wastes lots of time re-reading things). He also hates the racing thoughts that bug him frequently, and not being able to focus on things in class. I am hoping that meds might just help with some of these issues.

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[Anonymous]

librarian_chef, I read also that Inattentive type don’t respond as well to medication, but when they do, it is at a lower dose that for the hyperactive counterparts. My son does have some impulsivity and hyperactive traits, but not severe or many. He interrupts, gets a bit too loud and crude and has trouble bringing himself under control sometimes. He spends money like water, and he talks a lot. And he overestimates his abilities at times which tends to result in risky behaviours. But it is all quite minor stuff overall, compared to the degree of his inattention.

Thanks to all of you for your inputs. They are greatly appreciated.

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[Bill]

Thank you, KK, for such an excellent discussion and thank you also for posting about how things turned out. Too often we see the problem but not the resolution.

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[Bibliophile]

The racing thoughts, inability to wait his turn in a conversation, talkative nature and the loudness could be signs of Combined type. The stereotypical inattentive type are daydreamers and aloof. My opinion would be to definitely try meds before anything else. Most teenagers and adults grow out of the obvious hyperactive symptoms, i.e. jumping out of one’s seat or constantly moving the body, by late teens or early adulthood so perhaps he was attributed with the wrong subtype?

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[Wgreen]

A couple of comments on the reading issue:

1) Somebody needs to publish/produce audio versions of textbooks. Kids with reading disabilities—whatever the cause—can really benefit from being able to listen to a text while they try to read it, particularly now that technology allows listeners to vary the speed of a recording without changing pitch. It also helps keep minds from wandering.

2) I was told recently (by an academic) that some current research suggests we somehow are able to recall considerably more information from a printed page than from a digital one. Interesting—and curious—if indeed true. If this is not just some unfounded rumor (and my source is second-hand), gleaning information online or on e-readers may be even MORE of a challenge for kids who have problems with reading comprehension and recall.

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[Anonymous]

LC, I know the chattiness and stuff are all hypreactive/impulsive symptoms, but they don’t occur frequently enough, and there are not enough of those symptoms to put him in the combined category. I think testosterone contributes, as they all began or became much more apparent with the beginning of puberty, whereas the inattantive symptoms have been there all along. Inattentiveness plagues him daily, but it’s only once or twice a week that we have to deal with the over the top behaviour. He has never been one to be constantly on the move. When rating him on the various tests around the place, he only scores about a 5/9 on the hyperactivity/impulsivity index, but would need a 6 to rate as combined. Additionally, those symptoms were not present before age 7, but the inattentive ones were (and he gets 9/9 for those!)

Wgreen, Audiobooks would be great in schools. My son’s school has a centre for the visually impaired, but they use braille or large print texts. But perhaps they have some audiobooks that we could access. I know my son loves me to read to him, so audiobooks might be worth a try.

Anyway, I brought up the issue of medication with the psychologist today and got some names of good paediatricians who carefully monitor the kids on medication (rather than send them away with instructions to “see how you go and come back if you have problems”). Now I just need to get an appointment. Not always easy when they have a good reputation.

AND…..I got the names of some psychiatrists for myself!!! At last I got up the guts to ask. I can’t believe I finally did it. It’s still only a baby step, because I now have to go to the doctor for a referral, and then make an appointment with the psych, and actually talk about my problems (OMG!!! That’s the hard bit!!!). But I guess in my favour is my tendency to race off at the mouth and spill it all in a huge rush before I lose my nerve. I talk a lot when I am nervous, my conversation jumps all over the place, and I can’t sit still. All good points when asking to be assessed for ADHD. And I am doing it now, just thinking about it. Time to go, before this post ends up as an essay

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[Anonymous]

phone anxiety, hrmm? sounds like me!!!

To quell anxiety about seeing a psychiatrist.. compare risks vs. benefit

risks: temporary nervousness or embarrassment, cost, med side effects (however, you could just stop taking it)

benefits: potential benefit to a problem which has affected nearly every aspect of your life and will continue to

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[Anonymous]

Big time phone anxiety!! I really don’t like making phone calls, especially ones where the outcome is highly unpredictable – like with ringing the psychiatrist…there are variables about appointment lengths, whether or not I say why I want the appointment, considering what to do if there isn’t an appointment vacancy for many months, what about if the appointment I am offered clashes with something, deciding if I can afford the cost at the time of the appointment, what do I do if they want me to bring a significant other (not likely, but it still passes through my mind), and so on. Then I have to do it all over again if the psychiatrist isn’t seeing any new patients. Eeek!!

