Anonymous
09/07/2023 11:04
Subject: ADHD - what are the odds she won't need meds?
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.
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.
This study shows that medicating for ADHD in childhood for the short-term doesn’t have an impact. It doesn’t show that medicating for ADHD doesn’t have an impact.
Before medicating my child I looked at the research studies (I am a PhD trained in biomedical sciences including clinical work). My take-away was that long-term medication (started when needed and continued throughout the teen years) does have an impact on outcomes.
Please stop posting one study and suggesting it represents the whole field of ADHD research. Even meta-analyses of RCTs are not considered as single points of data, but within the context of all the research conducted.
Reasonable minds can differ. OP has very legitimate concerns about side effects.
Anonymous
09/07/2023 10:58
Subject: ADHD - what are the odds she won't need meds?
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.
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.
This study shows that medicating for ADHD in childhood for the short-term doesn’t have an impact. It doesn’t show that medicating for ADHD doesn’t have an impact.
Before medicating my child I looked at the research studies (I am a PhD trained in biomedical sciences including clinical work). My take-away was that long-term medication (started when needed and continued throughout the teen years) does have an impact on outcomes.
Please stop posting one study and suggesting it represents the whole field of ADHD research. Even meta-analyses of RCTs are not considered as single points of data, but within the context of all the research conducted.
Anonymous
09/06/2023 23:18
Subject: Re:ADHD - what are the odds she won't need meds?
My answer would be that if your child is doing okay in school and life without them, they probably don’t need them at this point. My very young son has trouble staying on task, focusing on directions and learning, and gets overstimulated in busy environments. I know that he needs medication as his under vigilance and impulsivity impeded his ability to learn and interact, and thereby affects his self esteem.
You can do a neuropsych assessment and see what a professional recommendation would be. Also, in 4th grade, your daughter might be able to give you a batter indication of how she feels about things - does she feel like she can’t focus like her peers?
You can do a neuropsych assessment and see what a professional recommendation would be. Also, in 4th grade, your daughter might be able to give you a batter indication of how she feels about things - does she feel like she can’t focus like her peers?
Anonymous
09/06/2023 21:49
Subject: ADHD - what are the odds she won't need meds?
I delayed meds until age 8 because I was worried about side effects and wasn't sure DD needed it because she she has no behavior issues at school. But a year of no improvement and low growth in her map scores showed me that she can't focus in order to learn.
Anonymous
09/06/2023 07:56
Subject: ADHD - what are the odds she won't need meds?
Anonymous wrote:Anonymous wrote:Anonymous wrote: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.
I’m not “boosting” anything. I’m just pointing out that there are reputable studies that show that the long-term benefit isn’t clear. There is also the more recent Florida study that showed a lack of academic benefits: https://news.fiu.edu/2022/long-thought-to-be-the-key-to-academic-success,-medication-doesnt-help-kids-with-adhd-learn,-study-finds
If anything gets boosted here and in the popular press, it’s meds!
The point is that barring behavioral issues that really require immediate medication (and that certainly exists) parents can reasonably choose not to medicate without it being some kind of parental neglect. It’s not like withholding insulin or chemo. OP should NOT feel pressured by scare tactics/exaggerations.
Probably because posters here have first-hand experience that showed major improvements with meds. I can understand that maybe they don’t change the long-term outcomes significantly in a whole population, but that’s not the same as saying they don’t help at all. The OP could be open to trying them, to see if it helps.
trying meds because her daughter is having significant challenges and they want to see if they help - that’s a good choice.
feeling like they “have to medicate” in advance of any severe impacts because they believe things like “unmedicated ADHD leads to car accidents and suicide!!” or because of some cocksmamie “developmental period” theory is not a good choice.
Anonymous
09/06/2023 07:54
Subject: ADHD - what are the odds she won't need meds?
Anonymous wrote:Anonymous wrote: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.
NP. This is the developmental period when we were told were most important to medicate - that DC would develop new, better, permanent pathways during this crucial stage of brain development because of stimulant medication.
It sounded dubious to me (and also undesirable) but I have also seen posters repeating the same thing. Taken for a time before puberty, stimulant meds have a permanent beneficial effect on the brain. This study contradictd that.
Yeah. I think parents like OP have to work hard to become scientifically/medically literate and tell the difference between a theory and something that is demonstrated with high-quality evidence. The “developmental period” thing is a theory, not evidence of the sort that needs to be weighed that heavily IMO.
At the same time parents (all people really) should do some introspection to understand their values wrt to medical care. If in your life you prefer to make decisions based on what most people do or prefer to just rely on what your doctor says, then that should inform how you handle ADHD too. The idea is you want to feel like you made a decision aligned with your values.
at the end of the day though, I really think a lot of sloganeering and fearmongering gets thrown around wrt ADHD.
Anonymous
09/06/2023 07:41
Subject: ADHD - what are the odds she won't need meds?
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.
I think it's time for you to consider meds then, the self esteem part is a compelling reason.
We held off on meds until 8/9 grace. In retrospect, it was a huge mistake, and we should have started medicating in 3rd. Not medicating earlier damaged my DC’s self-esteem, and although he is happier now, I think that shadow of early self-doubt and feeling like he is stupid will really shadow him forever. Not medicating also made it much much harder to make friendships, acquire social skills and it definitely negatively impacted his academics which created additional ripple effects in each higher grade.
I truly regret not allowing him to try medication much earlier.
It is way, way more common to feel like this (pp you are not alone!) than to regret trying medication, which I've rarely heard from anyone on this board or in real life/professional life. Trying is low risk, you can stop very easily at any point. Like another poster said, all I can report is the real impacts I've seen for my own child. There is confirmation bias for sure, of course i want to feel like I made the right decision. But given how few side effects we have, and the impact on improving interaction with peers and happiness I feel pretty strongly that for our family starting earlier will be a positive thing for his sense of self worth and that is really high on my list of important things.
