5 questions to ask before starting your child on ADHD medication

Medication for ADHD can make a dramatic difference if it’s used appropriately, yet some experts say these pills are being overly prescribed. In fact, according to study published in The American Journal of Psychiatry, approximately 2.8 million or 3.5 percent of children were prescribed ADHD medication in 2008, up from 2.4 percent 12 years earlier.

If you are concerned your child has ADHD, or he or she has already received a diagnosis, here are five questions to ask before opting for meds.

1. Is it really ADHD?
Advocating for your child to ensure that he has been accurately evaluated and diagnosed is important, according to Dr. Kenny Handelman, a child and adult psychiatrist and ADHD expert. “There are many people who need the diagnosis and need prescription medicine and are not getting it,” he said. “My worry is that sometimes there are people who are being diagnosed who don’t really have it, and getting prescriptions when they don’t need them.” If you have doubts, ask why your child was diagnosed or get a second opinion.

2. How severe is it?
Handelman says it’s important to understand what your child’s level of impairment is and how it interferes with his or her academic, social, and occupational functioning before making the decision to medicate. Some children can function well and may benefit from behavioral therapy only, while others who have severe academic, behavioral, and social difficulties need medication.

3. What are the options and side effects?
Stimulant medications like Ritalin and Adderall are the most common type of medications used to treat ADHD and are up to 80 percent effective in helping to increase attention, decrease impulsivity, hyperactivity, and disruptive and aggressive behaviors. “It turns down the volume on those types of behaviors,” according to Dr. Susan Ashley, author of 1000 Best Tips for ADHD: Expert Answers and Bright Advice to Help You and Your Child.

Concerta, Ritalin LA, and Vyvanse are also stimulant medications but are taken once a day and last for up to 12 hours.   Insomnia is the most common side effect, with children having trouble falling asleep and waking up in the morning, and feeling irritable.

Non-stimulant medications like Strattera take 4 to 6 weeks to start working and have to build up in the body so it can work longer than some of the stimulant options. The FDA issued a public health advisory in 2005 about the increased risk of suicidal thoughts within the first few months of using Strattera. And although the non-stimulants have fewer side effects, they are not as effective in some children.

Antidepressants, although not FDA-approved for ADHD, and antihypertensives, which are actually blood pressure medications, are also prescribed. Since there is not enough research about long term side effects of some of these medications, Ashley said it’s important to weigh the benefits and risks. “Maybe your kids can behave better but what’s the cost?”

4. Is there a dual diagnosis?
According to the National Resource Center on ADHD, two thirds of children with ADHD also have a co-existing condition like oppositional defiant disorder (ODD), in which medication will not help. So if you suspect your child has a condition other than ADHD, speak to her doctor and school to determine what’s really going on.

5. What are the alternatives?
“We’re in a cultural where we’re more likely to be comfortable taking a pill than going to see a psychologist,” said Ashley, adding that whether your child takes medication or not, behavior modification is what really makes a difference. In fact, according to a study published in the journal Archives of General Psychiatry, the combination of both medication and behavior therapy were found to be most effective.

Recent research shows promising effects of adding omega-3 fatty acids supplements to the diet and restricting sugar, additives and preservatives. Although not as effective as medication, dietary changes may be able to control symptoms when in used in combination. Speak with your child’s doctor about diet modification and to get referrals for local psychologists, community resources and support groups.