I dont wanna choose medication, Im getting desperate for ideas !

Jessica - posted on 05/09/2011 ( 130 moms have responded )

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I have no support system, I am a single mother to my five year old son. Whom not only has been recently diagnosed as ADHD but also has had a very rough time this past year and a half... Im trying behavioral couseling and behavior charts but sometimes his behavior is beyond my strength. I feel like Im fighting with him everyday... its a battle of wills. And by time Im home from work I dont have it in me to battle. Hes mouthy, disrespectful, nosey, impulsive, angry,loud, but behind it all hes an amazingly smart and sweet loving little boy. I just dont know what to do anymore ! I wanna give up all the time but I dont wanna medicate him just to make it easier for me. Im afraid it may change his personality... which without all the bad parts, is amazing. Hes a total people person! What should I do???

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Angeles - posted on 10/03/2011

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Yes Kate, there are more and more kids with ADD or ADHD than "normal" I beleive the human evolution is doing his part.
Ladys a great and a very easy book to read that might help BIG time: 1-2-3 Magic: Effective Discipline for Children 2-12
by Thomas W. Phelan

Lorene - posted on 10/02/2011

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Hey Gina, I sympathize with where you're coming from. My now 19 yr. old ended up in residential because both the school guidance counselor and school psychologist wrote subjective reports regarding my son and I lacked the education at the time to do anything about it. Bring it on now baby, cause I'm ready! But thankfully, once he got there his therapist realized the reports were bogus and had him out of there within a few weeks. The down side being the whole experience scarred him immeasurably. If you'd like to email me I can send you some info. on how to get a hold of the sound therapy we are currently using if you think he may be willing to try it out. It requires listening for 30-40 minutes daily for a couple weeks then every other day or so. leopardsway@mail.com. Although this approach requires time, not as simple as popping pills, it has been used successfully in schools by teachers who have unmedicated kids. There have been a number of good studies done on this by some of the best in the field, however, many have poo-pooed this approach because of the investment of time. Remember, we are a society of instant fixes, pills are fast and easy, require no time investment, and in some cases you get instant results, no matter how temporary they may be.
A big part of why I returned to school and gone into huge debt at the ripe age of 45 was to learn how to provide hope and guidance to families dealing with issues like this. Some of the best research available has been done by Dr. Daniel Amen of the Amen clinics. He has a book out called "Healing ADD". On the issue of the meds you might want to look up Dr. Peter Breggins (google his name). He is a Harvard trained psychiatrist and former consultant to the National Institute of Mental Health who has done exhaustive research into psychotropic medications. As well, Wilens, T. wrote a book called "Straight talk about psychiatric medications for kids" which is phenomenal. Berne, S. wrote one called, "Without Ritalin: a natural approach to ADD" which I found most interesting. It looks at the dis-order from several different angles and some pretty simple suggestions for dealing with it. Although recent research has poo-pooed the idea that ADD/ADHD is the result of poor nutrition he talks about it in depth, as does Dr. Amen. I figure any and all approaches should be considered because you know your child the best. On the non-medication side Dr. F. Baughman Jr. wrote a book called "The ADHD Fraud: How psychiatry makes "patients" of normal kids".
The key from my perspective is to look at the whole picture. If you didn't have issues with your childs behavior before he went to school you shouldn't be easily accepting a diagnosis of ADD/ADHD. Problems prior to entry into school are sometimes indicative of other disorders, not necessarily ADD/ADHD. According to the US CDC ADD/ADHD has a comorbidity rate of about 60%... but I have to wonder if the comorbidity is not introduced to the child as a result of psychiatric intervention and not the other way around, as it should be to truly be a co-morbid. disorder.

Gina - posted on 10/02/2011

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To the mother in doctorate school with much experience, I'm with u on advocating for our children who are like guinea pigs My son is 15 and couldn't tell u the number of meds he's been on. I get tired of when he has major meltdowns and then goes to inpatient and they change his meds again and again without success it causes him to loose who he is and loss of hope. I almost want to get my doctorate in psychiatry because I am not satisfied with the outcome of my son who now may need to be put into residential.

Lorene - posted on 10/01/2011

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Hey Moms... Having lived with this for more than 20 years I have a lot to say on this topic so will try to pass along a little of what I know and have experienced first hand. I am also a psych grad student who has done some pretty extensive research on ADD/ADHD because two of my sons and myself have dealt with it our whole lives.

