Parenting a Child with ADHD

ADHD Basics

A mom filling out a form about her child at her pediatrician's office.
The parent versions of the ADHD checklists will help evaluate for ADHD symptoms at home. Photo by RichLegg/Getty Images

A child being diagnosed with attention deficit hyperactivity disorder is very much different than his getting diagnosed with strep throat, a broken arm or diabetes. Although they are all medical conditions, with ADHD, many parents either openly or in the back of their minds wonder if their child's ADHD is because of some failure on their part.

I thought it would be easier being a pediatrician who cares for and sees so many success stories among his patients with ADHD, but it wasn't.

It did help that I knew the consequences of not treating my child. The frustration of always getting in trouble at school for talking, not paying attention, and not following the rules, could quickly harm his self-esteem. Unlike kids who are truly defiant, children with ADHD who get in trouble because they are impulsive often say that they are trying to follow the rules and not get in trouble and just can't help it. It is heartbreaking to see a child get in trouble over and over or fall behind at school when they are really trying to do better.

Getting a Diagnosis of ADHD

In our case, making the diagnosis was fairly easy, as he had always been a very hyperactive child. If the typical child with ADHD is described as being 'driven by a motor,' then he had a turbo jet engine. He was also fairly impulsive, easily distracted, and had a very short attention span. You could almost describe him as the 'poster child' for ADHD, but because his symptoms and behavior weren't causing any impairment for him before starting kindergarten, it was never a big issue before.

Your pediatrician and your child's teachers should be able to help you with testing and getting diagnosed. Other options are to see a child psychologist or psychiatrist for ADHD testing.

Choosing an ADHD Medicine

Once we confirmed the diagnosis and his need for treatment, we had to decide on which ADHD medicine to start him on.

Of course we wanted something that was safe and that would work, but that could apply to all of the current ADHD medicines. We also wanted a long-acting medicine that could be given just once a day, so at the time, that limited our choices to either Adderall XR, Concerta, Ritalin LA, Metadate CD or Strattera.

As he couldn't yet swallow pills, that narrowed our choices even further and we were left with Adderall XR or Ritalin LA, which are both capsules that can be opened, sprinkling the medicine on something your child can simply eat (like applesauce).

We finally decided on Adderall XR, both because of it's effectiveness and side effect profile, and because it was available in capsules with dosages as low as 5mg and 10mg, while the methylphenidate containing capsules we considered, like Ritalin LA, start at 20mg. I wanted to start him at the lowest dosage possible and then work our way up on the dose if we needed to, and Adderall XR offers that flexibility.

Did It Work?

In our case, starting medication, which we did on a Saturday, had a quick and dramatic effect. Starting on a day when your child is not in school is usually a good idea, so you can observe any side effects or problems with the medicine.

And we did notice some mild side effects, the most noticeable of which was that he continuously made a chewing motion all day, to the point that I thought he was chewing gum. Since stimulant medications can make tics worse, this side effect concerned me, but fortunately, it quickly went away by the next day. Although he didn't have any insomnia, stomach aches or headaches as many kids do, he does have a decreased appetite, which did get better.

The other big problem we noticed those first few days was that he would cry sometimes when he got frustrated or didn't get his way. 'Emotional lability' is a common side effect with Adderall XR, but this side effect, fortunately, also quickly went away and we didn't notice it any more after he was on the medicine for a few days.

The positive effects of starting Adderall XR were what was so dramatic though. He was still alert and had plenty of energy when he was playing, but he did so much better at times when he needed to calm down and focus.

That first afternoon, he sat and played a computer game for hours, but it wasn't a shoot-em-up or action type game. Instead, he was doing math and reading problems with an educational computer game, something he typically loses interest in after 5-10 minutes.

The next 'test' was when we went out to a restaurant that first evening, and he again did great. Whereas he is usually quick to try and jump out of his seat when we go out to eat, this time he sat, talked and eat his meal, even though other kids at the table were acting up.

The next day, I took him to a bookstore, something I used to enjoy doing very much, but had stopped because he would never do well in the store. This time, while I read a few magazines and books, he quietly would get books and comic books and read along with me.

The big test was his first day back at school after starting the medicine. In class, his kindergarten teacher stamps each student's notebook every day that they do well, and after seven days in a row of getting stamps, they can pick a prize. The first few days of school, our son was the only child who didn't get stamps, which disappointed him very much. On the medication, he was graded as being 'excellent' each day and he hasn't missed a day of getting a stamp.

We noticed other effects at home. He no longer runs around the house, instead taking the time to walk where he needs to go. He also has begun saying 'please' and 'thank you', something he never could remember to do before. And he no longer likes to watch television much, while we used to have to almost drag him from the TV. I guess he has found other things besides TV and video games to hold his attention now.

How ADHD Medicines Work

There are a lot of theories about how stimulants and other ADHD medicines work, and I am not sure if anyone knows the exact science behind them.

I don't like to think that ADHD medicines make your child better. They don't give your child better grades or make them behave better, instead, I think that they improve the symptoms that get in the way of your child living up to his or her full potential. So your child with ADHD will be less impulsive, less hyperactive and less easily distracted.

It shouldn't really change your child's personality or make him a zombie though. If you notice those effects, then you should talk to your doctor about changing your child's dosage or medication.

Final Thoughts

You don't always get the right dosage or right medication when you first start treating a child with ADHD, so don't be discouraged if you don't see as dramatic an effect as we did when you first start your child on an ADHD medication. It sometimes takes time to adjust the dose or find the right medication.

Also don't give up on a medicine because you are seeing side effects, even if they seem dramatic, such as mood swings or crying. Instead, talk to your doctor to see if they are something that will go away with some time or if a medication adjustment is needed.

Although starting our son on medicine for ADHD was a difficult decision, we quickly knew it was the right one as we see how well he is doing. I would still prefer that he not have to taken any medications, but I am very comfortable with the choices we have made.

Dr. John Sardo is a Pediatrician and our guest writer, but the name is a pseudonym as he wishes to respect his son's right to privacy.

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