When medication is indicated, Dr. Wilens said, parents need a little space and time to think about it, and it may take more than one visit to get to the point of actually writing a prescription.
What parents are most worried about, of course, is safety. “I go right to their worst fears,” Dr. Wilens said. “Is this going to hurt my kid, what are the side effects, what are the worst things that can happen?”
Dr. Greenberg said that she sometimes talks about the Milwaukee study that followed children with A.D.H.D. as they grew up, and suggested that those whose A.D.H.D. was treated when young had fewer problems with drug and alcohol abuse. “I emphasize that this isn’t just a school problem, it’s a life problem,” Dr. Greenberg said. Dr. Wilens cited a 2017 study that also found that A.D.H.D. treatment was associated with less substance abuse later on.
The doctor should also talk directly to the child, even if the child is young, Dr. Greenberg said, explaining the plan, and answering questions, and getting the child’s assent to treatment. Don’t promise that medication will do the impossible: “It doesn’t cure anything, but it fixes the problem,” she said. “I explain, we’re going to make their brains work better — it won’t get you a girlfriend, you won’t dance.”
Prescribing psychotropic medicines for children involves close attention to the child’s rhythms and patterns. “I want to know about their eating habits,” Dr. Greenberg said, since some A.D.H.D. medicines can reduce appetite. It’s important to know whether they are night eaters or breakfast eaters and to time the dosing so that it interferes as little as possible — and then to monitor the child’s growth carefully.
And the doctor should check regularly on issues of sleep; sometimes a child can’t tolerate an afternoon dose of a stimulant without sleep problems. Good sleep hygiene is important, and it’s often helpful for children with A.D.H.D. to wake up at the same time consistently, weekdays and weekends, Dr. Wilens said.
Doctors should explain how the dosing works, Dr. Greenberg said. “I always explain what the therapeutic range is — some people are fast metabolizers, some are not, and we always start low and work up.” Families need to understand the pharmacology, and what to do if you miss a dose.