Partners in Treatment

Ashley Karls/ November 3, 2010/ Sharing Stories

Alan Barret, who was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in second grade, had been my patient for five years. In that time, he’d done really well. At 13, he was a stocky, cheerful boy who loved to draw, did well in school, and had good friends. He was particularly close to his brother – the two boys played on the same soccer team and formed a band with two other kids.

So when Alan came in for a routine visit and reported that everything, going into middle school, was just great, it was a surprise to his mom when he added, “We need to talk about something, Dr. Lipton. I want to try going off my meds.”

Before I could ask him about it, his mom demanded, “Do you feel like they’re not working?”

“No.”

“Are you having side effects you haven’t told me about?” she persisted.

“No,” he said again, and turned to me, hoping I would understand why he wanted to give up a drug that was apparently making his life so much easier.

And I did understand. “Sometimes when kids get to middle school they feel really independent,” I said. “They want to rely on themselves. Alan wants to know if he really needs to take medications. And that’s an excellent question. I think you should stop taking your meds and see how it goes.”

I explained that off meds, Alan might feel it was harder to work steadily at a task. He might be more easily distracted. He might find he had more of an appetite. “It’s important for you to notice any changes,” I told him. “Your feedback is really important in deciding what to do next.”

I could tell Alan’s mom didn’t feel great about this decision and the next day she called to tell me so. “Children do change,” I said to her. “It’s just possible that Alan, with the excellent study habits you’ve helped him develop, will do okay with this. But you’re right, it’s far more likely that he won’t do as well without his meds. It’s important, however, to give children the freedom to be partners in their own treatment, so they know they have arrived at the right decision on their own. I know there are clinicians who would force the issue, just as I know that there are children who battle their parents over this, and spit out their medication.”

About five weeks later, the Barrets were back in my office. “What did you find out?” I asked Alan.

Alan smiled and shook his head. “I finally told my mom, ‘Look, I can’t pay attention to anything any more. I really noticed the difference. When the guy next to me was taking notes, I could hear the noise of his pencil on the paper. I notice the cars outside stopping at the light. The lavatory next to our classroom has a door that bangs twice, ba-boom, and now I hear it every time, even with the classroom door closed.”

“Alan started taking his meds again at the beginning of this week,” his mom said.

“It really makes a difference,” said Alan. “It makes me a real learner. Without meds, everything’s a mess. With them, it’s perfection.”

“All of us have things that need a little correcting,” I said. “I need glasses. I see kids who need insulin for diabetes. If you got an ear infection, you’d take antibiotics.”

Alan nodded. “I know. It’s lucky there’s something that helps.”

“Isn’t it great,” I asked his mom, “to have raised a child who makes the right choices and is so self-aware? The choice to stop taking meds and the choice to begin again, were both Alan’s. And they were both right.”

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