Dear Dr. Wong: Our nine-year-old daughter has ADHD. Her Grade 1 teacher noticed that she couldn’t pay attention, although she didn’t disrupt the classroom. She struggled in Grade 2, even though she is very smart. She was finally seen by a pediatrician and was started on medicine every morning. This has greatly helped her; she is excelling in school and has lots of friends.
My good friend’s son also has ADHD. He takes the same medicine but only on weekdays when he goes to school. He is a nice and polite boy when he comes over after school to play with our daughter. However, when he comes on weekends, he is bold, argumentative and aggressive. I really don’t want him around when he doesn’t take medicine. My friend said that when he takes medicine, it affects his appetite and makes him too quiet; she likes him more active when he is not in school. Should I do the same?
Answer: I am glad that you are giving your daughter her medicine every morning. What your friend is doing is wrong.
As your already know, attention deficit hyperactivity disorder (ADHD) is a genetic condition; children are born with it. It affects the front part of the brain and how it communicates with the rest of the brain, using chemicals called neurotransmitters. About five per cent of children worldwide have ADHD.
Some children have difficulty paying attention, while others are more hyperactive and impulsive. The more severe ones have all of these symptoms. If untreated, many have difficulty succeeding in school and can drop out in teenage years. Some can still succeed, if they have supportive parents and teachers.
Medications are helpful for most, if not all, children with ADHD. In recent years, long-acting medications can be taken once a day in the morning and stay effective until evening. Most of the time, if medicine is adjusted carefully, there is very mild side effect. The most common one is appetite, especially at lunch time.
Appetite suppression is usually temporary and will get better over weeks to months, when medicine is given daily. Some children may lose a bit of weight, but they catch up over time. After following many children over decades into adulthood, I have not seen a single child who didn’t grow.
Unfortunately, some parents are just too scared when their children come home with their lunch untouched. They are afraid that their children will lose weight. However, if they didn’t eat lunch, they will be hungry at supper or shortly afterwards. I always suggest parents feed their children with home-cooked meals and have leftovers after supper if they are still hungry, instead of giving them snacks or treats.
If parents give their children ADHD medicine daily, over time, the appetite suppression will decrease and they will eat their lunch in school, as well as their supper. However, if parents keep skipping medicine on weekends and holidays, children will be more hungry and eat more on those days but will continue to experience appetite suppression when they take the medicine on school days. The side effect will come back again and again.
The same is also true of their ADHD symptoms. If they don’t have medicine, they will not be able to pay attention as well in social situations and will not listen to their friends and adults. This can affect peer relationships and lead to behaviour problems that you have mentioned. Over time, when he is a teenager, he may refuse medicine altogether. It is much harder for parents to insist at that time.
Over the years, I have seen young people drop out of school and get into trouble with addiction and the law. This is a tragedy because all the heartache could have been avoided.
You have done the right thing to give your daughter her ADHD medicine daily. You may want to tell your friend about what you have observed. Hopefully, she will listen to you.
Dr. David Wong is a consultant paediatrician in Summerside and recipient of 2012 Distinguished Community Paediatrician Award of Canadian Paediatric Society. His columns will appear in the Guardian on the last Tuesday of every month. You can see a collection of his previous columns at Askdrwong.ca. If you have a question for Dr Wong, please mail it to Prince County Hospital, 65 Roy Boates Ave, Summerside, PE C1N 2A9.
