The difficult decision to medicate ADHD or not

As big decisions go, how to treat a child diagnosed with ADHD is an exceptionally hard one.

recently found myself at a brunch where every single parent had at least one school-aged child who had been diagnosed with—or was being assessed for—attention deficit hyperactivity disorder, commonly known as ADHD. All but one of these kids were boys, and none of them seemed to me to be particularly “difficult” that Sunday morning. Watching them tumble like a pack of puppies, I wondered aloud if it’s right that we label and medicate kids who, to my (admittedly untrained) eye, look perfectly normal—the picture of robust physical and mental health.
Well, let’s just say I didn’t realize that, by dropping this comment over my Bloody Caesar, I was unknowingly poking an extremely overheated hornet’s nest. For the rest of the day, I listened to parent after parent talk passionately about the reason why they did—or did not—choose to medicate their kids as a result of their condition. All of the arguments these parents presented were utterly compelling and heartbreaking, and in none of the cases was it an easy decision. I found myself identifying with each agonized parent I spoke to, even when they were completely at odds with one another. As big decisions go, how to treat a child diagnosed with ADHD is an exceptionally hard one.

One mother told me that, to avoid putting her son on the recommended stimulants for ADHD, she had pulled him out of his local school and sent him to a private school with tiny classes and a curriculum designed specifically for kids with learning disabilities. One father told me that his son had been an angry, frustrated kid with lacklustre grades until the age of 11, but half a semester into his first Ritalin prescription, it was like he’d had a personality transplant in the best possible way. Two years later, his son was now top of his class and socially well adjusted. “We reduce his dose to almost nothing during the summer holidays,” he said, “but he is happy to go back on his meds once school starts again.”
I left the brunch feeling utterly bewildered by the childhood ADHD medication debate and moved by the obvious and genuine concern of parents on either side. Then, to add to my confusion, I came across a large-scale study out of Columbia University last week that found that psychiatric medications for kids with ADHD are not being overprescribed (as is the common public perception) when compared to the number of kids who receive diagnoses.
The study in question used data from a national prescription database. Researchers looked at psychiatric prescriptions for 6.3 million American children between the ages of three and 24 years. (In the field of neuroscience, the human brain is now biologically classified as that of a child until age 25 because the prefrontal cortex isn’t fully developed until then.) Researchers subsequently compared prescribing patterns with known prevalence rates of psychiatric conditions like ADHD, anxiety and depression. Interestingly, it was the first widespread North American study to analyze prescription rates for psychiatric conditions in children.
The study found that an astonishing number of children—one in every 12, on average—are being diagnosed with or display symptoms of ADHD. It’s a staggering number when you think of it. According to the Centre for ADHD Awareness Canada (CADDAC), roughly five percent of children and four percent of adults worldwide are believed to have ADHD. (Other international studies have estimated the number to be as high as 12 percent.) To put those numbers in a global context, that’s roughly the entire population of the United States.

But despite this, according to Ryan S. Sultan, a teaching physician at Columbia University, kids are not being overmedicated. “At a population level, prescriptions of stimulants and antidepressant medications for children and adolescents do not appear to be prescribed at rates higher than the known rates for the psychiatric conditions they are designed to treat,” he says. “These findings are inconsistent with the perception that children and adolescents are being overprescribed.”
That raises another question: Are kids being overdiagnosed? Are we guilty of pathologizing their natural, uncontainable energy and lack of single-minded focus just because it doesn’t fit into our competitive, results-driven world? That’s a whole other hornet’s nest.
I do know that all the parents I know who have struggled with these issues—and it’s a long and growing list—have been most troubled by one issue in particular: whether or not to medicate. One close friend of mine, a mother of two, recently described to me how difficult it was for her and her husband to come around to the idea that something might be seriously wrong with their nine-year-old daughter just because she struggled at school and acted out at home. “A part of me was like, ‘So she is a bit of a maniac. Some kids just are, right?’ But the doctor told us that an ADHD brain doesn’t even look the same as a normal brain. It actually functions differently.”

Her daughter has also been diagnosed with oppositional defiant disorder, which often presents alongside ADHD. Like many parents, my friend is hesitant to medicate her daughter without trying other recommended treatments first—namely, talk therapy—but she is open to medication down the road if necessary. Like most mothers, she just wants the best for her daughter, and seeing her struggle is excruciating to everyone involved.
CADDAC is very clear that treatment for this condition must always be multifaceted. “While medication is often a safe and effective treatment option, it should always be prescribed in conjunction with psychosocial treatments, such as ADHD education for parents and caregivers, learning accommodations and, if required, additional treatment, such as behaviour therapy and specialized ADHD coaching and tutoring,” according to the organization.
As awareness and diagnoses grow, the good news is that ADHD is considered to be the “most treatable” childhood mental illness out there. Whether you choose to medicate or not, your options as an ADHD parent are growing. But the whole thing is still a hornet’s nest and, if you get sucked in, you’re bound to get stung.