Actually, I think the worst bit might be getting a referral from my GP. I think I might go to a different doc for that one. Maybe where I took my daughter for her mental health care plan for anxiety issues. She was a lovely doctor, and I don’t have to go back there again if I make a total ass of myself!! But if it turns out well, it’s someone else I can see if I feel I can’t talk to my usual GP (who I go to mostly because he bulk bills so I don’t pay anything, and he’s also not too bad at making sure things are thoroughly checked out).

I will get there in the end, especially with the support and encouraging words I have found here, so thanks heaps.

Regarding my son – I got an appointment with the first paediatrician on my psychologists list. The one she liked the best due to his follow through and careful monitoring, so I am really happy. It’s in 4 or 5 weeks though, but I am sure the time will speed by, as I have to arrange to discuss things with the appropriate people at my son’s school, take my daughter to her social skills class, on top of all the usual things I have to do, like work, chores, and all that other stuff.

Actually, does anyone have any tips about dealing with his school? Obviously I need to tell them that he has ADHD, but apart from a bit of extra one on one where possible, and making my son take responsibility for his actions (like if he does not wake up in the morning, we are to leave him be and let the school dish out whatever punishment is given for truancy), the psychologist didn’t really advocate much in the way of changes to his school environment. I certainly agree with him taking more responsibility, as he is becoming too reliant on us to nag him etc. We won’t be there to nag when he leaves home, and when he gets a job, he will also have to take responsibility for his own actions much more than he does now. But I feel there should be some concessions at school to help him learn what he needs to – the sort of things that an adult with ADHD would arrange for themselves, like audiobooks if reading is difficult, being able to leave his phone on in class so he can use reminders for music lessons and access the calendar and other organisational tools, or be able to listen to music to help filter out distracting noise while he is working. What has worked for others at school?

(Sorry for yet another long post. I just can’t seem to help myself )

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[Anonymous]

Well, so far I have not yet had a chance to talk with my son’s school. I have done up a folder with my son’s psychological profile/report, and some pages from Chris Dendy’s website (which I think is a great starting point for ADHD info) that include ADHD in terms of executive function and effects on schooling, info for teachers, info for parents, and info for teens. I thought it would be a good idea to have some info in one place so that anyone who is interested can have a quick read, including hubby, my son, our family, and teachers. I also thought I might add a list of what ADHD “problems” my son experiences, such as sleep disturbances, reading issues, difficulty with mental calculations/manipulation and such, so that people can see how ADHD affects him as opposed to others with it, in order to better understand him and assist him. We have had patients that have come through work with a disorder that we know almost nothing about, and when they take the time to supply some information about their condition and how they are affected, it really makes a difference to those who nurse them. We then know what we need to watch out for, what is “normal” for them, and how best to help them. I’d be interested to know if teachers appreciate the same sort of thing from their students.

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[Anonymous]

this is sort of irrelevant… Your anxiety seems somewhat similar to mine. I got a lot of benefit from reading over this material. http://www.cci.health.wa.gov.au/resources/infopax.cfm?Info_ID=46

i apologize for the unsolicited advice. I hope all goes well for you and your son

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[Anonymous]

Hey cool! That’s a pretty useful website. Thanks! My daughter has generalised anxiety disorder, so it will help her too. I watch her stress over all sorts of “trivial” things and it’s painful to see her like that. The hardest thing to do is to turn my back and say “you can cope with it”, but it certainly works in the long run. Her confidence is improving and she is sleeping better now.

I rang my son’s school this morning to ask what I have to do with regards to informing the right people of his diagnosis and discussing strategies to help him succeed at school. Found out that I have to fill in some sort of form. So now I have to go in and get the form. If I hadn’t been so tired at the time, I would have thought to ask them to send it to me. But then again, my brain doesn’t generally think that fast at the best of times, so maybe I wouldn’t have 😉

Still have to arrange an appointment for me And then sort out referral letters for both of us. Ugh! Why can’t anything be easy?!!

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[Author]

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