Next Step Therapy Blog: ‘To Medicate or Not Medicate’

Tracy 1SENECA, Pa. – Tracy Cowles, CEO and owner of Next Step Therapy, submitted the following article – “To Medicate or Not Medicate.”

For parents of children who have Attention Deficit Disorder (ADD), Hyperactivity Disorder (HD), both (ADHD), Obsessive Compulsive Disorder (OCD) or issues with behavior, anger, and attachment, the question of whether or not to medicate the child is a complex, and sometimes polarizing issue.

Over the years, I’ve seen a lot – parents who wanted their child medicated for normal kid behavior (like tantrums) because they just didn’t want to deal with it, teachers who genuinely felt a child needed medicated to function in the classroom, doctors who want to try thirty behavioral management techniques before they will write a prescription, doctors who won’t write a prescription at all, parents who seem oblivious to the fact that their child is out of control, and parents who have genuine concerns about the side effects of medications. On top of all of that, I cannot tell you how many times I have evaluated a child while a grandparent hovers nearby, whispering, “I don’t know why you are so worried about this….he’ll outgrow it!”

Here is the story of Aidan, which I think makes a strong case for at least considering medication for your child.

Aidan’s parents did everything “right.” They both had college degrees, they had dated a long time before marriage, they were both gainfully employed, they had many friends and family members locally for support, and neither had any “issues” such as drinking or drugs that would interfere with parenting. A nice, happy, young, in-love couple, who had a baby girl. She was a dream baby. She only fussed when hungry or wet, was easily comforted, met all of her developmental milestones on time or early – she was an absolute joy to watch as she grew from an infant to a toddler. Three years later, Aidan was born.

Aidan was sent home from the hospital as a healthy newborn with no issues. He cried incessantly for several months. Nothing comforted him. While most babies up until a year old will sleep fourteen to fifteen hours a day, Aidan slept only fitfully, and never for more than five hours. His parents were exhausted from day one. As Aidan turned five or six months old, he became less fussy, but was constantly in motion. He still only slept for a few hours at a time, and never for the entire night. His parents felt like zombies, but knew he would “eventually grow out of it.”

Aidan walked early, and these parents’ lives became a nightmare. When left in a highchair or playpen for his own safety so that they could make a meal or do a load of laundry, Aidan went nuts. He could not be contained without screaming. He got into everything. While another toddler would sit on the floor and play with toys, Aidan was climbing the couch, the bookshelves, getting behind the TV where the cords were. His parents state that Aidan NEVER, not once, responded to the word “No.” It was like he didn’t even hear it. They considered having his hearing tested, but based on the fact that he would coming running from another room to see what they had when they crinkled a potato chip bag, they knew it wasn’t his hearing. He was simply so self-absorbed, so into his own mind, that he didn’t hear them when they spoke, or was simply unable to make himself stop.

By the time Aidan was two, his parents had set up an “Aidan safety zone” in their house. One room, completely devoid of all electric cords, all window blind pulls, all things that could be climbed on, all things that could fit in his mouth. Every piece of furniture screwed into the wall so that he couldn’t pull it over. In that room were age appropriate toys he couldn’t choke on, and a couch. One parent would lock themselves and Aidan in the room, so he couldn’t escape, and then lay on the couch to try to “rest.”

These parents, again, did everything right. They talked to the doctor about Aidan’s excessive energy level and lack of sleep, they spoke to friends and therapists that they thought might have some insight, they ordered and read books on ADHD, and they implemented recommended behavioral treatments. Nothing worked. Nothing. At no point did this child “slow down” and “focus.”

The parents began to realize that not only did Aidan need a “keeper” every waking minute, but that Aidan was really not having the same developmental learning experience that other kids his age did. Aidan was unable to sit through the reading of a book. Aidan was unable to focus on a board game. Aidan did nothing for more than a minute or two at a time.

The parents also realized that despite their love and devotion to Aidan, Aidan was taking an incredible toll on them. Since Aidan only slept five to six hours a night, one parent had to stay up with him while the other went to bed. The sleeping parent then awoke at five in the morning to be up with Aidan. They never went to bed together. They never had intimacy. They never had an uninterrupted conversation. Their older child often received less attention because she was “good” and able to entertain herself, while Aidan needed an adult constantly. Aidan’s need for one on one supervision had convinced his parents that daycare would not be a good fit for him, so Aidan was watched by his grandparents on the days his mother worked.

