A lot of people seem to have the idea that attention deficit hyperactivity disorder is something less than a real condition. Many have claimed that the diagnosis of ADHD pathologizes what’s actually normal childhood behavior, or that it’s presented as a problem in order to sell a solution in the form of unnecessary medication with unknown long-term effects. Others say that ADHD is real but overdiagnosed, and medication is used where changes to the child’s environment would be more appropriate. Most recently, the New York Times reported on a doctor who prescribed ADHD medication to children who are struggling in school, regardless of whether they actually have ADHD. He believes that the school system is poorly suited to children, but that people are unwilling to make changes on a systemic level, and so they resort to medicating their children.
The problem is that many of these folk theories about the reality, causes and proper treatment of ADHD are mostly nonsense, perpetuated by people who think they’ve uncovered some grand conspiracy but have very little understanding of what they’re talking about.
Our 9-year-old son has ADHD, and he takes medication for it. His mother has ADHD, his father has ADHD, and his younger brother sometimes appears to have symptoms of ADHD – although this can be largely indistinguishable from the typical range of toddler behavior. And anyone who believes that ADHD is a hoax or can be addressed solely by environmental changes should really try spending some time with our son when he’s unmedicated.
While it’s certainly possible that children have been inappropriately diagnosed with ADHD in some circumstances, this does nothing to show that ADHD does not exist in other children. This also isn’t a matter of making an exclusive choice between either medication, or alternative means of support. There’s no reason why we can’t use everything at our disposal to treat this. And while the side effects of medication always need to be taken into account, it’s also crucial to consider the effects of withholding treatment that works.
We waited for as long as possible before looking into medication for our son. We explored every other option that was available to us. He had a specialized plan at school and extra tutoring, and he still does. We worked closely with him every day to help him understand his work, and we gave him extra practice in every subject. And it wasn’t enough.
This was not just an instance of a child chafing against the unreasonable constraints of standardized education. His environment was not the problem, and shaping his environment around him would have meant letting him flounder. This was a second-grader who would often spend three hours trying to complete a single sheet of simple addition, with the help of two adults. This was a child who had to be reminded a dozen times before he would even remember how to complete a basic task like setting the table – let alone actually getting it done. This was a kid who could not stop himself from talking, yelling, and running wildly around the house. His insomnia would keep him up all night, doing nothing but talking to himself in bed, until he was so tired that he fell asleep almost every day in school. His teachers would make him sit through 40 minutes of reading class, 15 minutes of recess, and 50 more minutes of science class just trying to get him to write a single sentence.
His eyes would glaze over halfway through trying his best to add 5 and 4, when he lost track of what he was doing and had to start over for the third time. He would stumble through trying to read short sentences, and couldn’t tell us what they actually meant even after we read them back to him. He continually failed to be influenced by incentives or even understand their purpose. He forgot to bring home his work, and he didn’t turn it in when it was finished. He would burst into tears every day when trying to do his homework. He told us he was “the worst kid ever” and that he wanted to kill himself. This was a child who was going to be held back a grade, again. And he knew that he had a serious problem. He did not like how he was, and he did not want to be like this. He just wanted to be good, and he couldn’t, no matter how hard he tried.
His instructors and evaluators refused to believe that he could have ADHD, because they thought it was “overdiagnosed”. They laughed at my partner when she suggested it, even when she told them that his father had been successfully treated for ADHD. Instead, they claimed he was mentally handicapped, and that was why he was consistently performing more slowly than the other children. We knew that couldn’t be the case, because in those brief moments when we could get him to focus, he could understand his work. Something was just getting in the way. Only after intelligence tests found him to be above average did his teachers admit that ADHD was a possibility.
We had already figured this out, and we still didn’t want to have to medicate him. We were worried about the long-term effects, too. We didn’t want him to have to rely on medication instead of developing coping strategies. But we were wrong. Eventually, we had to recognize that this constant pain was not encouraging him to develop coping strategies. It was only making him miserable. This wasn’t helping him to grow – it was destroying him. Those who criticize parents for supposedly “taking the easy way out” when they have their children treated for ADHD have made the mistake of thinking that struggle must always be virtuous. They want to believe there must be some great payoff in proportion to all the trouble. But sometimes there’s not. In reality, his ongoing struggles weren’t good for any of us. We had to accept that when it came to the well-being of our son, it wasn’t our principles that mattered – it was the results.
Has his medication been a cure-all? Of course not, and this was by no means an excuse to stop helping him. He still gets all the support he needs from his family and from his school. The difference is that now, it’s actually working. Instead of running just to stay in place and still falling behind, this makes progress possible. He remembers to bring his work home and turn it in. He can finish his homework on his own without requiring constant attention, and he gets it right. He doesn’t fall asleep in school, and when he stays up late, he actually chooses to read books. He can focus and tell us what the sentences mean. He listens to us, he can control himself, and he can behave himself. And he smiles so much more! He’s happy now, he’s less anxious, and his attitude toward school has improved remarkably considering how difficult it had been for him. He’s passing instead of failing, because he finally has the basic abilities that are required to learn and succeed.
The inertia of the status quo often gives it a certain privilege in people’s minds. They set higher standards of justification for switching to an alternative than they would for simply staying on the present course. But when we put our options on an equal footing and considered them fairly, we could not justify depriving him of the treatment that would actually help. This isn’t just a matter of how it’s affecting him now. When ADHD isn’t properly treated, it can lead to higher rates of substance abuse, anxiety, depression, dropping out, car accidents, unwanted pregnancies, STDs, unemployment, and everything else you might expect to result from being chronically unable to think clearly. And we’re not willing to stand by and watch him fail over and over while we try to find alternative treatments, when we already have one that works.
This was not our first choice, and if other means were sufficient to control his symptoms, we wouldn’t have chosen to medicate him. But as of right now, this is not possible. Do we enjoy paying for expensive medication? No, but there is absolutely no way I can regard it as some kind of scam. The value to our entire family has been incalculable. ADHD had made our above-average child seem like someone who was mentally challenged. This is what finally worked to undo that, and I could never expect other parents to forgo a treatment that’s had such a transformative effect.
Regardless of what anyone else may think, this is a personal decision to be made by the family based on their situation and their needs, and I don’t find it at all appropriate to issue blanket condemnations of medication for ADHD when this may be exactly what someone’s child needs. Everyone wants what’s best for kids, and certainly nobody wants what’s worse for them. But when people are unclear on how to achieve this, their ignorance can lead them to conclusions that fail to respect the reality of what these children are dealing with. We would know – we’ve been there.