Dear Shari,

My 5-yr. old son is a firstborn, perfectly healthy, always happy, no developmental or physical problems until about 2 1/2 years ago. My son was diagnosed with ADHD over a year ago and has since been on a medication called Focalin. He started at 2.5 mg twice a day and is now up to 7.5 mg twice a day.

Since the very beginning, I have been dead-set against medicating my son; I'd much rather deal with the difficult behavior than give him medication. I still feel that way, I carry a great deal of guilt and shame and I can't keep away from all the research and articles about ADHD and the medications; I am obsessed with all the information and the more I read up on it, the more I want to stop his med's.

His Psychologist is a wonderful, intelligent and caring woman. She thoroughly evaluated and tested him over several hours, she talked with him, they told each other stories, they drew pictures together, she performed various activities, puzzles and stretches with him and I honestly feel she diagnosed him accordingly. But, I have noticed as many cons as there have been pros and every situation that comes up, I can't help but ask myself if this would have been as prevalent if he weren't on his med's. For example, before the medication, my son had a great healthy appetite and now sometimes I have to force feed him. His eating habits have been one of the most discouraging side effects and I worry that his medication may be affecting his height & his weight.

Also, he has been having awful nightmares that wake him from his sleep screaming and crying uncontrollably until you physically shake him and wake him from his sleep. He also has been wetting the bed quite often. He is fully potty trained and has been for years now, but at night; he still has a problem.

The pros with the med's is that he is able to concentrate and focus and follow through in class and it shows in his schoolwork, such neatness and clarity. He can sit still and listen to directions, he is calm and not impulsive, he understands and really thinks things through. He is extremely sensitive and emotional, he has been through soo much in his first few years of life.

I am strongly considering taking him off his meds and keeping him at home with me. I love him soo much and I feel like I'm hurting him. I want, I feel like I need to take him to the best specialist out there and get another opinion; see if I'm doing the right thing for him. I would greatly welcome and appreciate any feedback you may have for me.

Needing some reassurance,

Laura Palada

Answer:

Shari has referred your question to me since the answer deals with treatment of ADHD, and adverse side effects of medication. You are questioning whether you are making the right choice in accepting his being on medication. It sounds like you have been reading some of the anti-medication for children literature. There are groups that have been quite vocal in expressing their strong feelings about using medications to modify children’s behavior.

First, you and your son should not need to live with significant undesirable side effects. All of the side effects that you describe can be side effects of the medication. The one exception is that a significant number of young boys are still wetting their beds at five and six and he should know that. This often seems to be worse at times of stress. The nightmares too could be stress related.

Treating ADHD with stimulant medication is a bit of an art. One has to aim for the lowest dose that will treat the symptoms with the lowest side effects. There are numerous medications available including some that are not stimulants. Your physician should be seeing your son regularly and plotting his height and weight on a growth chart. That way one can see if growth is below that expected for his age. Your physician should also be asking about appetite. I would probably try to reduce the dose, given the degree of loss you describe.

Another type of stimulant might have fewer side effects. It is trial and error with both you and his teacher watching both for improvement and for side effects. You need to talk with your physician to determine whether he is receptive to these suggestions. If not, your psychologist may know of physicians, particularly pediatricians, in your area that are accustomed to treating and carefully following children with ADHD.

The fact that his performance improves so much with medication is wonderful! You have done well in allowing him to take the medication. His ability to control his behavior and do well in school is certain to improve his self-esteem.

My additional recommendation is for you to ask his psychologist or physician whether they think that there made be some anxiety or depression contributing to his inattentiveness. The ADHD diagnosis is made by looking at the presence of certain symptoms. Anxiety and Depression can certainly cause a child to be inattentive and worried, contributing to the severity of his symptoms. I am particularly recommending this because of the degree of recent stress in the life of your family.

If you have additional concerns, I would be glad to try to address them. There are ample research based web sites on the net that give excellent information about diagnosis and treatment of ADHD. Some examples are CHADD and the American Academy of Child and Adolescent Psychiatry.

I wish you and your child well. I would be glad to answer any further questions you might have.

Kay S. Browne MD
Behavioral Pediatrician

http://www.chaddnorcal.org/

http://www.aacap.org/Announcements/psychiatricmeds.htm