By the time Aidan was four, his parents were truly just shells of their former selves. All of their dreams had pretty much shattered. Taking Aidan in a car, locking him in a car seat for hours….torture for them and him. Going to a public event? You know those kids whose parents put them on leashes? That was Aidan. They absolutely, positively could not run the risk that Aidan would slip their hand….he would run into traffic and get hit by a car, or be fifty feet away from them in a sea of people….for his own safety, they either had to leash him, or not go to public, busy places.

Aidan was seen by virtually everyone he came in contact with as “bad.” If Aidan was taken to the zoo or Sea World, and noticed a dolphin swimming behind the glass, it was a given that he would push people out of the way and step on their feet to get to the window. It wasn’t that Aidan meant to be “bad” or violate social protocols of personal space or turn taking – Aidan simply could not stop himself once he had an idea. In the world of ADHD, we call this “lack of impulse control.” Once a child with ADHD has a thought, they are immediately acting on it, without considering the consequences.

Aidans’ parents, the nicest people on earth, felt incredible love for their boy, and an overwhelming desire to see him succeed. Despite their love, constantly witnessing other people rolling their eyes, overhearing people say, “That kid needs a beating,” and watching the sweet lady who volunteered at the church nursery suck in a breath when Aidan was dropped off became a daily reminder that their child was not “normal” and was not getting better.

As with most desperate situations, something finally happens that is “the last straw.” Aidan’s parents were invited to bring the children to a cook out at another family’s house. This family knew Aidan, and accepted him. Like most kids with issues, Aidan frequently did and said cute, funny, and intellectual things.

The gathering commenced, the cookout was had, and the four children (two of the hosting couple, Aidan and his older sister) were playing in the yard. Suddenly, Aidan was gone. He was not playing with the other three. He had wandered off on his own, and all four adults knew immediately that this was an emergency situation. All four jumped up to go look for him. Fortunately, Aidan was found within minutes, unharmed, but he had gotten into something that he shouldn’t have. The visit was pretty much ruined.

I told you that Aidan’s parents had read books and done research. Here is what they knew, and if you search the internet under “accident rates for children with ADHD” you’ll find the same. Kids with ADHD are rated 57% of the time by their parents as “accident prone” compared to the general population at 11%. Kids with ADHD are three times more likely to be accidentally poisoned. 15.6 % of kids with ADHD have had FOUR or more serious injuries including knocking their teeth out, broken bones and needing stitches. 40% of teenagers with ADHD have had two or more car accidents once they start to drive, compared to 5.6% of the general teenage population. *

Not only was Aidan out of control, and not learning like other kids, he was in danger.

In addition, Aidan’s parents had recently realized something, something that we see at Next Step Therapy frequently. Aidan was four. He would be eligible for Kindergarten in less than a year. He was nowhere near ready. They could not imagine him in a classroom setting, and knew that he would be a constant disruption to his classmates. They could not send him as he was, and the time for him to “grow out of it” was rapidly passing by, with no signs that he was “going to grow out of it.”

Following the disappearance episode, mom cried in the car the whole way home. They had reached their absolute limit. Despite their exhaustion, they spent hours talking about what had to happen next, and fortunately for this family, both parents agreed. Mom called the pediatrician first thing the next morning, and made an emergency appointment.

Aidan was placed on medication for his ADHD. His parents were concerned about potential side effects, and were on the alert for them. Three to five days later, Aidan started to slow down, just a little. He was also tired at 10:00 PM instead of 11:00, and went to bed without issue. His mom got up at 4:00 AM instead of 5:00, assuming that Aidan would sleep his normal amount of time, but instead, he got up at his usual 5:00 AM. From then on, he slept at least another hour longer every night, and a few weeks later, another hour was added. With Aidan now sleeping from 10:00 PM until 6:00 AM, everyone was now getting eight hours of sleep. His parents thought they had hit the lottery.

Aidan’s behavior improved day by day, and week by week. He started to actually sit down, and participate. He was able to have a conversation, rather than just a sentence thrown out as he passed by. He began to enjoy book reading and board game playing. And, best of all, Aidan responded to “No,” stopping what he was doing and waiting for instruction. His parents were blissed out.