I see a lot of you questioning the medication route. My son's elementary school insisted on medication (1995) and sent social services to my door because I refused medication. My sons were eventually medicated... I caved and regret it to this day. The alternative was being charged with medical negligence. But back then we didn't have the considerable resources we now have available to us, the internet being the biggest change. The best thing you can do for yourselves is education. Several studies indicate parent training to be highly effective in handling ADD/ADHD successfully. Problem with this approach is that few parents are willing to face the fact that parenting style has everything to do with ADD/ADHD. Find out all you can about what ADD/ADHD is and is not. Choose your path and stick to it. There are literally thousands of resources available to you online. Know that you are not alone. ADD/ADHD is the fastest growing disorder in children, that said, it is also the one most often MISDIAGNOSED.
Ask yourselves this, was my child given a complete physical exam including blood work prior to diagnosis? If not, ask that these things be done. Iron deficiency? Several studies have linked the two. Also be aware that ADD/ADHD is a subjective diagnosis, that means it is based on human perception, usually those of a parent and a teacher. Sadly, your child's teacher has many reasons to want your child medicated. Think long and hard about who you ask to fill out the rating scales your Dr. asks for. Subjective analysis is opinion and personal perspective, nothing more. An ADD/ADHD diagnosis brands a kid for life and the use and side effects of the current medications can be devastating. Several children have died from them! Believe it? Google ADHD medication and death!
The doctorate level professionals have lined up on both sides of this issue, one says medicate (Russell), another says, psychotropic and stimulant meds are poison for children. Who to believe is the million dollar question. Personally, I keep track of what the researchers are doing because they stand at the cutting edge... sadly research shows no positive effect on behavior beyond the first 60 days with any of the stimulant medications, begin combining them into the proverbial ADD/ADHD cocktail that many kids end up with and you see the resulting behavior as a result of a brain heavily altered by chemicals. More and more research is showing ADD/ADHD to be a problem of electrical energy in the brain, the pre-frontal cortex not firing as it should. Recent research into sound therapies are showing promise because they alter the electrical patterns of the brain not the chemicals. Seems to me that treating an electrical problem with an electrical cure makes more sense than treating an electrical problem with a chemical cure. And that ladies, will be the basis of my masters thesis.
Google scholar has lots of great research online regarding ADD/ADHD as well.

Robyn - posted on 09/30/2011

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The real question is would medication make HIS life better? Any time a child is happy, we are happy :) I am also in the same boat, but I am actually trying to figure out what is wrong with my child first. I fear that I will be faced with medicating her and am honestly scared to death of it. However, if there is a small dosage of medicine to make their condition more manageable, it might be a good option. Medicine isn't something you HAVE to do for a lifetime because you choose to try it. Maybe start out on small doses to SEE if they help him. You are going to notice a negative change in your child so you can always STOP it or change to something different. Young kiddos are so hard to help simply because they cannot express things in the ways we need them to. They cannot elaborate on things they like/dislike about what they are feeling. As a mom that is deathly afraid of making wrong decisions on a daily basis, I understand your concerns. If you have tried anything and everything you can think of, why not try something that might help you both? If the medicine only curves it a little it might introduce what it feels like to be "normal" and that will also hemp HIM explain things going on because he can feel the difference and have something to compare to. Best of luck :) It's hard! This forum is fantastic because so many of us feel "alone" and like there is nobody else that can be going through what we are and there are so MANY! It's nice to have a support system that understands completely :)

Anne Marie - posted on 09/30/2011

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There's a terrific section on ADHD in Phyllis A. Balch's Prescription for Nutritional Healing (now in its 4th Edition at least). All natural! It's my family's health "bible" for everything. It's worth the cost of buying it as you will have it and use ir forever. 2 of my 3 children were often sick as babies and pre-schoolers but this book turned everything around. Good luck!

Kim - posted on 09/30/2011

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I have a fabulous homeopathic that healed my son's issues. She works with kids that have ADHD, eating disorders, allergies, you name it. My son was sick for the first 2 12/ years of his life until I found Dr. Michelle LeRoy. Her number is: 770.591.9153. I am also a single Mom and I know how hard it is out there. I've been unemployed for 2 years. Since corporate America isn't hiring, I started my own cleaning business. If u want more info about the doctor and other healing modalities that may help, please email me at: kime126@bellsouth.net. I have other information.

