To Medicate Or Not To Medicate, That Is The Question

P erhaps the most difficult question a parent of an ADHDer can face is, do I or do I not medicate my child? I am in favor of medication. There is an overwhelming amount of scientific data that shows both the benefits of and safety of long term ADHD medication use. The data should make the decision an easy one. Unfortunately it does not. There is a general distrust of anything that uses products created by Big Pharma, a distrust created one too many times by Big Pharma itself. [note 1] Even though many of the drugs used for ADHD have been around for decades, it is hard to trust a source that has been dishonest in the past. But there are other issues.

The medication is not meant to eradicate a virus whose existence and absence can be easily measured. The medication is meant to alter the workings of the brain, the physiological substrate of the mind. It is the human mind that makes us who we are. This becomes painfully obvious when we witness the dementia of an aging parent. Even if their body has deteriorated, we consider them to be the same person we’ve always known. However, when their mind goes, we start to wonder who we are talking to. We recognize the exterior shell but once they act or speak, we no longer recognize them. They have become strangers to us and sometimes they become strangers to themselves.

What does it mean, then, to medicate a child, to administer a medication that “alters” the workings of the child’s mind? Does it not imply that the child you have known, with all her quirks and characteristics, will not be the same child? Yes. It does. But the point of the medication is to alter particular characteristics, not all of them. [note 2] Only certain behavioral traits will be changed, albeit temporarily, as a result of the medication. The difficulty we have as parents is that the child that we know, with her various quirks and characteristics, is the pre-medicated child, the child who exhibits the problems associated with ADHD and also all of her other characteristics.

We can easily understand that when a child has a broken arm she will not be able to use that arm for a time and we can see how she cannot engage in certain activities until it has healed. But what if the child was born with a broken arm, metaphorically speaking, and we are unaware of that problem. We only know that child’s characteristics as they are manifested with that “hidden” broken arm. We take as a given that the child’s traits are what they are, and that is what makes her special. But then, some years later, we learn that there is a hidden injury, and that this injury explains why she cannot perform certain tasks. The child can take a medication that will “fix” this hidden injury (the fix is temporary and disappears after the medication has worn off) but this “fix” will, for at least the time the medication is active, change some of the characteristics of your child. Do you medicate or not medicate? [note 3] It would seem that the answer is obvious. Of course you medicate. But medicating your own child feels, to a degree, as if you are conducting an experiment on your child. Do you know how that experiment will turn out in two or three years time? What if it doesn’t turn out the way you had hoped? You can’t start over. Time only moves forward. Children only get older. There is no do-over. The flip side is that not medicating is also an experiment and carries with it the same exact problem. What if you made the wrong choice? What if you should have medicated your child? There’s still no do-over.

As parents we are totally consumed with our children. They are not simply the focus of our attention but they are part of our very psychic being. They are as integral to our minds, as much a piece of our sense of self, as any of the other “components” of our minds. Medicating one’s child is to accept, not only that there may be something within your child that requires “correction,” but also that your internalized conception of your child also requires “correction.” Making matters a bit more difficult, you must objectify your child, seeing her as an “object” that will be “administered” medication while, at the same time, you must objectify the mirror of that child that exists in your mind. It is as if you must excise, albeit only momentarily, something that is an integral part of you in order to “administer” the medication.

One possible answer to the medicate/not medicate question is to allow the child to make the decision. But the problem is that the child, who should be the best of judge of whether or not to medicate, is actually not the best judge at all. They simply do not have the life experience necessary to make that decision. As self-reflective as they may be, they simply do not know themselves well enough to make that decision. [note 4] By the time the child is old enough to make that decision, the characteristics of ADHD are so entwined with their personality that they cannot imagine life without those characteristics. It is possible that, decades later, the child — having become an adult — realizes that there is something radically wrong with their life and only then begins to take medication. The problem, of course, is that now there are decades worth of problems that need to be addressed. The damage of unmedicated ADHD has already taken its toll. [note 5]

To medicate or not to medicate. This is as much an existential question for the parent as it was for Hamlet. As a parent who decides to medicate, we are, in a sense, killing off a part of the child — both the very real physical child that we have raised and love, and that very same child that lives within our minds. That is not how a parent is supposed to treat a child. Yet we are confronted with hundreds of choices we make on behalf of our child, from food to clothing to schools to friends to movies, and each of these decisions, even the most trivial of them, molds and shapes the child in one way or another. Further, there are many forces outside of a parent’s control that molds and shapes them. Unfortunately we cannot see into the future with complete accuracy. We can only extrapolate based on past experience, intelligent guessing, and using what we believe is the best possible information for making those guesses. We can never know for sure what will happen in the future. It is extraordinarily difficult to make a choice without really knowing, until years later, if it truly was the wise choice to make.

