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Question: My child was recently diagnosed with ADHD, but medication just doesn’t seem to be an option for her. We’ve talked with her doctor, but we feel like we’re floundering when it comes to a choice about medication. Do you have any suggestions?
—Mom of a 7 year old
Answer: There can be a few reasons that medication is not an option: your child is unable or unwilling to physically swallow the medication, your child experiences side effects that are intolerable, or the medication has no benefit for her. It can also be that your child has decided not to take medication or you have made an informed decision not to use medication as part of her treatment plan.
Are you worried that your child won’t take the medication?
If you’ve made the decision to use medication management as part of your child’s ADHD treatment plan but you’re worried how your child will react, it’s important to stay positive about medication time. Children will pick up on your concerns and will reflect them back to you, often as reluctance or fear. Don’t say a medicine will be “yucky” or tell the child that she is “brave” to take the medication, implying that the medication is somehow scary. Acknowledge your child’s fears, but reassure her that you wouldn’t make her do something you believed was dangerous.
A calm and matter-of-fact approach to medication is helpful. Rewarding a child with stickers or five minutes of extra electronic time or a similar small award, can help the medication go down faster. Help the medication go down easier: if the medication is a liquid or chewable, find out if it can be flavored by the pharmacist and then let your child pick the flavor. Sometimes a little coloring can be added to the medicine by the pharmacist, and your child can pick out her favorite color.
A little roleplaying can also help, too. Let your child practice giving “medicine”—a little water or candies—to her dolls or stuffed animals first as a way for her to prepare to take her own medicine. Some children need a little practice swallowing first. You can talk with the doctor for suggestions on how to use small candies or little balls of bread for your child to practice swallowing a pill whole.
Does your child have trouble swallowing medicines?
If your child cannot swallow a pillow, even after practicing:
Ask the doctor to prescribe the medication in a liquid or chewable form, if one is available.
Talk with the doctor about an ADHD medication that comes in a patch that can be applied to your child’s skin.
Find out if the medication can be compounded into another form and ask if there is a compounding pharmacy that can fill your child’s prescription. Compounded medications are ones that have the active ingredients mixed into liquids, syrups, creams, or chewables that are easier to take. Some medications can be compounded into powders and mixed into drinks.
Use a measured syringe (without a needle) to squirt a liquid medicine into your child’s cheek pocket, where the natural swallowing action will take over.
Trick the sense of taste by coating a spoon in chocolate syrup or fruit syrup and give the spoon and medicine at the same time.
Check with the doctor or pharmacist if the pill can be opened and the contents combined with food, such as a little yogurt, ice cream, or applesauce, which your child can easily eat. Some formulations can be used this way, but do not open or crush an extended release pill because it interferes with how the medicine is absorbed by the body.
Does your child experience intolerable side-effects?
Anytime your child experiences a reaction that is or could be a side effect of medication, contact the doctor. Most side effects are limited in time; the most frequent side effects include a tummy ache, headache, sleeplessness, and loss of appetite. However, some children do experience more serious side effects that prevent a child from taking a particular medication.
If your child cannot take a medication due to side effects, discuss with the doctor other types of medication that may be a possibility for your child to take. Many children who cannot take a stimulant medication can take a non-stimulant. Some doctors have experience prescribing atypical medications—medicine developed for other conditions that are helpful for ADHD symptoms—and can provide additional options that don’t raise the same side-effect concerns. Some non-pharmacological treatments have been effective to a certain extent when medication cannot be used.
Psychosocial Treatment for Children and Adolescents: If a child cannot take any medication, discuss with the doctor behavioral management approaches to add to your child’s treatment plan.
Parent training: You may also look for a parent training program in your community to help you learn additional parenting skills to help your child. These programs are especially effective for the parents of younger children but can also benefit parents of teenagers. This approach is also the recommended first-tier approach for children age five and under.
Cognitive behavioral therapy: Older children and teens may benefit from cognitive behavioral therapy as part of their treatment plan.
Omega-3 supplementation: Talk with the doctor about research on Omega-3 fatty acids. While ongoing research shows supplements can help some children by decreasing symptoms, it takes several months for there to be a noticeable improvement. This approach varies for each person and is not as effective as stimulant medication. Your child’s doctor can talk with you about incorporating it as a complementary and not a primary approach to treatment.
Sleep and Diet: Changes to a child’s bedtime routine can help her get more sleep that can decrease some of the symptoms. If your child has a sensitivity to some ingredients in foods, such as artificial colors or preservatives, eliminating those foods or ingredients can help decrease symptoms.
Does your child refuse to take medication?
In both children and teens, it’s important to find out why your child won’t take her medication. Reassure a fearful child when you can; discuss treatment options with older children. With younger children, you as the parent have the final word. Teens, however, cannot be made to swallow medicine that they refuse. For both children and teens, sometimes a discussion with their doctor can help persuade them to take medication. If medication is still a not an option, refer to the above alternative treatments to explore.
Address a child’s fears about medicine. Sometimes a child doesn’t understand as much as we think she does and has questions that adults haven’t answered.
Create a rewards system, such as stickers or tickets for small favors, if she takes her medicine without complaint.
Avoid creating situations where a child must be restrained by another adult and given medication, as it can damage the parent-child relationship and cause greater reluctance to take any medications.
Have the teen talk with her doctor. When teenagers have more buy-in to their treatment plan, they are frequently more cooperative. Having your child participate in her treatment plan also teaches her how to manage her own health care and self-advocacy.
Create an agreement between you and your teen, related to grades or behavior. If grades slip or there is a behavior problem, the teen starts taking medication again until the end of the school year (or another appropriate time for your family).
Emphasize behavioral management and academic support as treatment. Work with your teen to create a behavioral management plan and to follow it. Some teens can benefit from working with a coach who provides accountability, rather than you the parent.
For more information on behavioral and medication management as part of child’s treatment plan, visit our Treatment Overview.
Do you have a question related to ADHD? You can call our Health Information Specialists Monday through Friday, 1-5 p.m., at 800-233-4050 or ask your question on Attention Connection Questions & Answers for feedback from our community.
What additional suggestions would you offer this parent?