A new side effect appeared. Aidan lost much of his appetite. This was a significant problem, as Aidan had always been thin due to his excessive energy level. Now he was losing weight. He had no appetite at breakfast at all, and in fact may have been a little nauseous. At lunch time, he only picked and had a few bites. At dinner, he only ate a few bites, if anything. But, between eight o’clock and nine o’clock at night, he became ravenous. He could eat a full sized meal, plus. For some parents, unfortunately, this side effect would be enough to stop the medication. Fortunately for Aidan, his family decided to work within these new parameters. They stopped trying to force him to eat when he couldn’t, provided his favorites for lunch to tempt him, purchased the high calorie, high vitamin drinks like Ensure or Boost for him to drink, and fixed him a plate of dinner to be reheated when he was hungry. Aidan thrived.

By the time Aidan had been on his meds for eight months or so, a decision had to be made about Kindergarten. Aidan was sooooo much better, but he was still a busy boy. Aidan’s parents attended a church with a private school, so they were able to talk to the Kindergarten teacher. She (God bless this woman) encouraged them to go ahead and enroll him. She was aware of his issues, and felt she could deal with them. Well, she did, but Kindergarten was very, very hard for Aiden. He had missed a lot of basic little kid education because of his ADHD, and had a lot to learn about socialization. At the teachers’ and pediatricians’ recommendation, Aidan’s parents got him enrolled with a psychologist who specialized in ADHD. All of those behavior management techniques that Aidan’s parents had tried previously? They worked now that he was on medication. An example: because kids with ADHD are often riddled with impulsivity, meaning they blurt out the first thing that pops into their minds, they often do poorly on tests at school. Teaching a child that they cannot answer a question until they have counted to ten (giving them time to think the problem through) has been shown in research to increase a child’s grades on tests by 20%. Just by waiting before they answer.

Aidan’s parents told me that if I ever wrote about him, they wanted me to make something clear. They believe, to the depth of their beings, that medication alone wouldn’t have helped Aidan’s situation very much. They believe that the counseling combined with the medication, combined with solid follow through at home has allowed this change in behavior to occur. I concur. The medication allowed Aidan to slow his thought process enough to a) listen to the counselor and his parents and b) allowed him to start to analyze his own behavior. Aidan wasn’t even aware that his behaviors were an issue until he began medication and counseling.

Aidan repeated Kindergarten, as he simply wasn’t ready to move on at the end of the year. Interestingly enough, his teacher adored him, and was excited to have him for a second year. She believed that with just a little extra time and practice, he would be ready for first grade the next year.

I don’t want you to think that everything for Aidan and his family turned into rainbows and glitter within a year after Aidan starting medication. That is simply not true. Aidan has ADHD, and he will always have ADHD. Medication changed his life for the better, but Aidan continued to have days that were rougher than others, and Aidan occasionally had an outburst. Just like Insulin manages, but does not treat diabetes, medication will not make ADHD go away. Over time, Aidan’s family, doctor and psychologist realized that while his normal daily dose worked most of the time, it wasn’t enough on stressful days, like standardized test days at school where Aidan had to sit for hours on end. They therefore added a “booster” that Aidan takes on days when he or his family feels he is going to need it. Aidan is now a teenager. If he misses his morning dose of medication, you can absolutely, positively tell two hours later.

Here is the beautiful part of this story: When Aidan was little, all you could see was his busyness, his energy level. I don’t know that most people saw Aidan as an intelligent little being. It turns out that Aidan has a very high IQ. He is virtually a genius on the computer. He has his own YouTube channel. He educates others. He has a wicked sense of humor. He has mad creative skills. He is a good friend. He has some sports skills and musical skills. At this point, if you saw Aidan sitting in the stands at a football game, he looks like any other teen. He acts like it, too. Aidan is now a young man that gets invited to parties, sleep overs and adventures like car racing by friends and their parents. And, when you take Aidan to events, he sits appropriately, follows the rules, engages in funny, smart conversations, and then shakes your hand and thanks you for taking him. I love this kid. His parents are so proud, and rightfully so.

I’ve been a therapist for twenty-four years, and a parent for seventeen. Experience tells me that kids like Aidan are born that way. It’s not poor parenting. It is, in some way, a different wiring in the brain. No amount of punishment, education, or rewards will re-wire that brain into a configuration that works like the rest of us. Sometimes the only thing that “works” is medication. So be it.

– Tracy

*Barkley, Russell A., PhD. “ADHD and Accident Proneness.” The ADHD Report. May, 2002. P 2-5.

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