Diagnoses are the on the rise, but the disorder has more than one form, and the symptoms aren't always obvious.
One of the toughest decisions for parents is whether to medicate. The majority of kids with ADHD—69 percent—give it a shot, according to the CDC’s 2014 National Survey of Children’s Health. Other supports may include school accommodations, outside tutoring and cognitive behavioral therapy. Many families pursue a combination of these approaches.
Decisions about medication usually come down to the needs of the individual. Drugs such as Ritalin and Adderall can help kids with attention, McCarthy says, but not as much with problems related to time management, organization and other executive functions. Although side effects such as appetite suppression and insomnia can occur, McCarthy still urges many families to consider medication as an option.
“There’s no amount of therapy that can do what medication does when a kid has a significant problem with attention,” she says. “To not offer medication to a kid who is struggling is to not offer the best treatment.”
There are risks of medication being used inappropriately. (We’ve all seen the news stories about stimulants like Ritalin and Adderall being used as “study drugs” to pull all-nighters, often by people who don’t have ADHD.) But Bashian, the Arlington pediatrician, argues it’s the unmedicated kids with ADHD who are more likely to end up with addiction problems, insofar as academic stress and feelings of inadequacy can lead to substance use, as well as behavioral issues, criminal activity and dropping out of school.
McCarthy concurs. Untreated, ADHD heightens the risk of anxiety and depression, she says, and eats away at kids’ self-esteem. They always feel a step behind.
Nevertheless, choosing to medicate is “a leap of faith” for a lot of families, says speech and language therapist Kristin Keller Daus, who sees many kids with ADHD at her McLean practice, Chain Bridge Speech & Language. Sometimes it’s a “game-changer.” But sometimes parents (or the kids themselves) are just uncomfortable with chemical intervention.
Asef-Sargent recalls when her daughter Adriana tried medication. A couple days after taking her first dose, Adriana hopped into the car after school and read aloud all the way home. “It was weird,” her mom says. “She was like a ‘normal’ person.” But Adriana said the drugs made her feel like someone else. She stopped taking them.
Timing can also be a factor. Susan Brown,* an Arlington mom, remembers being wary when her son, Michael,* tried Ritalin for the first time as a fifth-grader: “I’m like, You’re going to give my kid speed on purpose?”
At the time, the side effects were significant and they dropped the prescription. But now that Michael is bigger and in high school, he is back on a low dose. She thinks it helps.