People Who Push You on ADHD Medication

On this subject there are two separate groups of pushers, and both are doing the same thing.

The first group tells someone who does not take medication that they should. The second group tells someone who does that they should stop. Both mean well, both are right in their own way, and neither is the other person's doctor.

This article is about why these two groups make the same mistake.

The first group: "why haven't you started yet"

This group is usually made up of people who have benefited a great deal from their own treatment.

Their experience is real. Someone who struggled for years, started treatment and had their life change finds it hard to stay quiet when they see the same description in someone they know. It is impossible not to understand that.

But a few things get skipped.

The diagnosis may not have been made yet. The picture is not the same just because the symptoms are similar. Anxiety, depression, sleep disorders, thyroid dysfunction and iron deficiency produce similar appearances. The sentence "you have ADHD too, start medication" makes two separate decisions at once on someone else's behalf.

The same medication does not do the same job in everyone. The network meta-analysis by Cortese and colleagues (2018) shows that the effect and side-effect profiles of different active ingredients differ. The dose that works for you can produce side effects in someone else.

Other co-occurring conditions change the decision. The European consensus statement (Kooij et al., 2019) recommends that the order of treatment be set carefully when there are co-occurring conditions. Heart disease, a history of substance use, pregnancy, other medications; all of these are things the doctor knows and you do not.

And most important: not taking medication is a legitimate choice. The guidelines recommend a multi-component approach, and medication is only one of those components.

The second group: "don't you dare take it"

This group is louder and usually speaks with less information.

Their sentences are ready: it is addictive, it changes your personality, it numbs you, it stops a child's growth, the real problem is your discipline.

Some of these sentences are wrong, and some are a distorted version of something true. The two need to be separated, because rejecting them all at once would not be honest either.

"It's addictive." The World Federation consensus statement (Faraone et al., 2021) reports that appropriate use under a doctor's supervision has a good safety profile and that there is no evidence of an increased risk of substance use in people who are treated. The meta-analysis by Wilens and colleagues (2003) also showed no increase in that direction.

This sentence is wrong as it stands.

"It changes your personality." In a correctly adjusted treatment this is not the expected effect. Going dull and flat is a sign that the dose needs to be reviewed. So the observation may be real; the conclusion drawn from it is wrong.

"It affects growth." This is not a sentence to throw out entirely. The long-term follow-up study by Swanson and colleagues (2017) reports a relationship between long-term stimulant use and suppression of adult height.

But this finding stands not as a reason to stop the medication but as a reason for regular monitoring of growth and for reviewing the dose. The same study also does not remove the consequences of going untreated.

Tearing a finding out of its context and turning it into a campaign slogan is also unfair to the study that produced it.

"The problem is discipline." Beneath this sentence there is a denial of the diagnosis, and arguing it is not the subject of this article. I dealt with it in the article is ADHD a real disorder.

The mistake the two groups share

On the surface they are opposites. Underneath they do the same thing: they put their own experiences or their own fears in place of someone else's medical decision.

A medication working does not mean it will work for everyone. A medication causing side effects in one person does not mean it will in everyone. Two sentences built on a single sample are equally flawed.

There is also this: both kinds of pushing treat the person in front of them as someone who cannot decide. Beneath the sentence is "I have to think for you." For someone who has been corrected for years, this is a familiar and tiring position.

The difference between a decision being made for you and being helped with that decision lies in a single question: who chooses in the end?

What pushing actually does

Most pushy conversations do not change the outcome.

The person being pressured usually does not change their decision. What changes is this: they do not talk about the subject with that person again.

This has a cost. When they have a side effect from treatment, when a question comes up, or when they are undecided, the number of people they can talk to has gone down by one.

So pushing, in the long run, makes easier the very thing it tried to prevent: the person making their decision alone and in silence.

So should it never be talked about

It should be talked about. This article is not defending silence.

The difference is in where the sentence is looking. A few examples:

Pushing: "You have to start the medication, your life will change." Talking: "It worked for me. Would you like me to tell you how it went?"

Pushing: "Those medications are harmful, quit." Talking: "I read something, I don't know if it will worry you. Would you like to talk to your doctor?"

Pushing: "You have ADHD too, go and get a prescription." Talking: "What you tell me sounds very familiar. Have you thought about getting an assessment?"

The difference looks small. But the first is a verdict, the second is a door.

Suggesting an assessment and suggesting treatment are also separate things. The first can be done; the second is the doctor's job.

Where the line is

You have to stop somewhere, and the place is this: campaigning against a treatment decision made by a doctor.

Pressuring a family to have a child stop their medication, telling an adult with a diagnosis "these are numbing you," framing treatment as a weakness of character. These are interventions that have consequences.

The reverse is equally true: recommending medication to someone with no diagnosis, giving someone some of your own medication, telling someone to adjust the dose on their own.

Between these two extremes there is a wide area, and there is a lot to talk about in that area.

What you can do on your side

If you are the one being pushed, there are a few sentences that help:

• "I'm talking about this with my doctor."
• "I've made my decision, I don't want to argue."
• "If you're curious I'll tell you, but I don't want to be talked into anything."

None of the three closes the door completely, and all three end the conversation. When you have a ready sentence, you do not have to go on the defensive in that moment. I dealt with this subject separately in the article on stigma in ADHD.

Summary

On the subject of ADHD medication there is pressure from two directions, and both are fed by the same mistake: turning a single experience into everyone's decision.

This decision is made between the doctor and the person, and most of what needs to be known when making it is not held by a third person.

Telling is allowed. Deciding belongs to someone else.