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Answer:
Dear Debra:
To medicate or not medicate a child is one of the most difficult questions
parents of children with AD/HD have to face. The issue brings up ethical
and medical questions for most parents: If my child is medicated, will
she or he still have the opportunity to learn appropriate behaviors?
Will he or she experience side effects? In what tasks will medication
help my child? Will he or she be more or less prone to addiction as
a result of taking medication? Will my child have brain damage as a
result of the medication? Although I can't answer all of these questions
for your son, some of the resources I'll describe may lead you to your
own conclusions.
To gain an understanding of the possible side effects that your son
may experience, first talk directly with his physician about the medication
she or he recommends. The following websites are helpful in listing
medications commonly used to treat AD/HD and their possible side effects:
http://www.chadd.org/webpage.cfm?cat_id=24
Children and Adults with Attention Deficit Disorder (CHADD) is a national
organization that provides information, support and advocacy for families
of children with AD/HD. This site contains a fact sheet on medical management
of AD/HD.
http://www.additudemag.com/medical.asp?DEPT_NO=504&SUB_NO=3
This link, provided by ADDitude magazine, contains questions and answers
about specific AD/HD medication. There is a link to another website
where specific medications including recently developed non-stimulant
medications are detailed. There is also a link to a description of alternative
treatments.
http://www.nimh.nih.gov/sciadvances/16.cfm
The National Institute for Mental Health (NIMH) has researched the best
interventions for AD/HD. The Multimodal Treatment Study (MTA) compared
the effectiveness of behavior management, strategies, psychological
counseling and medication and concluded that medication, only when strictly
monitored on an ongoing basis, provides the most effective treatment
for AD/HD. An explanation of the MTA results is available at this site.
http://www.nimh.nih.gov/publicat/adhdqa.cfm
This link provides answers to questions commonly posed about the MTA
study.
http://www.nimh.nih.gov/events/pradhdmri.cfm
Regarding potential long-term effects of medication on the developing
brain, a previous Ask A Specialist answer addressed the question of
possible addiction. Recently, concerns about possible brain shrinkage
have been studied. Results demonstrated that children with AD/HD do
have smaller brain size than normal peers, but this is not a result
of medication. This link provides study results for your review.
Yes, your son will probably continue to learn appropriate behavior even
when on medication. However, because his behavior will not be as extreme
when he takes medication, others will not react in extreme ways. Because
medication generally decreases impulsivity, your son may have more opportunity
to think before he acts. Although medication will not usually increase
standardized test scores, your son's grades may improve because he is
more productive. Only a lucky few children are completely "normalized"
by medication, however. Your son may need continued support for organizational
skills at school and home. For more information on what medication can
and cannot do, refer to the book, Beyond Ritalin by Stephen Garber,
Marianne Daniels Garber and Robyn Spizman. Another book that may help
you make your decision is Should I Medicate My Child? by Lawrence Diller,
MD. Dr. Diller has a middle-of -the-road attitude toward medication
that some parents find sane and refreshing.
http://www.schwablearning.org/articles.asp?g=2&r=532
Whether or not you decide on medication for your son, you will want
to talk with him about the diagnosis and consideration of medication.
Some suggestions for this discussion by Dr. Shashank Joshi, a child
psychiatrist at Stanford University School of Medicine, can be found
at the above link.
http://www.chadd.org
You may want to contact the organization Children and Adults with Attention
Deficit Disorder (CHADD) and attend a meeting in your area to talk with
other parents facing the same decision. A directory of local CHADD groups
can be found at this link.
Good luck!
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