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.
- See this recent article in Scientific American.↩
- 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.↩
- 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.↩
- 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.↩
- 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.↩