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Medication Decisions and Medication Management

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

Finding the right dose

Even with the most skillful physician, finding the most effective medication treatment is not simple. Finding the correct medication and dosage for a particular person is a trial-and-error process. Children with moderate to severe ADHD symptoms, and/or those with other psychiatric or medical conditions, will require a specialist such as prescribing psychologist, or psychiatrist. Many general practitioners are qualified to diagnose and treat ADHD. However, they may not be the best qualified for more complex and severe cases.

medicationResearch has demonstrated that up to 85% of ADHD children perform better at school while taking Ritalin, or other stimulant medication (Elliott & Kelly, online). However, the authors also found that students without ADHD also performed better while using Ritalin. The authors attribute this to the attention- and focus-enhancing effect of the drug. Therefore, a positive response to this drug is not necessarily diagnostic of ADHD, as was once thought. For people with more severe ADHD symptoms and related problems, starting medication early on during the diagnostic process may provide much needed immediate relief. However, except in the most extreme cases, medication should not begin until the diagnostic process is completed.

Caregivers and children should be prepared for the sometimes lengthy and frustrating process of medication selection and "tweaking." There are no simple rules that determine the correct dose of medication for each person. Unfortunately, the recommended dosage cannot simply be calculated according to someone's weight. Each person has a unique body chemistry that influences which medications will be most effective, and at what dosage. Doctors aim for the lowest dose that results in successful symptom control, while minimizing side effects. The usual approach is to start with the lowest recommended dose, and to gradually increase it, until symptom improvement occurs.

Should I put my child on ADHD medication?

Understandably, most people are reluctant to put their children on medication. There is a great deal to consider. The benefits of medication for the treatment of ADHD are significant. However, there are side effects LINK and risks LINK. Many people find that the benefits outweigh the risks. For this reason, they are willing to try the medication to observe the results.

Studies of children with ADHD indicate the majority believe that medication dramatically improved their lives. Therefore, despite reasonable concerns about medication, most children and their caregivers think it is worthwhile.

However, medication is only one part of the recommended multi-modal treatment approach LINK. Tynan (2015), reported that there are 194,000 children in the United States between the ages of 2 to 5 years old who have been diagnosed with ADHD. Of these children, roughly half are not receiving the recommended treatment for ADHD. Recommended guidelines for this age group are that children receive intensive behavioral treatment before going on medication. Moreover, even with medication, the most effective treatment is the combination of medication with psychosocial interventions. These interventions may include behavioral therapy, family therapy, skills training, etc. This study found half of these children are on medication without any behavioral treatment. Tynan reports that this is a problem for many reasons. First, there are no clear diagnostic criteria in place for this age group. Second, hyperactive and non-compliant behavior is normal behavior for this age group. Third, there is little research on the impact of stimulant medications on this very young age group. Finally, there are other effective treatments (behavior therapy for children and parent training). The author recommends that parents carefully consider trying behavioral therapy prior to medicating children in this age range.

Deciding to put your child on medication is a difficult decision. There are many factors to consider: the extent/severity of ADHD-associated problems; the availability of supportive services; and, the likelihood of cooperation from school personnel. One moderate approach is to take medication for several years, then pause and re-evaluate. Since ADHD is a disorder that changes over time, it may be helpful to periodically stop the medication and observe the changes. This can be done during the summer, or even at the beginning of the school year to determine if the benefits still outweigh the risks.

Should children manage their own medications?

It is important that ADHD medication be taken exactly as prescribed. The effectiveness of the medication depends on regular administration at the correct time. For this reason, few children are capable of assuming full responsibility for their ADHD medication (including teens). Therefore, caregivers and school personnel need to take an active role in medication management. Each school has different guidelines, but a permission form is usually required for medication administration by a school official.

Should my child take a "drug holiday"?

Many children take their medication only on school days. The idea behind this dosing approach is that it may be beneficial to have a few days, each week, to be drug-free. These children might even have a longer "drug holiday" during school semesters, summer breaks, or during holidays. However, this approach is not appropriate for everyone. Some children, especially those with extreme symptoms, may need to take medication every day. The rationale behind this approach is that the child (and family) may experience significant benefits from the calming influence of medication. Positive experiences with family and friends can have long-lasting, beneficial effects that trump concerns of daily medication.