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Monthly NewsNote
March 2003/April 2003
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WHEN KIDS REFUSE MEDICATION
It is very common for me to hear that a student doesn't want to take the prescribed
medication for ADD. I hear it from students 6 to18, male and female. And what's
more frustrating, they often admit that the medication helps them function better
at home and at school.
Refusing to take medication often leads to a battle scene at home once or twice
a day. And the comments made to parents are often the same: "I'm not a
retard," "You can't make me," or "Leave me alone."
I clearly remember a teenager telling me "I'm not going to put that stuff
in my body," though he was much less discriminating when it came to alcohol.
The point of this note is to point out that, as professionals, we must explore
with the patient the reason for refusing the medication. The reason can be psychological.
After all, taking medication has the message that "I'm not OK," and
some kids want to deny being different in any way. Therefore, the meaning of
medication, the idea of ADD itself, and social concerns need to be reviewed.
But in my experience that is less often the reason than a side effect experienced
by the child but unknown to, or under-rated by the parents and physician.
Here is an example. Frank was in a few days ago. He is a 13 year old boy who
has been on stimulant medication for several years with excellent academic and
athletic results. He has always said he did not want medication but as he got
older he got louder and more resistant. His mother was having difficulty coping
with daily battles. Frank came in for a regular medication review. He told me
that the medication changed his personality. All his friends noticed he was
lots of fun early in the morning, but that all changed and he was different
when the medication started to work. He didn't like being that way.
I went through my notes and found that two years ago he had said "I don't
like the medication - when I take it I don't laugh at my friends' jokes."
While I noted his comment, I had not responded because he was doing so well.
Now, clearly, he needed a change.
Frank and I are currently in the process of finding an effective medication
without these side effects. All his resistance has disappeared and he is being
very cooperative as we look for something else.
I have a similar story about a 9 year old who didn't want the medication. He
said "Would you want a pill if it gave you a stomach ache every time?"
"For sure I don't want that kind of a pill," I said.
That's how I learned for the first time that the pill made Tom feel sick. Once
this was clear we were able to make changes to remove the problem while continuing
the successful results.
I think you can see that rejection of medication can have many reasons. A careful
evaluation to understand the underlying problem is essential. This is most effective
in a face-to-face discussion. When the reason for the resistance is understood,
treatment can continue with the cooperation of the patient while the tension
related to the use of medication is reduced or disappears.
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