Why we’re trialing ADHD medication with Dominic

I gave Dominic his first dose of Ritalin this morning.

I feel sad, and nervous, and guilty about this.

I’m nervous because I’m worried it won’t help, or it’ll make things worse.

I’m sad because I don’t want Dominic to need this sort of chemical assistance to find the best version of himself—to become more available for learning, and learning how to be a good friend.

I feel guilty because I suspect that Dominic is like the child another writer described as “an evolutionary remnant, a hunter personality trapped in a culture of desk jockeys.” I can’t shake the sense that we’re medicating to Dominic to help him fit into the Western school culture we have created, rather than accepting the way that Dominic was created and finding other ways to work with it.

But even in the face of this potent emotional cocktail, I am also confident we’re making the right decision to try this medication.

When the pediatrician first told me she thought Dominic had ADHD, I sat there a bit stunned.

“Really?” I thought. “But… he can focus when he wants to. I’ve seen him focus for ages on the iPad, and on something he’s interested in. And he’s not that hyperactive. I mean, sure he lights fires any chance he gets, and climbs anything he can wrap his hands around… but I’ve seen him sit still. At least a couple of times, surely.”

Needless to say, as I’ve dug into the literature on ADHD, I’ve learned that I didn’t really understand ADHD at all.

When it comes to attention, it turns out that ADHD is all about distraction… until it’s not. It’s not that kids with ADHD can’t ever pay attention, it’s more that they’re a bit bipolar with their attention–they’re either quite distractible and struggling to pay attention, or they’re hyperfocused.

This hyperfocus is sometimes called an ADHD superpower, because this ability to hone in on a specific task to the exclusion of everything else is quite awe-inspiring to see in action.

A child with an interest in electrical circuits, for example, may voluntarily concentrate intently for hours—creating new circuit combinations and demonstrating an instinctive talent for systems thinking and problem solving. We’ve seen Dominic do exactly this within the last month.

But this hyperfocus can’t be reliably sustained or controlled. It certainly can’t be “turned on” at will in a classroom.

When it comes to impulse control and hyperactivity… Children with ADHD often act before they think. They really struggle to control their initial response to a situation. Documentable differences in brain structure are partly responsible for this lack of ability to self-regulate—to modify their behavior with future consequences in mind.

And, similar to the hyperfocus dimension evident with attention, kids with ADHD seem to have a “hyper” setting on impulses and desires, too. Once they get an idea, they can fixate on this idea with great passion and momentum. They’re sure it’s the best idea they’ve ever had—the best idea in the whole world. And they’re sure it has to be done right now.

We see this almost every day in our household.

Once Dominic gets an idea stuck in his head (as he did, for example, yesterday morning when he decided we needed to cut down a tree on our neighbor’s land) we’re usually in trouble. He will go and get the toolshed keys, load up a wheelbarrow with a saw and the bushknife, and start for the gate. Once he fixates on something like this, it basically takes dynamite to derail that train of thought.

And we all know what happens when you have to use parental dynamite. The fall-out is destructive and messy. It takes a long time for the dust to settle.

Anyway, back to ADHD medication and why we’re trialing it.

When the pediatrician diagnosed Dominic with ADHD, she strongly recommended we try medication.

Since I was still struggling to assimilate the ADHD label, it’s probably not surprising that my initial reaction was strongly negative.

No, no, I remember thinking as I sat in her office. We’re NOT doing that. We’re coping without it. We have the support of the school. We are NOT using meds.

It took me about five days to change my mind on this point.

During those five days I read three books. I listened to multiple podcast interviews with experts. I talked to three additional doctors, an educational psychologist, an occupational therapist, an eating disorders specialist, three special education teachers, and five parents who were medicating their kids for ADHD.

And it became harder and harder for me to ignore the fact that medication might help him.

Neuroimaging studies show that Ritalin and other ADHD drugs selectively activate specific areas of the brain (the cortex, the cerebellum, and the basal ganglia) that are “underperforming” in children with ADHD. These areas are intimately involved in regulating attention, decision making, and impulse control. ADHD medications can help these areas of the brain better do what they’re supposed to be doing—what they’re doing in the brains of children without ADHD.

In turn, this might help Dominic focus better in the classroom, figure out and focus on what’s actually important, and think more calmly and clearly. It might help grant him a little bit of extra time to consider an impulse before he acts.

Dominic might indeed be that hunter personality, trapped in a culture that thinks it doesn’t need these sorts of “wild” men and women. Any which way you look at it that’s going to be a struggle for him, and Mike and I will do our best to help him find cultures and spaces where that sort of hunter personality can shine. But even hunters need to learn to think before they act, listen to other people’s point of view, not hit people when they get annoyed, and (for crying out loud) leave the neighbor’s trees well enough alone. So, today, as well as feeling sad, nervous, and guilty… I’m cautiously hopeful that Ritalin will be one tool amongst many that will help Dominic in his journey.