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

[Anonymous]

What's the cause of her insomnia? Sounds like that's your most pressing immediate issue. Is there an anxiety component? Are meds or supplements being recommended for that?

My DC's psychiatrist made a compelling case for ADHD meds after we held off for several years and tried everything else. Meds didn't solve every problem but we saw immediate improvement. It's like meds cleared the way for the behavioral and educational interventions to work, without the meds, those thing didn't gain traction.

It's a mixed bad, we've gone off meds in the summer so kid can catch up on growth since they do impact appetite. But no regrets in putting kids on meds, I think we did it in 4th or maybe 5th.

[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".

No, I think you need to find a provider who will work with you. DC had tics pre medication. We didn't get DC medicated by a pediatrician, we went to a very good psychiatrist who chose meds carefully based on history of tics and used low dosages working up.

So we were able to put DC on meds without increasing the tics. It can be done.

[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.

That's not what DC's psychiatrist said. She made a very compelling case for medicating based on the research on long term outcomes for medicated vs non medicated.

[Anonymous]

Anonymous wrote:

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.

I think it's time for you to consider meds then, the self esteem part is a compelling reason.

[Anonymous]

Anonymous wrote:

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.

Thank you, this is my understanding of the current research too - that there are definite long term benefits to medication in childhood. That and a few other reasons convinced us it was time to medicate.

[Anonymous]

Anonymous wrote:

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".

No, I think you need to find a provider who will work with you. DC had tics pre medication. We didn't get DC medicated by a pediatrician, we went to a very good psychiatrist who chose meds carefully based on history of tics and used low dosages working up.

So we were able to put DC on meds without increasing the tics. It can be done.

Would you mind sharing the name of your psychiatrist?

[Anonymous]

Anonymous wrote:

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.

One tip that our therapist gave us was to help her master one skill at a time. When she shows mastery, move on to the next thing. Our dd wasn’t able to handle learning to organize her school papers and cleaning up after herself and having good table manners, and fixing her own hair, and managing her time all at once. I was trying to teach her all life skills simultaneously, like I did with my neurotypical child, but that made my child with ADHD feel like a failure because she wasn’t truly mastering any one skill.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

One tip that our therapist gave us was to help her master one skill at a time. When she shows mastery, move on to the next thing. Our dd wasn’t able to handle learning to organize her school papers and cleaning up after herself and having good table manners, and fixing her own hair, and managing her time all at once. I was trying to teach her all life skills simultaneously, like I did with my neurotypical child, but that made my child with ADHD feel like a failure because she wasn’t truly mastering any one skill.

OP here - OMG get this us. This is awesome advice. Thank you!

[Anonymous]

Anonymous wrote:

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.

the longest-running trial shows no difference in long-term outcomes: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063150/

My point is not to say that medication doesn’t help at all - just that OP should understand that her child doesn’t “have to” take stimulants especially in light of her serious concerns for side effects.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

Thank you, this is my understanding of the current research too - that there are definite long term benefits to medication in childhood. That and a few other reasons convinced us it was time to medicate.

You’d be surprised:

“In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly-analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, or other clinically relevant outcomes).”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063150/

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

One tip that our therapist gave us was to help her master one skill at a time. When she shows mastery, move on to the next thing. Our dd wasn’t able to handle learning to organize her school papers and cleaning up after herself and having good table manners, and fixing her own hair, and managing her time all at once. I was trying to teach her all life skills simultaneously, like I did with my neurotypical child, but that made my child with ADHD feel like a failure because she wasn’t truly mastering any one skill.

OP here - OMG get this us. This is awesome advice. Thank you!

Sorry that should have said this is us.

[Anonymous]

Anonymous wrote:

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.

That's not what DC's psychiatrist said. She made a very compelling case for medicating based on the research on long term outcomes for medicated vs non medicated.

+1 I have not seen replicated, high quality research that backs what the first poster is saying. I agree with others op that if you are seeing self esteem impacts it is incredibly worthwhile to consider it. I have a child with ADHD and worked in this area professionally prior and in my personal experience, parents highly underestimate the "side effects" of struggling through this without the support of medication due to fear over potential medication side effects. I totally get it, I've been there myself, but the impacts on kids that can lead to other issues (anxiety, depression later) are really important to consider.

