We’re going to plunge headfirst into a topic this week that I’ve never seen addressed anywhere in books, articles or seminars on working with families of kids with ADHD…the use of medication for the specific purpose of helping kids function better during church-based programs and activities.
There are several reasons why I referred to today’s discussion as a “taboo topic.” Parents of kids with ADHD who do make their way to church are often very uncomfortable sharing information about their child’s diagnosis or treatment. Church staff and volunteers should (appropriately) avoid speculation about a child’s diagnosis or treatment needs. Physicians and other professionals involved with treating kids with ADHD are likely too uncomfortable broaching the need for medication at church or too oblivious to the reality that some parents would desire treatment in support of their child’s spiritual development.
First, my two cents: If your child’s experience at church is as important as their experience at school, the need for effective treatment at church is as great as their need for treatment at school.
Because medication is the single most effective stand-alone treatment for ADHD and the therapeutic effects of the medications used to treat ADHD are very short-lived, the child’s experience in church on a day to day or week to week basis may be highly contingent upon their medication status.
Why would a parent not give their child medication on the weekend that would help them have a better experience at church? Here’s data from a study I presented ten years ago at the American Academy of Child and Adolescent Psychiatry looking at prescription fill rates for children and adults with ADHD:
Bottom line: The “average” kid with ADHD who has been prescribed medication isn’t on their medication on any given day. I suspect parents avoid medication whenever they can get away without it. Appetite suppression is common. Some kids have more difficulty sleeping on medication. Kids with ADHD who also have anxiety disorders (30%) often become moody or irritable on stimulants. Parents administer medicine because…
(A) Their child wouldn’t make it through school without it
(B) Without medication, their child’s behavior would be too disruptive to family life and peer relationships.
Parents haven’t been conditioned to think about the impact of ADHD on their child or family’s church participation because I suspect most clinicians don’t ask. In the last 25 years, I can count on the fingers of one hand the number of times a parent spontaneously volunteered concerns about their child’s ADHD at church before I raised the question. Talk about don’t ask, don’t tell!
Scheduling of activities for children and youth can create challenges for medication administration. There’s a big pool of kids out there for whom their needs for support in church will vary from activity to activity. The parent who gives their kid his medicine two hours before leaving for church may not send medication along for a weekend retreat. If your church offers AWANA (or similar midweek programming) and has a high percentage of kids with ADHD, it’s important to keep in mind that the three most commonly prescribed medications for ADHD (Adderall XR, Concerta and Vyvanse) typically wear off around dinnertime when kids take medication before leaving for school.
The only time I’ve needed to have a parent sign a release of information so I could talk to my wife occurred when she was serving as AWANA group leader. A patient of mine with ADHD was in her group and got into a fight with another kid who probably should have also been a patient. Understanding this boy’s challenges in the evening led to a medication adjustment and a successful year in AWANA.
There’s a big pool of kids out there for whom their needs for support in church will vary from activity to activity. The parent who gives their kid his medicine two hours before leaving for church may not send medication along for a weekend retreat.
The other side to this discussion involves the perspective of the child’s prescribing physician/clinician. Why wouldn’t the kid’s doctor instruct parents to use medication on Sundays or for evening church activities?
- Maybe the physician felt uncomfortable asking about family religious practices? In our ultra-PC world, more and more physicians are likely to avoid any discussion of religious practices altogether for fear of offending parents.
- The physician is so busy typing into an electronic record during the all too brief appointments the insurance companies pay for that they don’t have time to ask about church.
- The physician may not have the cultural competency to understand the importance of church in the life of the child’s family.
- The physician may recommend withholding medication on weekends to minimize the impact of side effects: It’s not uncommon for kids to have difficulty eating or fail to gain weight while taking medication for ADHD. Appetite and growth concerns are probably the most common reason physicians suggest to parents that they withhold medication on weekends.
- The physician may not have the depth of understanding about ADHD that would lead them to individualize the child’s treatment for evening or weekend activities. Some docs have a greater level of sophistication in understanding ADHD and the nuances of the medications used to treat it. Educated parents who have done their homework and make well-reasoned suggestions to their child’s physician often get what they want.
In a nutshell, it should be possible to find a solution for church for kids who benefit from medication at school. Short-acting versions of extended-release ADHD medications are readily available that may be very helpful when kids with ADHD can benefit from improved symptom control for several hours for a church activity with a minimal impact upon their side effect burden.
My hope would be that parents would become as comfortable addressing the need for medication at church with their child’s physician as they would discussing the impact of their child’s ADHD in school or at home, and physicians would routinely ask about the impact of ADHD on the child’s church participation and spiritual development. We’ve got a long way to go before those conversations become routine.
