First, great you got DS diagnosed. As a late-diagnosed adult I wish I'd had the advantage of meds (and understanding) as a youngster. You've probably resolved it by now, but some thoughts in case helpful anyway :-)
To medicate or not? IMHO, yes, yes, yes, please do - and persevere until you find the right meds, at the right dose. (Wish someone had done this for me :) Sure, there are risks with all medication, but having lived with the condition for decades, I've reached the conclusion that the risks on not medicating are far higher.
Having ADHD is monumentally stressful - for the kid, as well as parents. Untreated, it can lead to many long-term issues such as low self-esteem, bullying, social exclusion, and the stress and misery of living with it can eventually take a terrible toll on physical health. For me ADHD meds have been miraculous; quality of life at last, for 10-12 hours a day. (If only the first few decades could have been like this, I wouldn't have had to work 10 x as hard just to manage stuff others do in a fraction of the time, and would probably have been much healthier too).
When treated, many kids grow out of the need for meds by the early 20s. I'm no expert nor medically trained, but having researched in depth I suspect this might be because a child's brain is so adaptable, so with the right treatment, by adulthood they can have generated different neural pathways and coping strategies that enable them to not just manage without meds, but to excel. (Not quite so easy with later life diagnosis).
If DS doing OK academically, he may well be just getting by and hugely frustrated that he's not excelling. There's a common misconception that ADHD medication curves peoples creativity and 'dulls' them down. This is simply not true; rather, it enables us to get closer to achieving potential by enabling us to actually finish a task - that little thing most people just take for granted!!
Concerta XL (CXL) vs Medikinet (M): I've taken both and absolutely recommend CXL over M. The CXL timed release builds slowly, no 'jolts', and tails off slowly. I can't feel it, don't know when it starts and stops; it's more that I can or can't concentrate and do / don't have clarity of mind. I find Medikinet can give an instant 'hit' causing heart palpitations. I keep some to use at lowest dose for pm boost if needed, but I'd never again rely on it as main medication.
To get best results from CXL:
- Take at appx. same time every day
- Must be taken with a decent breakfast containing FAT (e.g. cereal and Greek yoghurt, eggs on toast with butter, glass of full fat milk).
- Practice meditation to get to sleep (or be awake all night with racing thoughts as the effect wears off).
- Titrate dose up SLOWLY.
- Once meds at optimum dose, get therapy. The two go hand in hand, but therapy is useless unitl meds work due to ADHD effect on short term memory.
- Accept that whilst it may be a bit of a miracle, medication not a magic bullet. It helps concentration, but not what to concentrate on. That's a really important distinction because if I choose* to 'concentrate' on binge-watching TV instead of working, the work still won't get done.
- If (like I did) DS excels academically in some areas but fails uttely in others, it may be necessary to accept that there are some things his brain just won't do. ADHD rarey rides alone; a very high % also have dyspraxia, dyslexia, dyscalculia or a combination thereof.
So why bother? Because where it's marginal, meds can help provide the clarity to makes the difference between success and failure. And because even with severe ADHD one
can excercise choice*, and more of (what everyone suspected all along) we were capable of is achieved, concentrating on the right thing gets easier.
Talking of choice, if DS behavior remains pretty dreadful, are there consequences? As an adult we're more aware that to have a happy life, the diagnosis must not become a crutch, nor an excuse for bad beaviour, but kids need more help with that. I never got to behave badly because where / when I grew up, schools (and society in general) just didn't put up with it. Whilst more understanding with the internal struggle would've been good, I'm grateful for the societal / educational framework that helped me function - so well in fact, that like many, I became adept at masking the neurological challenges, albeit at a high personal cost. DS is soooo lucky it's been spotted early on, but he'll have to do his part.* It CAN be done though. And there are rewards, many! Wishing you much luck in moving forward.