Talk to a psychiatrist. Don't count it out without at least talking to someone who is really an expert in this. Your concerns are so valid and we do use melatonin to help my son fall asleep due to the stimulant but it has been so, so worth it. There are also non-stimulant ADHD meds that can actually help with sleep, though I believe they usually aren't as helpful with the focus piece so may not be the right fit. But a good child psychiatrist will know waht the options are and insomnia is a common adhd symptom so you aren't alone! you are certainly not the only family navigating it and a good child psychiatrist will have seen many families through it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

That's not what DC's psychiatrist said. She made a very compelling case for medicating based on the research on long term outcomes for medicated vs non medicated.

+1 I have not seen replicated, high quality research that backs what the first poster is saying. I agree with others op that if you are seeing self esteem impacts it is incredibly worthwhile to consider it. I have a child with ADHD and worked in this area professionally prior and in my personal experience, parents highly underestimate the "side effects" of struggling through this without the support of medication due to fear over potential medication side effects. I totally get it, I've been there myself, but the impacts on kids that can lead to other issues (anxiety, depression later) are really important to consider.

Talk to a psychiatrist. Don't count it out without at least talking to someone who is really an expert in this. Your concerns are so valid and we do use melatonin to help my son fall asleep due to the stimulant but it has been so, so worth it. There are also non-stimulant ADHD meds that can actually help with sleep, though I believe they usually aren't as helpful with the focus piece so may not be the right fit. But a good child psychiatrist will know waht the options are and insomnia is a common adhd symptom so you aren't alone! you are certainly not the only family navigating it and a good child psychiatrist will have seen many families through it.

You don’t thing the NIH project is reputable and long-running? Ok.

Again no issue with people who chose medication. But the scare tactics and pronouncements about it are way too much.

[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.

We had a diagnosis in third grade, started medicating for ADHD in 8th. ADHD also causes anxiety so it’s possible by not treating DD, you are feeding the insomnia. My DD never had trouble sleeping but ever since puberty has trouble with insomnia. I have terrible insomnia so I think it is genetic. Anyway, she takes a stimulant and a low dose of hydroxyzine which is an antihistamine. But you don’t need to go the stimulant route. You can try non stimulants, some of which cause drowsiness. I’m thinking Clonidine. Anyway, see a child psychiatrist - there are so many things they can do to help. It’s very common for ADHD kids to have sleep troubles. A good psychiatrist will be able to give you a lot of options.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

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.

That's not what DC's psychiatrist said. She made a very compelling case for medicating based on the research on long term outcomes for medicated vs non medicated.

+1 I have not seen replicated, high quality research that backs what the first poster is saying. I agree with others op that if you are seeing self esteem impacts it is incredibly worthwhile to consider it. I have a child with ADHD and worked in this area professionally prior and in my personal experience, parents highly underestimate the "side effects" of struggling through this without the support of medication due to fear over potential medication side effects. I totally get it, I've been there myself, but the impacts on kids that can lead to other issues (anxiety, depression later) are really important to consider.

Talk to a psychiatrist. Don't count it out without at least talking to someone who is really an expert in this. Your concerns are so valid and we do use melatonin to help my son fall asleep due to the stimulant but it has been so, so worth it. There are also non-stimulant ADHD meds that can actually help with sleep, though I believe they usually aren't as helpful with the focus piece so may not be the right fit. But a good child psychiatrist will know waht the options are and insomnia is a common adhd symptom so you aren't alone! you are certainly not the only family navigating it and a good child psychiatrist will have seen many families through it.

You don’t thing the NIH project is reputable and long-running? Ok.

Again no issue with people who chose medication. But the scare tactics and pronouncements about it are way too much.

to the NIH study booster - you are misrepresenting the study. it is only based on children who take medication for 14 months between the ages of 7-9.9 years.

Conclusions
Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0–9.9 years old) does not predict functioning six-to-eight years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best longterm prognosis. As a group, however, despite initial symptom improvement during treatment that is largely maintained post-treatment, children with Combined-Type ADHD exhibit significant impairment in adolescence. Innovative treatment approaches targeting specific areas of adolescent impairment are needed.