Choosing not to medicate 7yo with ADHD

[rehearseit]

My son is 7, has ADHD, and is currently not medicated. More and more people keep trying to push me towards medication. I have done a lot of research and agree that it must be life changing for some people. My reasons for not medicating are due to the fact that he does a high intensity sport that is his sole focus outside of school. He eats, sleeps and breathes it. He's obsessed with it, and it regulates him to no end. He does ok at school and whilst he struggles with focus, the only thing he is behind on is reading/phonics, but not majorly. He has great friends, is super social, yes he has big meltdowns, but things are a lot better since I have been implementing coping strategies.

Despite this, my family and a couple of friends keep ranting on about how I should 'try some meds'.

It's making me question myself and my choice.

I worry about the affect on appetite and growth, and also whether he really needs it.

AIBU to not medicate?

It’s not an easy decision and not all people react the same. DD tried as a teen and initially liked it (said it made her head quiet so she could concentrate) but since leaving school she doesn’t feel it’s beneficial. DS has a circadian rhythm disorder and I read a really interesting paper on treating adhd as a circadian rhythm disorder with bright light therapy in the morning and dark light therapy in the evening and melatonin which showed a reduction in symptoms. Ds doesn’t have adhd but uses bright light therapy for seasonal affective disorder. Dd was not a bit interested in early nights or sitting in front of a lamp brighter than the sun over breakfast as she’s in her 20s and will sleep when she’s dead.

I think you are so right to be looking at other strategies, as these will carry him through to the rest of his life - maybe not the specific strategies themselves, but him having the knowledge that sometimes strategies stop working, how to research other things that might help, how to implement them or ask for help implementing them, how long to try them for before trying something else etc... really valuable skill.

But on the medication front, a friend who has ADHD coped similarly at school (excellent sportsman) to how you describe your boy, and has now been on medication as an adult and has found it really hard to come to terms with the fact he would have been able to do so much more, and be under so much less constant stress from his own brain, if he had been medicated. Coping with the noise well, for some people doesn't compare to the bliss of having the noise reduced to begin with. He has struggled with friendships and relationships a bit, because all his energy had to go on getting through education, work, life skills. He struggled with sleeping and with his moods and both of those things have improved massively since going on medication.
I think from his perspective, him coping meant life was easier for others, but if he had been medicated life was easier for him. He didnt realise how much his brain was affecting him until he tried the medication, really.
He could try it, give it a go and let things settle in, and then if he doesnt like it, he could come back off it.

Food is definitely difficult! He's vegetarian (I'm not) because he loves animals, flat out refuses to eat meat so we use kids supplements for vegetarians, but his diet is very, very good. Dreading the day he discovers that veganism is a thing!

I understand your concerns, I also have children with ADHD who play high intensity sport. Two of them can’t take medication in the 12-24hrs prior to competitions, as it takes the edge off. Your approach to medication seems very rigid though, and I’m wondering why it’s an all or nothing thing? One of mine takes a short acting stimulant 2-3 times per week to help with focus in key classes/areas of difficulty. My eldest primarily takes it around exam periods (obviously not an issue for your son yet), and none of mine have ever used it on weekends and holidays.
Sport is definitely important, and helps many kids manage their symptoms. It does sound though that there is (or at least will be) a role for medication in helping your son academically, but your current views and rigid thinking may impact his ability to access appropriate treatment. I’d be looking at trialling short acting medication, even 2-3 times a week, to help with key areas of schooling. Having 12hrs of coverage a week isn’t going to cause him to stop growing or sleeping!

I didn’t get diagnosed until I was well into adulthood. As a consequence our son had left school before we realised my maternal line ADHD gene(s) had been included in the egg that later became him.

My position on medication is for myself and my son (had he been diagnosed as a smallie).

I don’t want to be medicated out of who I am in order to shave off my square edges in order to shove me into a round hole. The problem is the hole, not me. There are square peg holes. I want to be me in the right shaped hole.

That philosophy works well for both myself and my son.
Changes to the home/work/life environment
Planning for energy, not availble time.
Projects that are sprints, not marathons
Aiming for 1% better challenges rather than “turning over a new leaf then failing”Internal locus of control flavoured support
Coaching not “the world must bend to accept you and accomandate you as you are” input.
A whole range of trade offs compared to The Norm.
I homeschooled him because neither of us could cope with Italian state school.
We are both self-employed because that’s what keeps motivation up and procrastination to the minimum.
It’s been a lot more work than a prescription, but for us personally it does retrospectively feel like it was the right choice, because our outcomes have been good. Not perfect. But good.