Key Ministry encourages our readers to check out the resources we’ve developed to help pastors, church leaders, volunteers and families to better understand the nature of trauma in children and teens, Jolene Philo’s series on PTSD in children, and series on other mental health-related topics, including series on the impact of ADHD, anxiety and Asperger’s Disorder on spiritual development in kids, depression in children and teens, pediatric bipolar disorder, and ten strategies for promoting mental health inclusion at church.
Oh my goodness!!!!! Bless you for addressing this topic. I post your articles to my personal wall all the time. This is what I said along with your post: “As someone who has a son who struggles as well as having taught children at church for almost 20 years, I offer no condemnation of choices but only my sadness watching kids struggle so much. I fully understand the “no medication” and “medication” camps. I’ve been in both. They are both valid for different reasons. But when a child could do so much better socially and have a postiive-self-esteem experience versus a constant one of isolation, I think if we’re medicating our children during the school week, the benefits of continuing that during a social children’s church/Sunday School setting should be considered…..for the sake of the child, *not* the teachers. For me, it *always* comes down to what’s best for the child. Always.”
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I don’t know if you want feedback on this? Yes, you tackled a pretty controversial subject :-), and expressed valid concerns. Can I please give you another perspective?
We parent 4 kiddos, all adopted and all with special needs. 3 of them readily “look ADHD” to most people, and even to a few doctors that don’t ask questions first (they quickly become “not on our team” if we have that choice!). Our 4th child looks, acts and feels ADD. Not ONE of them is true ritalin-helped ADHD nor ADD. Not one. Only one of them carries an actual ADHD diagnosis, and it’s a reverse form… in that Ritalin makes it way worse (and yes… we gave it a one pill try anyways… and boy was the testing neuropsychologist correct!!). So because of the challenges we face day by day… this is an area I have gotten the equivalent of a parental PhD in, lol.
Please note this page: http://www.gmhcn.org/files/Wellness/50ConditionsthatMimicADHD.html . The 3 children that we parent, that do not actually have ANY diagnosed form of ADHD upon extensive testing by a pediatric neuropsychologist (these are tests that take at least 2 days to complete), have OTHER conditions that make them appear to be ADHD to others. Huge Visual Processing deficits are common to ALL FOUR of our children (not genetically related!), for example.
The uninformed, who fail to take the time to ask us first, tend to throw out this one ugly dismissive comment “You know…. they make Ritalin for kids like him”. Your email post today concerns me… that too many in the church will take it upon themselves to add to that chorus. ASK the parents, yes. OPEN a discussion, yes. URGE them to medicate, no please! This is just WAY too misunderstood of an area; way too undiagnosable for the most part.
Pediatricians, etc who do a simple screening test for ADHD often fail to understand how often a food sensitivity or mild seizures or a deficit in visual skills, etc ?? can skew the test. And too many of them take it upon themselves to prescribe Ritalin and similar drugs… that DO have huge impacting side effects, because the drugs are not a good fit for the child. 😦 And even if Ritalin, etc does work for a time… it stops working, or the side effects become too huge, later on for many children.
So… bottom-line. IF an ADHD med was a good fit for a child, and side effects were nonexistent or very minimal… parents would not “avoid medication whenever they can get away with it”. The meds are an imperfect fit with many (most?) such children, because this is such a misunderstood area, medically. Please don’t add to the misunderstandings?
Thanks for listening 🙂 – Cindy B
I think the one area in this article that was missed was the parents wanting to have some drug free time for their kids. It’s hard to have your kid constantly on meds when there is an option to give him & his body a break from them. But, I also feel that communication should be prevalent when this occurs, and that in these situations the parent should then be more willing to be available to help – not necessarily every week – but still pitch in. Especially in communication with how to handle challenging situations. Maybe even get a peer buddy involved.
Medication for our son was a tough thought process and decision for us. Our pediatrician gave us a key thought to ask ourselves which we have used in many situations – will this better the quality of our son’s life? We came to the conclusion that yes it would. After figuring out which meds worked best for him, we then were pleased that we had the option to give him some drug-free time if we felt a break was needed and were told that some parents opt to not give the meds on the weekend. We considered that, and, have done that some. But…our son LOVES church. We had to ask ourselves, would giving him his meds give him a better experience, a better quality of life at church? Yes. Occasionally we may forget, but thankfully we are in a loving, encouraging church with leaders in the children’s and youth ministries that while they don’t understand the experience personally, they understand us. Grace is given in abundance 🙂