KATE - I apologize for my misdirected email regarding the issue we're discussing. It was meant for the Mom of the original post.

Kate - posted on 09/30/2011

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Hi Bonnie - I was so desperate to try anything but the medication! I did make huge progress with him but it nearly drove me over the edge - and then watching how easy teaching him on meds was - I couldn't justify keeping him off them! He's a happy little guy now! And sure, we're not without issues but why add to the load? Growing up is hard enough! So glad you found your solution! xx

Emily - posted on 09/29/2011

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When my oldest was about 4 he was, what seemed like at the time, beyond my control. We tried the natural remedies that were to help calm him down but it didn't work. Now my son has never been diagnosed with ADD or ADHD but we got him into Tae Kwon Do and it seemed to help. They learnn respect and it gives them somewhere to get all their energy out. He is about to turn 7 and as long as he is involved in something he seems to do alot better. I am not saying he is perfect all the time but keeping them involved in something seems to help. I hope you can find something that helps you.

Bonnie - posted on 09/28/2011

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Hey Kate - Very interesting you stated you took your child out of school to homeschool for a few months. I too debated pulling my son out of school, right up until a few days before it began, just thinking it would give him a chance to build back up some of the instruction he lost while battling ADHD in the second grade. I didn't, I have put him into the third grade and I am SO glad I did, especially after reading what you said. We really as moms are extremely hard on ourselves, and want to fix it all without help, like we are bad moms! Thanks for your post, it helped confirm my own choice this year. Continued good luck this year!

Mary - posted on 09/28/2011

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I had that same problem and I really did not want to medicate Tony but it was my last resort. I finally did put him on meds and with counseling he learned how to control the behaviors and to calm down. Our old Doctor that we had said that in time most Kido's learn how to control there behaviors and some of them can get off the medication; I was on Meds for ADHD also and I did not need any after the age of 10 years old and I started on meds at the age of 4yrs old, Tony is going to be 8 here shortly and we just moved back here and he has not been on meds for about a year and he is doing better but still needs meds and some Intervention but he over all is much better than he was even 2 years a go.

Kate - posted on 09/27/2011

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I soo agreee with Angeles about these kids being a 'new' generation that we're actually not equipped to deal with yet and wish we could change society and schooling to accommodate THEM - noticed how MANY 'problem' kids there are these days? Almost more than 'normal' kids...

But reality is that we do have to help them cope in this society. So totally agree with Angeles! Wow - thought I was the only one with this theory! :-)

Angeles - posted on 09/27/2011

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True is that our society is not prepare for kids with ADHD, school, family and friend labeled with the bad boy (girl) how many times we have to leave the reunion because an incident with our kid or calls from the school were you have to pick them up for bad behavior, I was very desperate my self to see my soon going through all the rejections, I knew my son was not happy when at 4 year old asked me Why do I hit other kids? I have no more friends... it really broke my heart then I realize that medicine could be an alternative, I was fighting my self to avoid this alternative, but thanks God I change my mind, as a parent you have to explore a different options, we have to remember that we are dealing with kid extremely smarts, with a different perspective of learning and attention, they can do 3 things at the same time with a short fuse, losing temper very easily, a lot of Love and patience and be open to different options, you will find the right method, it's very disappointed that nobody can tell us exactly what to do, but every kid is different and we are dealing with brain functions, I believe this is a new generation of extremely smart people, we are just not prepare for them yet and we need to help them to fit in our society but most important to make them happy to enjoy every minute of their life.

Adair - posted on 09/27/2011

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Hey ladies! My heart goes out to you all, so I can't help but share that I do know of an alternative to medications. I have had my son on a complete and total nutritional supplement for 5 years and he has high-functioning autism. We feel that we've had similar results to what parents look for with meds, but without the fear of any side-effects (in fact, his immune system is amazing now!). I'm building a business from home with these products because of the results we and others have seen. Let me know if you would like some info and I can set aside some time to tell you more about it (no obligation, just information!). Good luck to you all!

Raina - posted on 09/27/2011

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I am going thru the exact same thing with my step son who lives with my husband and I full time. IDK what to do either!

