Expert: Dr Billy Levin - 12/3/2008

Question
I have an 8-yr-old who has been diagnosed with ADHD.  We have managed his condition without medication so far. We are not opposed to medication, but we have not deemed it necessary for him to function well in school.  So well, in fact, that his 3rd grade teacher has recommended a mid-year promotion to 4th grade.

Academically this would be a great thing for him, he is currently unchallenged and works much above grade level. However, we expect that this change will create new challenges for his ADHD.

What steps would you suggest in helping him adjust, including, which medication is to you the first thing you would try?  I am concerned about stimulants but it appears that they are the first line of attack, with non-stimulants secondary.  

Any advice is welcome.

Answer
I am opposed to midyear promotion just for academic reasons. Please consider his emotional, physical, social and developmental levels as well. Next, the decision to medicate or not does never depend on how well the parents cope. There is a medical science that decides if the condition is severe enough to warrant medical treatment. The doctor's skill and experience  guides the parents for the sake of the child.  Short acting Stimulants are always the first choice because they are more effective then the  non stimulants and an optimal dose can be achieved within 10 to 20 days. Non stimulants may take up to 8 weeks to start working. You should not be concerned about stimulants. They are exceptionally safe, have no long term side effects and are the easiest to monitor and adjust to optimal levels.  The treating doctor who knows the patient will be in a good position to advise about counselling if required. If he has a high IQ he must not be judged by average marks in the class but rather how close he performs considering his true potential. Rating scales are essential  to determin if medication is needed and if it works.