ADHD - what are the odds she won't need meds?

[Anonymous]

My daughter has ADHD-I and is unmedicated right now. Insomnia is such a huge deal for her. What are the chances that we/she will be able to manage the ADHD without meds? I've always heard the medication is the first line of defense and allows the behavioral treatments to be accessible to kids with ADHD. But we are afraid that medication will make her sleep issues unbearable.

[Anonymous]

You should dig into the actual research. The benefits of ADHD meds tend to be exaggerated on this site and articles. But stimulants are only really shown to improve behavior in the short term and don’t lead to better grades or learning in the long term.

Behavioral therapy can be extremely effective, especially something like PCIT. Classroom accomodations. Tutoring. Lots of ways to support the child.

And of course there are non-stimulants you can try.

[Anonymous]

TBH, medication is a huge help if you can find one that works.

Don’t be afraid to try. Discuss with psychoatrist - there are many options. The main class of meds used for ADHD are stimulants, and they can be tried for a day and discontinued immediately if they have any negative side effects. The half life of stimulants is very short, which means that they don’t have effects that last days and once you stop them they are pretty much completely out of your system. If the stimulant is too high or an extended release your DD might be too stimulated to sleep. OTOH, by addressing her ADHD, she might be able to better stick to routines that help with sleep or be able to do homework more consistently and remember to turn it in and not worry about those things before sleep.

Also, there are other classes of medication that are NOT stimulants. Atomoxetine, for example, is not in the stimulant class. It is an SNRI shown to be effective with ADHD. It is thought to tamp down the DMN network of the brain which allows the brain network focused on task completion to operate more effectively. Tamping down the DMN can help diminish rumination, which may be a reason why your DD can’t fall asleep.

Also, there are many other aspects of sleep which should be investigated - sleep apnea? anxiety? And there may be other things that can help with sleep - exercise, early morning light, melatonin, magnesium, etc.

Your kid should be fully evaluated by a psychiatrist who can help you discuss options and do med trials.

[Anonymous]

Anonymous wrote:TBH, medication is a huge help if you can find one that works.

Don’t be afraid to try. Discuss with psychoatrist - there are many options. The main class of meds used for ADHD are stimulants, and they can be tried for a day and discontinued immediately if they have any negative side effects. The half life of stimulants is very short, which means that they don’t have effects that last days and once you stop them they are pretty much completely out of your system. If the stimulant is too high or an extended release your DD might be too stimulated to sleep. OTOH, by addressing her ADHD, she might be able to better stick to routines that help with sleep or be able to do homework more consistently and remember to turn it in and not worry about those things before sleep.

Also, there are other classes of medication that are NOT stimulants. Atomoxetine, for example, is not in the stimulant class. It is an SNRI shown to be effective with ADHD. It is thought to tamp down the DMN network of the brain which allows the brain network focused on task completion to operate more effectively. Tamping down the DMN can help diminish rumination, which may be a reason why your DD can’t fall asleep.

Also, there are many other aspects of sleep which should be investigated - sleep apnea? anxiety? And there may be other things that can help with sleep - exercise, early morning light, melatonin, magnesium, etc.

Your kid should be fully evaluated by a psychiatrist who can help you discuss options and do med trials.

the research shows that there may be short-term benefits of meds, but not long-term. I don’t say this to challenge/criticize anyone who found meds helpful for themselves or their child. but rather to reassure OP that she has a reasonable basis to choose not to medicate.

[Anonymous]

How old is your child?
We were able to manage without medication until middle school.
I guess the answer is, you can manage without medication until you can't anymore. You will know when the time comes.

[Anonymous]

Anonymous wrote:How old is your child?
We were able to manage without medication until middle school.
I guess the answer is, you can manage without medication until you can't anymore. You will know when the time comes.

Op here. Thank you and this is what I'm thinking. She's in 4th grade. It's not hard to manage now, but as she gets older and is required to do more on her own (i.e. manage homework, study guides, a planner), I can tell she needs more support from us. For a long time she's been able to coast with smarts and background knowledge, but I think those days are numbered.

[Anonymous]

Anonymous wrote:

Anonymous wrote:How old is your child?
We were able to manage without medication until middle school.
I guess the answer is, you can manage without medication until you can't anymore. You will know when the time comes.

Op here. Thank you and this is what I'm thinking. She's in 4th grade. It's not hard to manage now, but as she gets older and is required to do more on her own (i.e. manage homework, study guides, a planner), I can tell she needs more support from us. For a long time she's been able to coast with smarts and background knowledge, but I think those days are numbered.

All kids have to learn organization and study skills at her age.

[Anonymous]

Anonymous wrote:My daughter has ADHD-I and is unmedicated right now. Insomnia is such a huge deal for her. What are the chances that we/she will be able to manage the ADHD without meds? I've always heard the medication is the first line of defense and allows the behavioral treatments to be accessible to kids with ADHD. But we are afraid that medication will make her sleep issues unbearable.

That really is for ADHD-H or predominantly H. Some people with I are helped by meds, some are not.

And sleep issues make everything worse, whatever the diagnosis (or NT).

[Anonymous]

Anonymous wrote:

Anonymous wrote:My daughter has ADHD-I and is unmedicated right now. Insomnia is such a huge deal for her. What are the chances that we/she will be able to manage the ADHD without meds? I've always heard the medication is the first line of defense and allows the behavioral treatments to be accessible to kids with ADHD. But we are afraid that medication will make her sleep issues unbearable.

