Church4EveryChild

With the start of a new school year, and the start of a new program year, an appropriate topic to put on the table for children and teens who need ADHD medication for school is the question of their medication needs for church activities. In our office, we’re completing a very busy time in which we’ve been re-evaluating the medication needs of our patients with ADHD at school. If the activities our kids participate in through church are at least as important as what they do at school, it makes sense that we’d want to reassess their need for medication at church.

If I were serving as a children’s pastor or ministry volunteer and had a kid whose difficulty paying attention and maintaining self- control was creating disruption in the learning environment for other kids and discovered the child takes medication during the week to function in school but not on weekends at church, I might be a little upset. Why wouldn’t the doctor tell the parents to give the medication to the child on Sundays or in the evening for church?

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 that they don’t have time to ask about church. For any of you who’ve been to the doctor in the last few years, you probably recognize that there’s less and less time available to share your concerns with your child’s physician. Families who depend upon managed care to cover the cost of their child’s treatment or families receiving care through large hospital systems may have enough time at a follow-up visit to discuss one aspect of their child’s treatment.

The physician may not have the cultural competency to understand the importance of church in the life of the child’s family. I’m fascinated by some of the gaps in the range of culture academic physicians are exposed to, especially the lack of exposure to families from more conservative Protestant traditions. Docs tend to train in large, urban hospitals. Evangelicals tend to hang out in the suburbs. There was and issue of the journal Child and Adolescent Psychiatric Clinics of North America devoted to the issue of religion and spirituality a few years back in which there was an article entitled “Cultural Competency with Protestant Christians.” Let’s face it…there’s a really big difference in the values and attitudes of folks involved with the Church of Christ vs. folks in the United Church of Christ and between Presbyterians and Pentecostals. My specialty (child and adolescent psychiatry) includes a significant percentage of foreign medical graduates, many of whom were raised in countries where Christianity is far from the predominant religion. Bottom line: There’s a good possibility your child’s physician may come from a cultural or educational background in which they wouldn’t realize how important church is for some families.

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. That’s probably the most common reason physicians suggest to parents that they withhold medication on weekends. I won’t digress into a comprehensive review of the research on the long term effects of medication on growth, but it’s not something I worry too much about with my patients.

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. As with any other field, 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. There are currently 25 different FDA-approved products to treat ADHD. 22 of the 25 approved medications are stimulant products. All of the stimulant products have in common one of two active ingredients. One family of stimulants has as  a base ingredient some type of amphetamine salt or prodrug (Adderall, Adderall XR, Dexedrine, Dexedrine Spansules, Procentra, Vyvanse). The other family of stimulants contains methylphenidate as a base ingredient (Ritalin, Concerta, Metadate, Focalin, Focalin XR, Daytrana, Quillivant XR). The differences between the products within a given family involve the form the medication comes in (pills, liquid, patch), how the drug is released into the body, and most importantly for this discussion, how long the medication lasts.

While these medications are highly effective (the odds that a kid will respond to a product from at least one of the two families of stimulants is around 90%), a slight majority of kids clearly respond better to products from one stimulant family or another. What this tells us is that kids who take an extended-release form of stimulant (8-12 hours or more) to get through school during the week will probably respond to a short-acting form of the same medication on weekends, or a short-acting booster to extend the duration of medication effects in the late afternoon or evening. For example, a kid who takes Concerta or Focalin XR (pictured left) during the week might take Ritalin or immediate-release Focalin (pictured below) on a Sunday morning to get about 4 hours worth of medication effects. A kid on Adderall XR or Vyvanse might take an immediate release Adderall to get 4-6 hours of effects on weekends. With late afternoon booster doses, the same principle would be true…the potential drawbacks being medication effects on appetite at dinner or delaying the onset of sleep. Some physicians will use booster doses in the late afternoon that are less potent than the equivalent long-acting stimulant medication in the evening to try to minimize side effects.

I’m not neglecting the three approved non-stimulant medications in this discussion (Strattera, Intuniv and Kapvay), but kids on non-stimulants are usually treated seven days/week and the question of whether to give medication on the weekend typically doesn’t usually become an issue. Non-stimulants are generally less effective than stimulants. One observation: Most of my patients on Strattera typically take medication twice daily (first thing in the morning and after school) because I’ve found the effects typically don’t last the entire day. Most of the manufacturer’s clinical trials with Strattera were conducted with medication administered twice daily. Bottom line: Kids who are prescribed Strattera and struggle with evening church activities may need a second dose in the late afternoon.

We put together a sheet that parents can download and share with their child’s physician when they would like their child with ADHD to experience the benefits of medication for church activities. The purpose of the sheet is to help parents share their concerns about church activities with the child’s physician and provide them with the information they’ll need to make any necessary adjustments.

Download the form here: Medication Request for Church

Note to church staff and volunteers: Don’t share the existence of this form with parents who have not explicitly disclosed that their child takes prescribed medication for ADHD and expressed interest in using or adjusting medication for church. The use of prescription medication should not be a precondition for a child’s involvement in church activities.

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Key Ministry offers a resource center on ADHD, including helpful links, video and a blog series on the impact of ADHD upon spiritual development in kids and teens. Check it out today and share the link with others caring for children and youth with ADHD.