A Parent's Guide to Medication in AD/HD

Jane was an active nine-year-old girl that I recently evaluated for the presence of AD/HD. She had been having increasing difficulties at school, both in her academics as well as her behavior. As the evaluation process progressed, it became apparent that Jane did, in fact, have AD/HD, combined type. After several discussions with the parents regarding medication use, it was decided to initiate a medication trial with a stimulant medication. Since Jane had never been on any medications, she was started on a very low dose. Two days after the medication was started, her father called in frustration and asked if we should consider switching the medication. During our discussion, I asked if she was having any adverse effects. It turned out that Jane wasn't experiencing any adverse side effects, but "she wasn't any better."

I reassured the father that Jane was on a very low dose of the medication, and that during this initial part of treatment, we were monitoring her for any adverse effects. Once it was clear that she was tolerating the medicine, we would begin to increase the dose accordingly.

This story highlights several important points. It is imperative that you have realistic expectations regarding medication treatment. It is also essential to remember that AD/HD is a long-term condition. It is essential to be patient during the initial phases of medication treatment. There are numerous situations when the lack of patience of either the physician or the parent leads to unnecessary medication changes or unnecessarily high doses of medications. Your doctor should tell you in advance when to expect maximum benefit.

Usually, it is necessary to start the medicine at a low dose and increase it slowly. This is especially true if your child has never been on any kind of medication for AD/HD. When your child first starts a medicine, that is the time to evaluate how well they are tolerating it. The goal during the initial part of treatment is to look for any side effects.

There were two weeks left in the school year when I was asked to evaluate Marcus, a 17-year-old young man who was supposed to be graduating from high school. The problem was that Marcus was failing most of his classes. The situation seemed dire since Marcus had fallen behind in all of his classes. When I met Marcus and his parents there was an obvious urgency and apprehension regarding the situation. The parents asked if there was a "pill to help him graduate."

Marcus had struggled academically throughout high school, but he always did enough work to pass all of his classes. The result of the evaluation was consistent with a diagnosis of AD/HD, inattentive type. Both Marcus and his parents were very invested in finding the "magic pill to graduate."

Rarely do emergency situations arise where there is an urgent need for a quick fix. There may be situations like the one Marcus is facing, where it seems there is a need for emergency intervention and you have to make a hasty decision on the spot regarding the use of medications. In those situations, it is essential to remember that AD/HD is a long-term problem with a long-term solution. There is no "magic pill" or quick fix.

For Marcus, it made sense to begin a medication trial, but the same basic principles needed to be followed. There was no guarantee that Marcus was going to tolerate the medication, so he was started on a low dose of a stimulant. In fact, Marcus did not tolerate the initial medication that was started, and there was a need to do a trial with a different stimulant medication. Marcus ended up needing to go to summer school in order to graduate. He received intensive tutoring with an organizational coach along with the medication trial. He ended up going to a local community college for a year before he transferred to a four-year college.

As a parent, you should never feel that you have to make a decision on the spot regarding the use of medications. Refer to Rule #21 for a more detailed discussion about this immensely important point.