  1. See this recent article in Scientific American.
  2. See the video from Dr. Barkley in this post concerning the “gift” of ADHD and how ADHD is only a small facet of the total personality.
  3. The changes can, with sufficient work and professional help, become “permanent” in the sense that many tasks can be incorporated as habits and, as such, can remain a more permanent part of the child.
  4. Interestingly, we do not accept the opinions of children concerning credit default swaps, the amount of insurance coverage we should have on our automobiles or homes, or whether the current tax structure is fair, and yet in matters of religion they are considered experts. See Heaven Is For Real.
  5. For a sobering look at the long term effects of untreated ADHD, see Barkley’s ADHD in Adults: What The Science Says. Warning. It is a difficult book to read.
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  • Betsy Davenport, PhD

    First, the verb “medicate” implies that someone is doing something to someone else, a passive recipient. It bothers people, legitimately, to know parents and doctors are doing something to children.

    When my daughter began taking medication for ADD, we had had many conversations about what was going on in terms of her inner experience, her actions, feelings, thinking. She was desperately unhappy about her 7 year old life and was interested to know that it was her brain letting her down and not something else “wrong” about her. She knew I took medication for ADD. She was aware of its effects. When it was suggested to her that what she was experiencing could be alleviated with medication, she DECIDED to TAKE medication and see if it helped HER.

    If that one change could be made in how we think about ADD and medication and children, it would make a huge difference across the lifespan. In our case, because the medication altered her cognitive experience significantly, and she became more effective, she was a religious taker of medication, which in turn resulted in more consistent cognitive function.

    Not saying any of this was easy, but it is worth thinking about how we think and talk about this.

    • Jeffs ADD Mind

      Points are well taken. We need to rethink a lot of the terminology that we use. And it’s great that she was an active participant in making this decision.

  • Jo-Ann Rogan

    I wish this decision was so easy to be a med or not to med. With a complicated medical history it’s an excruciating decision. There is such a thing as a ritalin allergy.
    Will try new meds and new approaches.

    • Jeffs ADD Mind

      Jo-Ann, I hope that I did not make it seem like it is an easy decision because that was certainly not my intent. I wanted to flesh out some of the socio-philosophical issues that we face as parent. I skipped over, or perhaps alluded to, in very unemotional terms the emotional turmoil that we, as parents, face when we need to make any decisions about our children. Our children are a part of us as much as we are a part of them so any decision we make also affects us.

      Most importantly, I hope Ryan is okay.

      • Jo-Ann Rogan

        They gave him short acting because of his history of weird drug allergies, he was fine 5 hours after the dose.Of course, we will try other medications.. My fight is this. According to those who use medications for ADHD he is doomed without it. I know in my kids school alone 2 kids who medically cannot take ADHD drugs because of heart issues. What is to become of those who cannot take this medications? Why not figure out a way to include these people in the ADHD discussion because they have as much right to a successful like as the people who can tolerate medicines. Of course these people are a small percent but they are there and feeling left out on the sidelines.

        • Jeffs ADD Mind

          I wish I had a great response…but I don’t. There are many things that can help but, so far, nothing is a substitute for drugs. Those other things are supplements like Omega-3, etc.; but he shouldn’t get them without being evaluated further. You may want to check out Dr. Parker’s site: (Other things that help are physical activity and also quiet time that doesn’t involve a computer/video.)

          And I saw your latest post and diagnostic news. I’m not an expert…far from it…but ADHD (which, by the way, doesn’t really capture the complexity of the condition) can play havoc with many things, such as auditory problems (Gina Pera has written about this. See this PDF: ) and other “processing” issues. Again. I’m not an expert. But ADHD can be a significant factor.

          • Jo-Ann Rogan

            All those issues were still present when Ry was on his short term med trip. For a while they thought he had autism but that was ruled out but he has quite a few autism type symptoms. I have always known I was looking at more than ADHD having ADHD in my family . You have to remember he also has a seizure disorder. Many of these issues worsened after the seizures. Ry was approved by insurance for neuropsychological testing. All the professionals who work with Ry are excited that this testing will tell us a ton about how his brain is working and not working. Ry’s ADHD is his primary diagnosis but these are and have always been huge issues for him and meds or not the issues need to be addressed. He struggles to get simple points across at times, and the kid has always had over the top sensory issues. I could go on and on how his sensory issues impact his life. The meds, when we get a new trial of a new type, may help but he needs more help than that.

            Sorry to hijack your thread but I feel passionately about those who cannot take the meds and always have. I see them as left behind in the whole ADHD discussion. It is only 10 to 15% of people with ADHD but that is a ton of people with little to no resources or community.

            • Jeffs ADD Mind

              Don’t worry about hijacking the thread.

              You’re definitely on a hot button issue, re: those who cannot take the “standard” meds. I would not be surprised to learn that there are others that are taking the meds and have a low-level allergy/reaction to it but don’t know it.

              It’s hard to disentangle the issues — autism-like symptoms; ADHD; seizures — and I hope that the neuropsychological testing provides real insight into what is going on.

              “The meds, when we get a new trial of a new type, may help but he needs more help than that.” – Agreed. The meds are always part of the solution and never the entire solution.

              My thoughts are with you and Ryan.

  • Dr Charles Parker

    These are just a few of the reasons we’re even talking about this subject:

    • Jeffs ADD Mind

      Great slide show!

      • Dr Charles Parker

        It’s amazing how many problems arise, but face almost pervasive denial!

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