Sunday, June 3, 2018

Our Experience with Adderall

Near the end of second grade, my youngest son was evaluated by the school district and we were told that he was high-functioning autistic. The specialist who gave me the news seemed to think she was doing us a favor. We could get accommodations now, she said.

One of those accommodations was special education. For certain school subjects, my son would be in a classroom with only a handful of other students. He would get specialized attention. This sounded like a good thing, since in his regular classroom his teachers often gave up on trying to engage him at all.

The first time I met with my son's fourth grade special education teacher, she asked me if I had considered putting him on medication.

"No," I said. There wasn't a medication for high-functioning autism. By then I'd had a year to read up about it, had been meeting with the school's autism specialist, and we had been making progress using Applied Behavior Analysis. I didn't see any need for medication.

The teacher proceeded to tell me the story of a boy she knew who had been put on a small dose of medicine and it had helped him so much in school. He had turned into a model student and was now in high school and you wouldn't know he'd ever had problems.

"I'm not interested in putting my son on medication," I told her.

She then told me that if I didn't do something about his behavior in school, my son would end up in remedial classes in middle school, with the "bad kids."

A little shocked to hear a special education teacher call students in remedial classes "bad kids," I dug in. I don't like being threatened. There was no way I was going to medicate my son. We were going to do this by patient effort alone.

And a lot of effort it was. Hours of sitting at his elbow repeating, "What's your next problem?" like a broken record. Day after day of turning away friends at the door, "He's not done with his homework yet." Assignments that should have taken him twenty minutes took two hours. And then they only took one hour. And then I didn't have to sit next to him. And then he could work downstairs with the rest of the family around him. We had come a long ways.

And then came middle school.

Our first semester of middle school was really hard work for both of us, but we did it, and did well. My son was in all honors classes, despite his fourth grade teacher's dire prediction, and he even got a 3.5 GPA his first semester. Still, it took a lot from me and from all of his teachers. Most days I had a phone call or an email about a behavior problem, usually because my son was not paying attention or not doing work in class.

When it came time for the annual IEP, one of his counselors, a woman who had really gone out of her way to help him, someone I'd come to really trust and appreciate, said, "All of his teachers say he has a hard time focusing in class. Have you considered putting him on medication?"

I looked around the table at those weary teachers, and felt the ache of exhaustion in my own bones. This was taking a lot out of all of us. "I don't even know where to start with that," I admitted.

"Just go see your regular doctor," she said.

So I did. Apologetically, I told the doctor I really didn't want to do this, but the school had suggested we try it. He didn't ask me any questions about my son or his behavior, just wrote out a prescription for Adderall, like it wasn't a big deal. We decided to start on the second to lowest possible dose. It almost scared me how easy that was.

We started the medication over spring break. On the second day of taking it, my son felt a little nauseated for part of the day, but it went away, and that was the only side effect we had. I noticed some differences immediately. I could ask him to do something that took more than one step, and he would complete the task without any further prompting from me. This was an entirely new and wonderful thing.

When school started up again after spring break, my son found it easier to focus in his classes and do his work in the mornings, but after lunch the medication would wear off. He could feel it when it happened. We raised the dose one notch, and after that he could get through the whole school day. I still had to monitor his school work and check up with his teachers somewhat, but he started getting more done in class and therefore had less to do at home. For several weeks things went very well. He liked being able to concentrate and get things done. I even thanked the counselor who had suggested the medication.

Then the inevitable happened. The medication stopped being as effective. Once again I found blank classwork in his folder and got notes from the teachers saying he had spent the class period doodling. "It just isn't working," my son said tearfully one evening as we struggled through an essay he had been too distracted to write in class. "At first the medicine was great, but now it doesn't help me any more. In fact, it's worse than before we started. I got used to it being easy, and now when it's hard, I can't do it."

"Do you want to try a higher dose?" I asked.

"No, I want to stop taking it," he said.

I didn't think he should stop when it was only three weeks to the end of school, so I suggested we just keep going until then. "If the medicine isn't working as well, it's up to you to try harder to focus. You know what it feels like to focus now, don't you? Can you do it on your own?"

He rubbed the tears away and told me he would try.

Things got better again. Grades that had dropped came up. Best of all, my son was learning to work with himself. One Saturday morning, I noticed the door to my walk-in closed was shut. I opened it to find my son sitting on the floor, working on a project for social studies. "I had to come in here so I could focus," he said. He was almost finished, and had done the project all on his own.

On Saturdays he doesn't take medication. He had found his own solution.

It's summer break now, and we're not planning to use Adderall again next school year. I think we've learned what we needed to learn from it. When my son was taking the medication his grades didn't go up. His personality didn't change. It only made things a little easier for me and for his teachers, and it made it easier for him to do his school work. He learned that he could focus, and began to find ways to do it on his own. For that, I'm grateful we gave it a try.

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