That really is for ADHD-H or predominantly H. Some people with I are helped by meds, some are not.

And sleep issues make everything worse, whatever the diagnosis (or NT).

Right. We're meeting with her pediatrician to tackle the sleep stuff head on. Her worst, scattery, spacey days are the days when she hasn't slept well or falls asleep super late. It's definitely an issue.

[Anonymous]

Anonymous wrote:How old is your child?
We were able to manage without medication until middle school.
I guess the answer is, you can manage without medication until you can't anymore. You will know when the time comes.

This was our experience too. Was able to manage without medication for a long time, but when middle school came, the work demands increased, the willingness of teachers to tolerate his talking/fidgeting/wandering/etc decreased and he was getting in trouble every day/getting C/D's on assignments, missing assignments, etc - he was frustrated with himself and his self esteem plummeted. DH finally agreed it was time to try meds. He started meds and we stopped getting daily notes home re: his behavior, his grades increased to A/B, and his self esteem improved dramatically. This was 7y ago and he is now a senior taking AP/IB/DE classes with all A/B's, multiple sports, and a job. When his meds wear off at night I was see what he would be like unmedicated and I am 100000% he wouldn't have been able to manage as well as he does now.

You'll know.

[Anonymous]

Anonymous wrote:

Anonymous wrote:How old is your child?
We were able to manage without medication until middle school.
I guess the answer is, you can manage without medication until you can't anymore. You will know when the time comes.

This was our experience too. Was able to manage without medication for a long time, but when middle school came, the work demands increased, the willingness of teachers to tolerate his talking/fidgeting/wandering/etc decreased and he was getting in trouble every day/getting C/D's on assignments, missing assignments, etc - he was frustrated with himself and his self esteem plummeted. DH finally agreed it was time to try meds. He started meds and we stopped getting daily notes home re: his behavior, his grades increased to A/B, and his self esteem improved dramatically. This was 7y ago and he is now a senior taking AP/IB/DE classes with all A/B's, multiple sports, and a job. When his meds wear off at night I was see what he would be like unmedicated and I am 100000% he wouldn't have been able to manage as well as he does now.

You'll know.

Thank you! This is reassuring. I'm seeing the self-esteem stuff starting to creep in even now. She gets so frustrated when she forgets things or doesn't follow through and says things that break my heart. It's also so so hard for us to find the balance between total helicopter and completely dropping the rope on some things. I think my husband and I need some help with that.

[Anonymous]

Its so hard to find anyone on this forum who doesn't medicate. I have a kid with similar issues, and the answer is always "who cares if your kid will have tics from meds, at least their homework is done".

[Anonymous]

exercise seems to help our ADHD-I daughter the most. Helps with sleep too.

[Anonymous]

Anonymous wrote:

Anonymous wrote:TBH, medication is a huge help if you can find one that works.

Don’t be afraid to try. Discuss with psychoatrist - there are many options. The main class of meds used for ADHD are stimulants, and they can be tried for a day and discontinued immediately if they have any negative side effects. The half life of stimulants is very short, which means that they don’t have effects that last days and once you stop them they are pretty much completely out of your system. If the stimulant is too high or an extended release your DD might be too stimulated to sleep. OTOH, by addressing her ADHD, she might be able to better stick to routines that help with sleep or be able to do homework more consistently and remember to turn it in and not worry about those things before sleep.

Also, there are other classes of medication that are NOT stimulants. Atomoxetine, for example, is not in the stimulant class. It is an SNRI shown to be effective with ADHD. It is thought to tamp down the DMN network of the brain which allows the brain network focused on task completion to operate more effectively. Tamping down the DMN can help diminish rumination, which may be a reason why your DD can’t fall asleep.

Also, there are many other aspects of sleep which should be investigated - sleep apnea? anxiety? And there may be other things that can help with sleep - exercise, early morning light, melatonin, magnesium, etc.

Your kid should be fully evaluated by a psychiatrist who can help you discuss options and do med trials.

the research shows that there may be short-term benefits of meds, but not long-term. I don’t say this to challenge/criticize anyone who found meds helpful for themselves or their child. but rather to reassure OP that she has a reasonable basis to choose not to medicate.

I'm not sure this is true. I've seen at least two researchers (can't find the links now) that cited studies that showed kids who took meds in childhood actually saw a reduction of symptoms as adults. Definitely something you might want to look up or ask your health care providers about. But overall, a lot is going to depend on your child as to how well she can manage on her own and how the meds hit her.

FWIW, we have tried several meds during elementary, but still haven't found the "one," as my kiddo is so sensitive to the side effects, that we can't get to a dosage high enough to see any benefit. After a lengthy break where we focused on behavior management and therapy only, we're trying again now with the methylphenidate patch, which he's been able to tolerate better, but it makes him sleepy, so not sure if we're just substituting one focus issue for another.

[Anonymous]

Anonymous wrote:Its so hard to find anyone on this forum who doesn't medicate. I have a kid with similar issues, and the answer is always "who cares if your kid will have tics from meds, at least their homework is done".

NP here and this is my concern as my child already has tics than can get bad so I am nervous to even try the meds because i have heard it can increase tics and they linger even after stopping the medication. Can anyone speak to this from experience? Are there any meds for ADHD that don't increase tics in someone that already has them?