Having said that, a long time ago I had a student with very severe ADHD.
His parents refused to accept the diagnosis, so niether medication, nor strategies were on the table. Strategies are not cost free. They are energy hogs, sometimes require investment in guidance, and can lead those who are sensitive to outside critism feeling raw because their choices and paths chosen are unusual.

In his case medication very well could have been the least risky route given the circumstances. He was left very vulnerable to exploitation and ended up in prison. I can’t guarantee medicating him would have avoided that outcome, but it might have given him a fighting chance.

It really is going to depend on the unique circumstances of the individual, the family, the choices availble and the trade offs that all concerned are willing to deal with.

you have ADHD yourself - so you understand the energy taken to mask the symptoms at school hence why he is probably having meltdowns at home?
Why don’t you want his life to be easier?

I'm quite conflicted about this too for my 6yo. He's also Autistic and already has an EHCP and is doing OK in school with that extra support. No behavioural issues at school. Home behaviour is extremely challenging though and he doesn't always want to go to school so I'm wondering about trying it to see if it makes home life better. I'm wondering if he found focusing at school easier whether he would be less dysregulated generally.

What led to your pursuing assessment if he is not struggling? What alternatives would you set in place to help him? Would you consider nonstimulant meds?

I was diagnosed with ADHD as an adult after a lifetime of struggling and medication changed my life, but I would also be careful of medicating a 7yo. It just depends how much he is struggling and what accommodations are put in place to make sure unmedicated ADHD is not impairing him.

The assessment was for ASD which he also has, and they suggested an ADHD assessment too.

This was me when my ds was 7. However ds is now entering puberty and his emotional dysregulation = violence. We are now choosing to medicate, having done everything else within my power except medication. He has an EHCP, huge amount of OT support, exercise, supplements... You name it we've tried it. But now its time for medication, and I am glad we've at least tried all other avenues.
Follow your gut and do what's right for you.

We are currently in for assessment and I have no plans to medicate my DS as I don't see it necessary in our case, not at this young age anyway. Perhaps when he is in his teens.

Well done you for doing lots of research and making life changes rather than going straight for the medication. These will definitely benefit him enormously. There are downsides to taking the medication, which can't be ignored. Your option might not be popular but it is clearly working well for your son.
Medication is always there as a future option if needed.

So he might have AuADHD ?

That’s beyond the limits of my personal experience, but I’m in an ADHD group for adults, some of whom have AuADHD, and a couple have mentioned that while medication helps with some aspects of the ADHD, it can aggravate some aspects of the Autism. However that’s hardly conclusive evidence of anything. Especially since they are adults.

Might be worth digging into the pros and cons of medications specifically for AuADHD, because it might change the field in terms of which medications are/are not a good fit given that there are two neurological conditions in the mix.

I have ADHD, diagnosed well into adulthood also autistic.

I ‘coped’ well in my life, have a great job, earn well, husband and 2 kids. On paper amazing.

Internally I’ve been beating myself up for years. Now I’m on meds and they are life changing.

So yes I coped, but I didn’t thrive. My eldest has ADHD, she’s the same as me. She’s great at school, passed her 11+ and going to grammar school. But she isn’t thriving, she’s struggling internally and so we’re going to try meds.

Do you want your son to cope with life, or thrive?

I think choosing not to medicate is fine, as long as you are reviewing that frequently. Ds has been medicated since he was 12. I wish we had started earlier, but i dont think it was necessary hugely before. Perhaps 9 or 10 in his case.

I am interested though that you feel so many people are telling you to medicate. In my experience, friends and family are often anti medication unless they have personal experience. So i would be wondering why you are getting this push back. What are they seeing that you aren't? Doesn't mean it's relevant or you should change your decisions, but i would certainly want to know why they believe this.

Sil didnt want to medicate DN at similar age due to concerns about health and growth etc. The rest of us sawe a child whose behaviour was often hugely troubling and who was starting to find friendships etc more difficult. She wants only the best for him but she was in denial. Unfortunately, unlike you, not only did she not medicate, shes made no effort to find alternatives and he is now very isolated, has few friends, and his school performance is dropping off.

You dont sound like her but I think you can and should ask someone you trust if they have specific reasons for suggesting meds or if they are just recommending it as a sort of general "best practice".

I think your reasons for not medicating sound fine.

One thing to consider regarding the emotional regulation: meds could possibly reduce the intensity of his emotional experience so that difficult situations are less overwhelming. That could help him practice emotion regulation skills without maxing out his capacity to cope. If emotional regulation is still challenging, maybe a short trial of meds to support skills development would be helpful.

