In the last section, we discussed the Four Points of Arguing. The Four Points of Arguing were that arguing doesn’t work, arguing usually escalates, each person controls 50 percent of the problem, and teens love to bait parents. We also discussed the Two Steps to Avoiding and Stopping Arguments. The two steps were to stop talking, and to be prepared for the ADHD teen’s next move.
In this section, we will discuss medication and children with ADHD. I have found that there are Five Points to consider when thinking about medicating an ADHD child. See how your criteria corresponds with mine. These Five Points to consider when thinking about medicating an ADHD child to be discussed on this CD are 1. the attitudes of the child and parents toward the use of medication, 2. the use of medication in the beginning is only a trial, 3. medication is not a cure, 4. some medications have contraindications, and 5. any child about to take psychotropic medications for ADHD should have a physical exam.
Todd, age 10, had recently been diagnosed with ADHD. His parents, Sally and Jeff, were considering medication. Sally and Jeff were worried, though, because they had heard that some medications didn’t work, while others had negative side effects. Sally stated, "I just don’t want to do anything that would make it worse. He’s already behind enough in school."
Jeff added, "I’ve been worried about his social abilities, too. He doesn’t seem to have many friends, but we don’t want to do anything that would scare off the few friends he does have." Do you have clients with similar concerns for their ADHD child?
Five Points to Consider with Medication
♦ Point #1 - Attitudes of Parents and Child
I explained to Sally and Jeff that the first point to consider when thinking about medicating an ADHD child is the attitudes of the child and parents. I stated, "You need to discuss your opinions about the medication. Consider answering the questions, ‘Which drugs can we consider? What are the possible benefits? What are some possible side effects?’" I also suggested, of course, they consider Todd’s opinion of medication.
As you know, some children with ADHD are resistant to the idea of taking medication. I asked Sally and Jeff, "Have you talked to Todd about it? What were his thoughts?" Sally answered, "We haven’t mentioned it yet, but Todd’s always been a pretty easygoing kid. If he thinks medicine will help him, he’ll probably want to take it."
♦ Point #2- Use of Medication in Beginning is only a Trial
I then explained Sally and Jeff the second point to consider when thinking about medicating an ADHD child, which is that the use of medication in the beginning is only a trial. I stated, "If you did decide to medicate Todd, it would not necessarily be a sure thing. It is true that not all kids will experience benefits from drugs. Todd might be one of them, and there is no way to know unless you have tried medication."
As you know, less than 10 percent of children encounter side effects which prevent the continued use of medication. I stated, "If you try one drug and it doesn’t work, you may have to try others. Sometimes finding the right medication can take weeks. Sometimes, but less often, it can take months." Jeff asked, "What happens if we find one that does work? Will Todd have to have that drug for the rest of his life?"
I explained to Jeff that some children may take it for a long period of time, and other children may be able to do well even after they’ve discontinued drug use. I stated, "About 25 percent of ADHD children can discontinue medication and still do well. It won’t necessarily be a lifetime project."
♦ Point #3 - Medication is NOT a Cure
In addition to considering the attitudes of the family members and seeing the medication as a trial, the third point to consider when thinking about medicating an ADHD child is that medication is not a cure. I explained to Sally and Jeff that even if they did decide to try medicating Todd, the medication should not be used by itself. I stated, "It should be combined with other needed treatments, such as therapy."
I also explained that the benefits are temporary. I stated, "Even when drugs do provide assistance, it’s usually only for a short period of time. Regular forms of some common drugs only last about four hours. If Todd were to take those drugs, there may still be regular times when no medication is available for him."
♦ Point #4 - Contraindications for Medication
I then explained to Sally and Jeff the fourth point to consider when thinking about medicating an ADHD child, that there are contraindications for some medications. As you know, other factors are considered before medicating an ADHD child. I stated to Sally and Jeff, "For example, the presence of a high anxiety level, tics, or psychosis may rule out the use of any stimulant in a child with ADHD."
Jeff nodded and stated, "That makes sense to me, but I don’t think we have to worry about that with Todd. He’s never had any of those problems."
♦ Point #5 - Necessary Physical Exam
Finally, I explained to Sally and Jeff the fifth point to consider when thinking about medicating an ADHD child, that any child about to take psychotropic medications for ADHD should have a physical exam. As you know, a baseline blood pressure is important before a child takes, for example, Dexedrine, and a baseline EKG is necessary before using a tricyclic. I explained this to Sally and Jeff, and stated, "A physical exam would provide a lot of information about Todd that would be necessary before choosing a drug."
Sally hesitantly stated, "I think we might try medication. But now I’m worried about if we forget to give him his medicine one day. What happens then?"
♦ Technique: Family Medication
I explained to Sally that a common technique clients use to avoid forgetting to medicate the child with ADHD is "Family Medication." I asked both Sally and Jeff, "Do either of you take medication or pills for anything?" Jeff answered, "My family has a history of hypertension. I’ve been on some medication for that for a couple of years, now." Sally stated, "I’m not taking medicine, really, but I do usually take calcium pills. My mother has osteoporosis, so I’m doing what I can to make sure I don’t get it later."
For the "Family Medication" technique, I explained to Sally and Jeff that they simply needed to medicate Todd at the same time that they themselves took pills. I stated, "It may help all three of you to make sure everyone’s remembering medication. It also might help Todd feel more responsible when he sees that his parents are taking medicine, too."
Do you have clients like Sally and Jeff who are considering medicating their ADHD child? Would your Sally and Jeff benefit from knowing the Five Points to consider when thinking about medicating an ADHD child? Would it be beneficial to replay this section for yourself as a review prior to your next session?
In this section, we have discussed the Five Points to consider when thinking about medicating an ADHD child. The Five Points to consider when thinking about giving an ADHD child medication are 1. the attitudes of the child and parents toward the use of medication, 2. the use of medication in the beginning is only a trial, 3. medication is not a cure, 4. some medications have contraindications, and 5. any child about to take psychotropic medications for ADHD should have a physical exam.
In the next section, we will discuss a guideline for effective home-school partnerships, avoiding the obstacle of misunderstanding.
Peer-Reviewed Journal Article References:
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Effects of behavioral and pharmacological therapies on peer reinforcement of deviancy in children with ADHD-only, ADHD and conduct problems, and controls. Journal of Consulting and Clinical Psychology, 83
Kane, L., Bahl, N., & Ouimet, A. J. (2018). Just tell me it’s going to be OK! Fear of negative evaluation may be more important than fear of positive evaluation in predicting excessive reassurance seeking. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 50(4), 217–225.
Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. (2019). Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological Assessment, 31(2), 236–247
Overgaard, K. R., Oerbeck, B., Friis, S., Biele, G., Pripp, A. H., Aase, H., & Zeiner, P. (2019).
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Shahidullah, J. D., Carlson, J. S., Haggerty, D., & Lancaster, B. M. (2018).
Integrated care models for ADHD in children and adolescents: A systematic review. Families, Systems, & Health, 36
Tamm, L., Denton, C. A., Epstein, J. N., Schatschneider, C., Taylor, H., Arnold, L. E., Bukstein, O., Anixt, J., Koshy, A., Newman, N. C., Maltinsky, J., Brinson, P., Loren, R. E. A., Prasad, M. R., Ewing-Cobbs, L., & Vaughn, A. (2017).
Comparing treatments for children with ADHD and word reading difficulties: A randomized clinical trial. Journal of Consulting and Clinical Psychology, 85
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