The answer is: “It is an option.” The variables to take into consideration include:
- First, is the diagnosis confirmed?
- If the diagnosis is established
- Is the deficit severe enough to warrant a medication trial (here secondary effects from school failure may increase the concern)? and
- Have other alternatives been explored, such as, smaller classroom size, special school placement?
- If 1, 2a, and 2b are met, does medication safely correct the measured attention disorder? This can be established following baseline testing using short acting agents which within one hour, if effective, will reverse the cognitive deficit while permitting in office observation of acute side effects. Longer trials may determine if undesirable side effects occur later. If so, the medications may be discontinued, switched to an alternative if re-testing confirms effectiveness or the use of blocking agents to minimize side effects.
Because of the depth of baseline testing we employ to assure as accurate a diagnosis as contemporary methods allow; we are confident regarding diagnosis accuracy. But additionally, one should know if there are co-morbid diagnoses. Commonly in attention disorders, academic problems co-occur most commonly in reading comprehension and arithmetic calculation accuracy…but they may not or other academic issues may be present. Interestingly, there is an unusually high frequency of emotional disorders occurring those with attention disorder. Indeed, anxiety itself may induce a cognitive problem in focus of attention. These other co-existing problems may influence choice of medication (other criteria having been met for a medication trial) and the nature of the school intervention program.
In the case of stimulants, follow up visits at least every six months permit assessments to determine whether or not there is persisting benefit or the development of late side effects. Stimulants may be used only on school days if academics are the only concern. Furthermore, dose delivery form can be optimized to assure an adequate number of hours of benefit for school and if needed any homework assignments after the the school day.