I thought it would be easier being a Pediatrician who cares for and sees so many success stories among his patients with ADHD, but it wasn't. It did help that I knew the consequences of not treating my child. The frustration of always getting in trouble at school for talking, not paying attention, and not following the rules, could quickly harm his self-esteem. Unlike kids who are truly defiant, children with ADHD who get in trouble because they are impulsive often say that they are trying to follow the rules and not get in trouble and just can't help it. It is heartbreaking to see a child get in trouble over and over or fall behind at school when they are really trying to do better.
Getting a DiagnosisIn our case, making the diagnosis was fairly easy, as he has always been a very hyperactive child. If the typical child with ADHD is described as being 'driven by a motor,' then he had a turbo jet engine. He was also fairly impulsive, easily distracted, and had a very short attention span. You could almost describe him as the 'poster child' for ADHD, but because his symptoms and behavior weren't causing any impairment for him before starting kindergarten, it was never a big issue before.
Your Pediatrician and your child's teachers should be able to help you with testing and getting diagnosed. Other options are to see a child psychologist or psychiatrist for ADHD testing.
Picking an ADHD MedicineOnce we confirmed the diagnosis and his need for treatment, we had to decide on what medicine to start him on.
Of course we wanted something that was safe and that would work, but that could apply to all of the current ADHD medicines. We also wanted a long-acting medicine that could be given just once a day, so that limited our choices to either Adderall XR, Concerta, Ritalin LA, Metadate CD or Strattera.
As he can't yet swallow pills, that narrowed our choices even further and we were left with Adderall XR or Ritalin LA, which are both capsules that can be opened, sprinkling the medicine on something your child can simply eat (like applesauce).
We finally decided on Adderall XR, both because I just generally tend to favor this medicine, its effectiveness and side effect profile, and because it is available in capsules with dosages as low as 5mg and 10mg, while the methylphenidate containing capsules we considered, like Ritalin LA, start at 20mg. I wanted to start him at the lowest dosage possible and then work our way up on the dose if we needed to, and Adderall XR offers that flexibility.
Did It Work?In our case, starting medication, which we did on a Saturday, had a quick and dramatic effect. Starting on a day when your child is not in school is usually a good idea, so you can observe any side effects or problems with the medicine.
And we did notice some mild side effects, the most noticeable of which was that he continuously made a chewing motion all day, to the point that I thought he was chewing gum. Since stimulant medications can make tics worse, this side effect worried me, but fortunately, it quickly went away by the next day. Although he didn't have any insomnia, stomach aches or headaches as many kids do, he does have a decreased appetite, which I am hoping will get better.
The other big problem we noticed those first few days was that he would cry sometimes when he got frustrated or didn't get his way. 'Emotional lability' is a common side effect with Adderall XR, but this side effect, fortunately, also quickly went away and we didn't notice it any more after he was on the medicine for a few days.