ADHD and Medication

I wear glasses.  As far as I know, my eyes are healthy. They are not sick or diseased.  However, I am significantly myopic and must wear my glasses in order to function effectively.  My glasses are a tool that makes my life much more manageable.  However, my glasses don’t do my work for me.  I must still do that.

Many times I’ve talked about my eyesight and my glasses to children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and who are about to begin medication. I point out the parallels, comparing my near-sightedness to their poor focus, comparing my glasses to the medication they will soon begin taking. I explain to them that, as far as I can tell, they are healthy.  They are not sick or diseased.  However, they cannot focus very well and like my glasses there are medicines to help them to function more effectively.  Medications are a tool given to make life, especially school life, much more manageable.  But, as with my glasses, I remind kids that they still have to put forth the effort. Medication may help to improve attention, but little else.  Making good choices, having a good attitude and working hard is up to them.  Medication may help to make it easier to complete the task, if they so desire, but it never does the work.

As a father and grandfather, the decision to prescribe medication was never made lightly.  I knew of many children whose lives were transformed for the better with the proper use of medication.  However, I knew just as many children who did not need medication or who did poorly when medication was tried. I saw that the use of medication required more than adherence to “evidence-based” algorithms. Rather than get trapped into the polarized and politicized view that medication was either wonderful or awful I knew that each child had to be carefully, meticulously evaluated. When all the information was gathered and considered, I then would ask myself, “If this were my child?”

I remember diagnosing a 5^th grader with ADHD and starting him on medication.  A few weeks later he came to my office excited to tell me how school was going.

“Dr. Boxer, it’s been great!  I’m getting my work done.  The teacher’s not yelling at me any more.”

I smiled and said, “That’s great.”

He then looked at me, pointed his finger and said with a serious expression, “But Dr. Boxer, I want you to know something.”

“What’s that?”

“Dr. Boxer, it was one-tenth the medicine and nine-tenths me.”

I asked him to explain.

“Well, Dr. Boxer, the medicine helped me to sit still and pay attention, but I still had to do all the work.”

I nodded and told him, “You’re right.”

Often there are misconceptions or magical thinking associated with medication.  Some parents and children come hoping that medication will make the problems go away. Some come expecting a fix or a cure.  However, at least for ADHD, if improvement is to occur, it is both the medication and the patient effort.  One-tenth to nine-tenths is about the right ratio.