Will he still struggle in middle and high school some? (in response to the NIH poster) I would honestly be surprised if he didn't. We'll be managing this for awhile. That doesn't mean it isn't benefiting him now.
Anonymous
09/05/2023 20:00
Subject: ADHD - what are the odds she won't need meds?
You can try meds very briefly. You know almost immediately if they work. If you don’t feel they help or the side-effects are problematic, you can always stop.
DD and DS have Tourette’s. DD’s tics didn’t worsen on stimulants. She went from struggling academically and interpersonally in late elementary and early middle school to a happy, successful kid post-meds. My biggest regret will always be that we didn’t get an accurate diagnosis and medicate sooner. To the poster who says that there are no long-term benefits, it really doesn’t matter if they help in the here and now. It is very evident when DD (now in college) is off her medication. DS was given a diagnosis of suspected ADHD in 3rd grade. For him, stimulants worsened tics but the neurologist strongly encouraged us to stay the course even with the tics. A later follow-up showed no ADHD so we stopped the meds and the tics improved. So while for DD it was a non-issue, every case is different.
DD and DS have Tourette’s. DD’s tics didn’t worsen on stimulants. She went from struggling academically and interpersonally in late elementary and early middle school to a happy, successful kid post-meds. My biggest regret will always be that we didn’t get an accurate diagnosis and medicate sooner. To the poster who says that there are no long-term benefits, it really doesn’t matter if they help in the here and now. It is very evident when DD (now in college) is off her medication. DS was given a diagnosis of suspected ADHD in 3rd grade. For him, stimulants worsened tics but the neurologist strongly encouraged us to stay the course even with the tics. A later follow-up showed no ADHD so we stopped the meds and the tics improved. So while for DD it was a non-issue, every case is different.
Anonymous
09/05/2023 18:59
Subject: ADHD - what are the odds she won't need meds?
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.
I think it's time for you to consider meds then, the self esteem part is a compelling reason.
We held off on meds until 8/9 grace. In retrospect, it was a huge mistake, and we should have started medicating in 3rd. Not medicating earlier damaged my DC’s self-esteem, and although he is happier now, I think that shadow of early self-doubt and feeling like he is stupid will really shadow him forever. Not medicating also made it much much harder to make friendships, acquire social skills and it definitely negatively impacted his academics which created additional ripple effects in each higher grade.
I truly regret not allowing him to try medication much earlier.
Anonymous
09/05/2023 16:40
Subject: ADHD - what are the odds she won't need meds?
Anonymous wrote:Anonymous wrote: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.
I’m not “boosting” anything. I’m just pointing out that there are reputable studies that show that the long-term benefit isn’t clear. There is also the more recent Florida study that showed a lack of academic benefits: https://news.fiu.edu/2022/long-thought-to-be-the-key-to-academic-success,-medication-doesnt-help-kids-with-adhd-learn,-study-finds
If anything gets boosted here and in the popular press, it’s meds!
The point is that barring behavioral issues that really require immediate medication (and that certainly exists) parents can reasonably choose not to medicate without it being some kind of parental neglect. It’s not like withholding insulin or chemo. OP should NOT feel pressured by scare tactics/exaggerations.
Probably because posters here have first-hand experience that showed major improvements with meds. I can understand that maybe they don’t change the long-term outcomes significantly in a whole population, but that’s not the same as saying they don’t help at all. The OP could be open to trying them, to see if it helps.
Anonymous
09/05/2023 16:37
Subject: Re:ADHD - what are the odds she won't need meds?
Would someone share a name in dc or Va for a child psychiatrist that is an expert in ADHD?
Anonymous
09/05/2023 16:33
Subject: ADHD - what are the odds she won't need meds?
Anonymous wrote: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.
NP. This is the developmental period when we were told were most important to medicate - that DC would develop new, better, permanent pathways during this crucial stage of brain development because of stimulant medication.
It sounded dubious to me (and also undesirable) but I have also seen posters repeating the same thing. Taken for a time before puberty, stimulant meds have a permanent beneficial effect on the brain. This study contradictd that.
Anonymous
09/05/2023 16:28
Subject: ADHD - what are the odds she won't need meds?
Anonymous wrote: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.
I’m not “boosting” anything. I’m just pointing out that there are reputable studies that show that the long-term benefit isn’t clear. There is also the more recent Florida study that showed a lack of academic benefits: https://news.fiu.edu/2022/long-thought-to-be-the-key-to-academic-success,-medication-doesnt-help-kids-with-adhd-learn,-study-finds
If anything gets boosted here and in the popular press, it’s meds!
The point is that barring behavioral issues that really require immediate medication (and that certainly exists) parents can reasonably choose not to medicate without it being some kind of parental neglect. It’s not like withholding insulin or chemo. OP should NOT feel pressured by scare tactics/exaggerations.
Anonymous
09/05/2023 16:26
Subject: ADHD - what are the odds she won't need meds?
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.
That's just not true. And it seems like maybe you do have some issues with people medicating their children based on your responses. This article does a good job explaining why treating the symptoms is important:
https://www.additudemag.com/long-term-effects-of-adhd-medication-brain/
In any case, we reached a point where the symptoms were really impacting our 4th grader socially and academically. It took a couple of trials but we have found a stimulant that works really well for him. He can really show who he is without the impulsiveness that got in his way. It did make sleep tough for about a week and then that side effect resolved. It is an extended release medication and we make sure to give it to him by 7am so that it wears off well before bedtime.