I dont think its the expectation that people who have ADHD SHOULD be medicated but I wouldn't rule it out either.
When i was teaching I was doing supply and met a young man who really struggled at school (ADHD diagnosis). A few months later I was back at the same school and one day we were taking part in a concert at a local theatre. He managed so well but as the afternoon went on you could see the lack of focus coming back.
Although as a parent ofcourse its mainly uour decision, but it is really about your son, how it will affect him.
How does he feel now?
Does he want support?
What is his view on taking medication? Does he want to try it? Then make a judgement.

“Fix his brain”? And that’s why I don’t get my medical advice from teachers.

My severely ADHD DD had teachers, family members and others telling us to medicate from 4. She was diagnosed early because she had very classic boy-type ADHD. The medical advice has to medicate only when DH and I could say that it was for her, not the people around her. Thank goodness for the pat doctor.

She’s now, after years of very hard work on her behaviour, environment and supports, a wonderful, clever, happy, friendly, hardworking, artistic, and unmediated teenager. People now look incredulous when she tells them.

I’m not saying, OP, that you shouldn’t. I am saying don’t take medical advice from someone who doesn’t have the best interest of your child in mind. And teachers (one particularly awful one in our case) are sometimes focused on classroom management not welfare. DD moved to another class the year after and had a brilliant teacher who also has ADHD and helped her immeasurably.

Out of interest, what does your son feel about whether he should take medication or not? Does he feel impacted by ADHD and would he like his levels of concentration to increase or to be given the chance to see if his daily lived experience and educational outcomes can be improved?

In my experience, the main plus of ADHD medications, (apart from their generally positive effects on concentration), is that they only remain in the system for a maximum of 8-12 hours a day. This means that you can try them and easily assess whether they are helpful. You can also choose not to take them at the weekends and in the holidays, so they can be used only to improve attentiveness at school. We followed this approach with my son and he learned to ask for them when he felt he needed them, which meant that he was totally in control of his condition as he progressed into adulthood.

You say that you have ADHD and are glad you were not medicated, but your son may feel differently. Surely his view needs to be considered in the conversation?

Who is 'pushing' you to medicate OP? Is it your doctor / CAMHS or just well-meaning family and friends? If the suggestion is coming from medical professionals then I would be inclined to take their recommendations but ultimately you should decide what you consider to be best for him. You know your son better than anyone else. If the suggestion is coming from others then it's pretty irrelevant TBH, you can't just 'choose' to medicate anyway without your doctor considering it necessary and relevant. Doctors / CAMHS really don't prescribe ADHD medication unless they have to.

My son was diagnosed with ADHD (amongst other things) at 7 and we did choose to medicate. He had a happy, productive experience at primary school and I'm glad that the medication was able to support with this.

Heading to secondary school, he found life much more challenging. Puberty, school pressure and teenage peer pressure can be tough for kids that don't have the challenge of neurodiversity. My son struggled massively and the impact of that has had ramifications across not just his life but the live of our family too. I'm not being dramatic or exaggerating to say that medication has probably saved his life. If we hadn't already been on that pathway I suspect that we would have been too late to start the process, as the damage would already have been done.

I suppose what I'm saying is that it's fine to decline medication for now but try and keep an open mind and be mindful that things change, and can change quite quickly. If your son's doctor is suggesting medication it then it's likely with good reason.

We recently started medication for our son (and me) and he's basically not eating at school now. I can't get the timing right so he's hungry. It's SUCH a pain and if he was younger I'd be really worried - but he's 12, eats at home, and grew an inch in December. It helps focus a bit but not emotional regulation for him - for me, it reduces overwhelm, which is nice. I don't know. People talk about how it's like going from life being set to extra difficult to being set to easy, but it's not been like that for us. But I wonder if even making things slightly easier is just the right thing to do. Especially as it's out of their system so fast. I kind of wish we'd tried it sooner.

Fine to try out other remedies, particularly as you are committed to doing so.

Keep the medication in mind to trial before secondary school.

I would be introducing more protein into his diet - eggs, dairy and the odd meat. He is seven after all and tasting new foods should not exclude fish and meat.
Would medication (melatonin) assist with sleep? Sleep is a huge factor in maintaining health.

It is very important that DS7 improves his language skills.
Does he need glasses? A tutor? To decrease time at sport and pick up more reading?

If he were my child I would need to trial low dose mediaction. I would cease, perhaps, once DC was in the top group for reading and writing. I would have to find out if, for my child, the medication made positive changes.

This is my only question

I was bright at school - I think being bright but slow and needing extra help in reading is not a good start. Kids know where they are in the class. Better to be bright across all subjects.

It's not offensive. If ADHD is affecting your ability to live life to the full, it is "offensive" for a parent to decide not to improve things for their child.

Okay I agree it's not an injury, however it is not "offensive" and it's an understandable comparison. If you take offence at this, you're going to struggle with life.