2 letters to people with opinions about ADHD

Dear parent who thinks that I need to “fix” your child with medication,

I know you are at your wits end. You are tired of getting the phone calls from teachers. You are scared that every time the day care calls, it could be the call saying that your child needs to be picked up and never come back. Believe me, I want to help … but medication does not fix everything.

The primary and best, first treatments for Attention Deficit Hyperactivity Disorder (ADHD) are not medications.

If your child is hyperactive, he or she needs structure and a consistent behavior plan that is applied across all caregivers. This means that mom and dad, grandma and grandpa and the school need to all be on the same page about what is acceptable behavior and what is not. Reward good behavior, be consistent in responding to bad behavior.

For children who have problems with attention, medication might help them remember to get their homework home or turn it in on time or help them get their chores done at home. It might help, but many times their bad habits are so entrenched that medication won’t touch it until you put a system in place that will help them organize their day. A system of folders for homework, listing chores with checkboxes and other simple fixes can go a long way and will likely be necessary whether your child is on medication or not.

Anytime I make the diagnosis of ADHD and we move toward using medication, there is one message I want my parents to hear loud and clear: “The goal of using ADHD medication is not perfection.”

We are not looking to get your child to be the citizen of the year … at least not with medication. The goal of medication is to help your parenting strategies to be more effective.

Here are some symptoms that are not necessarily a result of your child having ADHD: being disrespectful (especially talking back), physically violent or being mean to other children. Medication is not likely to improve any of these behaviors. Yet, many of these are the behaviors you specifically want me to help with.

However, when these symptoms are present or when things are not improving the way we would like, it is important to include counseling in the treatment regimen for ADHD. Counselors can help children understand what is going on and give them strategies to cope. Perhaps more importantly, they can help you, as the parent, better understand and manage your child’s ADHD and other behavioral problems.

I can’t “fix” your child with medication but together we can help them.

Sincerely,

Justin Smith, M.D.

Dear person who think that ADHD does not exist,

I get it. Most likely you’re reacting to one of the following:

1.It seems like everyone you know is putting their kids on medications.

2.A teacher recommended that your child be put on medication even when you think they are normal (and they are).

3.You think that ADHD is a result of bad parenting.

You have a good reason to be concerned. But do not overreact and make the statement that ADHD is not real or smugly share the article, “Inventor of ADHD on his deathbed says that ADHD is a fictitious disease.” What he actually said was ADHD is over-diagnosed and doctors should investigate all the psychological and social reasons why the child is struggling before prescribing medication.

What I see in practice is this:

1.Parents who want a quick fix for everything (see above).

2.Parents who are desperate to help but just don’t know how.

3.Parents who are desperate to help, have tried everything and are coming to me as a last resort.

Some of my most difficult patients are #1. They get very angry when I will not prescribe medication and recommend counseling instead.

Some of my favorite patients are #2 and #3.

Most of these kids are not “bad kids.” They are struggling. They can be challenging to manage in the classroom and in the home. I am often exhausted after just a 30-minute consultation with them and their families; I can’t imagine what the parents are feeling.

My first discussion is generally walking through the non-medical tools we can use for ADHD. I can plug the families in with a good counselor. I can talk about what medication can do for their child, as well as the possible side effects, but I never prescribe medication as a first treatment.

The satisfaction that comes from seeing a child, who is struggling in school and at home, respond to either non-medical or medical treatment is amazing. I do not care what brings about the results, the goal is results.

So, please stop saying ADHD doesn’t exist. Stop sharing articles without knowing the true story. It’s insulting to me but, most importantly, it’s insulting to parents who are simply working hard to do the best for their children.

Sincerely,

Justin Smith, M.D.