Kate - posted on 09/27/2011

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Hi Jessica. I can so relate to where you are in all this! I battled against medicating my son also - for four years!! It was a complete nightmare - I kept trying harder and doing more and beating myself up that I wasn't getting it right. We kept my boy back a year believing he would cope better, only to be told half way through the next year that it hadn't helped or changed anything. I eventually gave in and went for the assessments - then to a psychiatrist, psychologist, neurologist - all of them agreed that he had ADHD and definitely needed medication, but I STILL felt like I had failed and if I just tried a little harder I could help him! I changed his school, then 'home-schooled' him for a couple of months - again believing if I could teach him in a way that would keep his interest he would pull through! While he was at home with me I would watch how he would struggle to write letters and struggle to read - just heartbreaking. Also, like you said, I KNOW he is a bright child - when he's interested in something he takes information in really fast, thinks about ideas and concepts, elaborates on stuff, questions - he just couldn't manage the 'normal' processes of learning. Also I recognized a ton of his 'problems' as things I had gone through and experienced as a child - as Roxanna said - ADHD is inherited - and I suddenly knew what I was looking at! I too was forced to learn 'coping mechanisms' growing up and through schooling but man do I wish my mother had given me medication to help me - I also feel angry about all the things I may have accomplished had I been given the opportunity!
So, (seeing as how the neurologist had already diagnosed me with ADHD - while at my son's appointment!) I tried the medication first and the realisation that "this is how the rest of the world gets stuff done" was such a jolt for me - all those millions of 'urgent' thoughts in my head were quieted, I could finish things I started, focus - it was a HUGE thing for me to go through - well into my 30's!! So I put my son onto his medication - the conclusion being why should it be left harder for him when it can be SO easy? Why let him question his own intelligence and ability on a daily basis and watch his self-confidence almost disappear? By the time we did put him on the medication my beautiful, happy, bright little boy was almost unrecognisable to us! Now, he's doing BRILLIANTLY, his school work is excellent and his self-confidence back! His personality did not change at all - as in he did not become zombie-like - and afternoons, weekends and holidays I don't give him any meds so he can be as wild as he likes!! I think the deciding factor for me was the realisation that a child who grows into a confident adult can accomplish anything they put their mind to, but without self-confidence a whole bunch of other problems will plague their lives.
Whatever meds are recommended / tried with the assistance and monitoring of your doctors / specialists will be unique to your child but I can't even begin to explain how happy I am that I did eventually make the choice to medicate - our whole family is different - we actually enjoy each other now instead of constantly battling and worrying our way through each day!!
Medicating does not make you a bad or lazy mother - like the others said - if your child needed glasses, wouldn't you get some for him? It really IS as simple as that.
I wish you all the best in whatever you choose to do - just so understand the anguish of where you find yourself.

Roxanna - posted on 09/26/2011

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I need to put my disclaimer: I am very outspoken and have no patience for ignorance. That said, my parents fought with me for years, beatings, emotional abuse and emotionally distant. Why? Because I lashed out, I couldn't concentrate, although I was smart, borderline genius, I kept failing at school. Tried to commit suicide numerous times as a teen and I was promiscius. At 24 I had my first child and was diagnosed with PPD. Three months later I was still miserable and fought for two years before I started taking Zoloft. The reason why, I was stealing from my company for the rush. Instead of jail time, I had to be diagnosed and put on meds with twice a week counseling. Through counseling I learned I also had ADHD and that it is inherited. Things start falling into place. I see behavior issues with my oldest, but no doctor wants to diagnose her. I changed her diet, kept her busy, rewards for good behavior, etc. At 11 I HAD to put her on medication for her ADHD because I knew that I alone could not help her. Educate yourselves! Mental illneses are a legitamite disease. If your child has diabetes, you give them insulin, if they have cancer, they take meds, why would you NOT help your child and give them medicine for a mental illness? A chemical imbalance of the brain can be just as damaging to ANYONE as Cancer or Diabetes. Just recently I began to see a Psychiatrist, at 40 years old I am having mood swings, rages and bouts of depression that my regular medication could not help. I was diagnosed with Bipolarity. The side effects of Bipolarity are Depression and ADHD. I could develop Schizophrenia as I get older and do not medicate. Three months after, my oldest was diagnosed with the same because ALL mental illnesses are hereditary. This is not about you, but about helping your child become a productive menber of society, not a criminal or a junkie. Good luck.

