When a child has ADHD, even parents who feel confident about the diagnosis are often surprised by how heart-wrenching it can be to put their child on medication. Studies show that the most effective treatment often includes a combination of medication and other interventions, but the decision to medicate can be frightening, with very real pros and cons. As the school year begins, many parents find themselves wrestling with this decision.

ADHD may be a common diagnosis, but it’s nothing to take lightly. Children whose ADHD goes untreated usually experience more academic failure and more behavioral or emotional problems than children whose symptoms are well-managed. What’s worse, ADHD doesn’t just cause learning problems. It also carries social consequences, as other children avoid the child who is loud, impulsive or unintentionally annoying. Furthermore, some studies even suggest that kids with ADHD suffer more frequent physical injuries than other children do.

On the other hand, parents worry about potential negative consequences from medication, with good reason. There remains a stigma attached to mental health diagnoses, even though we now understand ADHD is a neurological condition. Parents worry that teachers will treat their child differently or that extended family members will criticize the diagnosis or treatment.

Parents also fear medication side effects. Although largely safe and effective, medications used to treat ADHD can cause mood changes, appetite suppression or headaches and stomachaches in some children. Not only that, but most parents I talk to report having at least one acquaintance whose child “acted like a zombie” on medication.

Clearly, to medicate or not to medicate is a complex choice. Frankly, this decision requires an ongoing risk/benefit analysis, one that continually reexamines a child’s needs as he grows. If you’re a parent debating what to do for your child, several questions can help you choose.

First, how bad are the symptoms? Mild symptoms can often be managed with classroom accommodations and strategies at home, many of which are clearly explained in a multitude of ADHD books and websites. A therapist can also give you more individualized strategies. For these children, medication might only be necessary if other interventions prove insufficient.

Next, how old is the child? These days, “academic rigor” is all the rage, even in Kindergarten. In reality, typical childhood development follows a predictable course associated with brain growth, and that pace won’t go any faster just because a policy maker says it should. We can’t force kids to grow taller just to fit in bigger chairs; neither will their brains mold to inappropriate expectations. Many young children simply aren’t ready to sit still and focus for long periods. We have to understand the child’s current capabilities before we address any complaints.

In addition, what else is going on with the child? Children who have other issues, such as anxiety or depression, may not do as well with medications for ADHD. Sometimes children are particularly sensitive to feeling “different” from peers, so the very fact of taking medicine makes them feel less capable and confident. It’s important to address more complex situations like these with a therapist who can help the child understand his needs and feel comfortable with whatever treatment option appears best.

Finally, how well does the child recognize symptoms? Many children, especially young ones, lack awareness of their symptoms, but self-awareness improves with age. Over time, most kids begin to notice when they daydream or grow restless, or when distractions slow them down. Therefore, even if you opt for medication early on, your child may be able to learn more self-management strategies when he’s older. As an adult, he can choose a career path that fits his needs in ways the traditional classroom might not have.

For many families dealing with ADHD, the start of a new school year brings anxiety. Even parents who readily accept medication for their own health issues may find it hard to choose it for their children, and many don’t realize that an ADHD diagnosis doesn’t necessarily require lifelong medication management. Medication can certainly be a game-changer for kids who need it, but it’s not the right choice for every situation. Don’t let fear keep your child from getting help; instead, discuss these factors with your healthcare provider and make a well-informed decision that fits your family.

Tamara Stevens, MA, is a child psychologist with Washington Pediatrics and can be reached by calling 252-946-4134.