Worried about 5 yo nephew's treatment for ADHD
My 5-year old nephew is an adorable, energetic, and feisty boy. I have spent quite a bit of time with him over the years, and I have seen his temper flare and his inability to listen and calm himself down. But still...he is 5! My brother and his wife have struggled mightily with him since birth (I am completely empathetic, as I have my own "beast of burden" at home as well). He was always more challenging at home, and a lovely boy at his preschool, as reported by his teacher (a play-based preschool). Beginning about a year ago, they began to take him to counseling. They did a combination of individual and family therapy, but weren't really seeing the behavior change that they wanted to see. They contacted the public school department to see if he would qualify for services there, but he did not qualify. Finally, a few months ago, they took him to a child psychiatrist who, lo and behold, prescribed Ritalin. They felt relief; I felt terror. I know that this and other stimulants help many, many children, but he is 5! And I feel that there could have been so many other stones to turn over before putting him on such a powerful drug. We just visited with them, and he was clearly "hopped up": he had no appetite and a hard time settling down for bed. Classic side effects. My brother and sister-in-law are not the "alternative medicine" types and they live in a fairly conservative community (though proximate to NYC), but I am wondering if there are folks in this area who can offer some ideas that I might propose *in a non-judgmental way* that might help. He's my little nephew, and I would love to see him given a few more years before going down the road of psychoactive medication. Thoughts?
Parent Replies
I empathize with you because I have a niece with slightly different but equally challenging behavior issues and the way her parents have chosen to deal with them is absolutely not the approach I would take. With that being said, I do not think there is any way to tactfully approach discussing the decision your brother and wife have made with them. There is no way to propose alternatives that does not come across as judgmental even if you mean well. It appears they have tried many appropriate avenues and while people have strong feelings and differing opinions about the effectiveness and appropriateness of these medications in young people, they are under the guidance of a trained doctor and have made a decision they clearly feel is right for them. I'd be a supportive aunt in other ways - praise the good behavior when you see it, treat him to special solo time if you can, etc. He may ultimately grow out of this or his parents make come to a different decision but ultimately it is theirs to make and I'd stay out of it.
My son had severe ADHD and was helped dramatically by eliminating sugar and processed food from his diet. If your nephew's family is skeptical of alternative-type treatments, they may be less inclined to try a diet change, but it made all the difference for us.
Overcoming the decisions of the parents, therapists, school and psychiatrist would almost certainly be seen as judgmental. I think this not an area for family members to step in to. It sounds like the parents tried everything they could before going to medication.
May I gently suggest that you not offer any opinions to your nephew's parents on this topic? I'm sure your concern is genuine, and it is wonderful that you love and care about your nephew. But his parents have likely made a well-informed decision in consultation with their pediatrician. They sound like attentive, caring parents. If Ritalin is not the right choice for their son, they will likely find another treatment in time. The fact is that neither you nor anyone reading this newsletter can substitute her judgment for this child's parents. They may have information that you do not, and they certainly have more information than internet strangers. Even if they are making a mistake, it is their mistake to make. It is not a situation of abuse or neglect. I'm sure there are other ways you can offer love and support to the family that don't involve questioning their medical decisions.
Leave them alone. Honor their way of parenting as you'd want them to honor yours.
As a parent who started our child on stimulant medication when he was 6, let me advise you to MYOB. Believe me, your brother and his wife already know what you think about their choice. That's why they haven't asked you. Stimulant medication is a godsend for many children. It enables them to participate in activities, to interact appropriately with peers and make friends. Ask yourself why you would begrudge your nephew these normal aspects of childhood including the ability to control himself so that he isn't reprimanded 100s of times per day more than his peers. It also enables them to focus long enough to learn to read and write. That is what kids with ADHD grow up with. They are born a chemical imbalance and refusing to treat it can be cruel. His parents and doctors are treating it in a completely appropriate and medically studied manner. The NYT is one of the most virulently anti-ADHD medication publications around. They know about the disapproval. They know about the people who claim sugar, gluten, additives, sleep, bad parenting etc are to blame. If you really want to support them, offer them your caring ear and just listen.