Paula - posted on 09/26/2011

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being the mom of a now 24 yr old son who had ADHD and Bipolar w a touch of ODD. i can so feel what ur going through. i also fought off the medication thinking i was just trying to make it easy for me. WE r wrong. If ur son was a diabetic would u not give him insulin? yes u would this diease is the same they need this med to control those urges n their brain. by not giving them the med we r hurting them more. they r never going to b like the other kids, n my opinion they can love much more. my son looked at me one day and said mom i just dont want to feel like this anymore im tired. i calld our dr right then and we got help including meds. they hurt so bad inside and dont know what to do. if i had a dollar for everytime i was told to just bust his ass id b a rich women ppl who dont raise these kids have no idea what weve been through and how hard it is. u have to make this decision but i will tell u after we got the right help and medication my son actually playd on the varsity football team and wrestled all through high school and even made some friends :) it was nice to c him fit in as best he could. i will pray for u and your son as this is a really tuff road it takes lots of love and the strength of God.

Kimberley - posted on 09/25/2011

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the medication dosnt make it easeier for u it helps him concentrate and also help with the hyper ness the reason i know this is because my littlle boy corrie has got adhd and the ridiline he is taking is realy helping his concentration at school also it helps him process information which makes it easier for him to understand the stuff u tell him i didin t wont him to have it neither but the doctor told me it would make his life easier for him reconcider the medication because it becomes easier for him not u ok im not critisining put your self in his shoes i had tried and it works you are very confused and angry all the time plus hypo and if some was told the could give u a tablet to make u better u would take it so look at it like that i know what u are going though with it because i felt the same untill corrie said to me mum i wont to be better so thats what made me let him have the medicene but im not having a go im hoping this look on things helps sorry if i make u intimidated of feel like it s your fault baceuse its not if u would like to talk or share information then here is my address kimjaydon2009@live.co.uk

Terri - posted on 09/24/2011

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I understand how you feel about not wanting to medicate your child. Mental health treatments are still for some reason considered almost taboo by some. Consider this, if your child had an infection would you give him the proper antibiotics? Do you always make sure your child gets all the proper immunizations that are life saving? Would you have the doctors put a cast on a broken bone? To me this is no different. Your child is suffering and needs help. We are fortunate enough to be living in a time when there are medications available to help with his condition. You should feel no guilt in trying to help your child. ADHD is treatable with medication and counciling. By doing both together the outcome is going to be twice as good.

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I have two boys that have adhd. One has more of a behavior issue that is associated with the ADHD Being mean to his siblings.. I never wanted to go through the whole meds things. It was like a failure on my part. We tried all natural fish oil, changing diet, and strict discipline. It really did not workfor my situation. My son could not grasp or pick up anything presented to him in school. He was challanged with other children his age reading and he just couldnt get it. I finally gave up. I cant afford private one on one education. I took him to the doctor and they tested him and tried several meds all that would go from not eating all day to a zombie like child. It was horrid. My mother was watching something on TV about this med called VYVANSE. It seemed to be the trick. No horrible side effects. he eats all three meal and his grades are incredible. I am not preaching the meds by no means. I know this worked for me. it made my son actually want to learn and be happy, He coould not control his thought process without it. I wish you luck in your journey. It is not easy. I was told that they have all sorts of programs for chilren with ADD/ADHD from your school. I did not really check into it b/c I did not want my son to be singled out . I wish you all luck and patience.

Bonnie - posted on 09/21/2011

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Hey Jessica! I had to reply to you - you're post is exactly where I was when my son was 5. When I transitioned from preschool to Kindergarten, my son was a nightmare. The behavior was so bad and the disrespect was absurd. We did occupational therapy, counseling, behavioral therapy, the whole thing. My son is amazing, smart, and a hard worker. But when in certain situations and pushed to the limit it seemed his frustration tolerance was negligible and he had a terrible self-concept, calling himself "stupid" and other language which I have never used with him. Fast-forward to the middle of second grade last year and I finally had him placed on medication after being diagnosed ADHD. He was first placed on Concerta which made him shut down completely, and then would "snap" with no warning when he reached his limit. I again reconsidered, and placed him on Focalin. THIS worked for him (every child's chemistry and brain functioning is different). The difference is amazing. I know medication can be a big step but you have to realize that this is an imbalance within your child, and it is like withholding something that can incredibly change your child's view of themselves (they know when they are acting out - and they begin to think of themselves as a "bad kid"), and medication with behavioral management will help you in the long-run as well. Good luck, I wish you the best!

Melinda - posted on 09/20/2011

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Was he diagnosed from a family doctor or a Neurologist? I just went through a battle to keep my daughter off medication. Sometimes the cause can be an allergy. I don't agree with medicating a child just to see if it works. The family doctor, counselor, teacher, father, and stepmother all thought she had ADHD. The neuropsychologist tested her and said that it was only a slight learning disability that could be solved with a steady routine and tutoring.

Nicole - posted on 09/19/2011

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My daughter is 8 and she also has it, I can't think of the name of the meds right now, not in front of me, but she is like night and day with it, if she misses it, wow you definitly know, and with school just starting it's about 3 weeks in and she has been doing almost 100% better, i wasn't sure about meds at first either, but I'm glad I decided on it, she is doing soo much better.

Cindy - posted on 09/19/2011

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Its NOT a bad thing to try medication!! I fought this for 2 years with my son and I finally gave in and decided to try it. Best choice ever!! Some kids just need it and my doctor told me this....if your child needed glasses would you get them for him? Well this is the same thing. We are using adderall xr and it has not changed my boy at all. He hasn't experienced any side effects either. Its worth a try and if you don't like the way he acts or you think its not right for you and him then you can always discontinue use of it. Just an opinion from someone who fought starting medication also. Hope things get better for you and your son!!!

Jessica - posted on 09/14/2011

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My little boy is 5 also and was diagnosed with ADD just this past Friday. My doctor wants to do mediciation free for the first month and then we will re-meet in October to see his progress. He's having trouble in school (seems to be in another place, can't finish his work once started, being asking many times to do something). He fidgets alittle but nothing extreme. I'm doing a routine at home with him:
Comes home and relax -- watch TV, play with toys or computer
Karate practice or we sit down and eat dinner (he goes to Karate twice a week)
Homework time after dinner
Bath, story, bedtime by 830.

This routine works well for him so far. I'm starting a rewards chart and a rules chart too!! He has also made comments that his "brain tell him to do things" that are wrong but he doesn't know how to stop it. Thats when I knew something was wrong and took him to the doctor. He's a smart kid, very bright, and extremely creative. I don't want medication right away, but I knew it might come to that and I'm okay with it! If it's what's best for him, I will do it.

Crystal - posted on 06/08/2011

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I have been there and fought the meds till my daughter who is a "A" "B" average fail 1st grade. At that point I took her to the doc and gave in about the meds. I could not hold to my believes if my child was going to fail because of it.

Yes at first it did seam like I had a zombie and family and friends did see it too. But after about a month they should be back to their self's minus the ex-stream temper. If not then the meds are to strong or just wrong for that child try something else.

My mom is still against the medications but as my daughter told her..... "It is not about you grandma and I still love you but I don't like who I am with out the help."

Angelique - posted on 05/31/2011

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Hi Im so glad to read that there are other mothers out there who do not want to medicate... My son Jason is on Herbal drops, Bio-strath, omega-3 and we are now trying to find another formula with ther herbal drops. It all helps allittle but at least there isent the side affects like the other drugs out there.. Even though he wont be considered normal but who is? Now we have just found out there are problems with his eyes and eye excercises will help, going for the tests tomorrow hopefully we will get some more tips to help prepare him for school...

Tiffany - posted on 05/11/2011

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So I'm not the only one who is dealing with this? I have seen kids who go on medication, and while they do settle down, it seems like their "spark" goes out. I want him to feel better about himself and be able to concentrate, but not make him into a zombie.

Heather - posted on 05/11/2011

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I am in the exact same boat! I am so against medication for the same reason, but then I wonder if I am hurting him by not doing it. He tells me all the time he doesn't know why he does the things he does (punching kids in school, hitting/kicking/spitting at me) I feel he honestly can not stop himself, he says that he HAS TO do it or he says maybe there is a bad germ inside me that makes me do it. He was diagnosed ADD, but sometimes I wonder if its more. He is also an absolutely awesome kid otherwise. Very smart, sociable(sometimes too much so), funny, loving. I don't want him to change, but I also don't want him to suffer right along with all of us. I would like to know the pros & cons from other mothers who have opted for medication.

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