Fight vs. Flight - Summer Medications?

Read Time: 4 glorious minutes

“I had heard enough…..so I punched her in the face.”

Oh boy….this one is gonna be juicy. In our last newsletter, we had a tear-jerker. In this one, we get to hear what happens when enough is enough.

But first, let me explain what these newsletters are for. Over my career, I have found that there are two kinds of families. Only two. The kind that survive and thrive in the struggle of raising kids with neurodevelopmental disorders….and the kind that slowly wilt and die.

We will call them Oaks and Orchids.

Oaks are people who know how to access "Big Mario" energy to complete the levels of life and unlock the virtues on the other side (unashamed 80’s video game reference).

Orchids need indirect sunlight, distilled water, and 70% humidity—that’s “small Mario” energy. As you can guess, this type of mindset rarely works.

Once I realized this truth, I started to pay attention to the differences between these two groups. What I am offering you in these first few newsletters are insights that I have gained from watching the Oaks up close and personal.

Now you know…so back to the story.

We’ve all had that moment in public when someone wants to open their mouth and give you feedback while your child is struggling. You know what I mean…..the lady at the grocery store who interrupts your child’s tantrum to give you unsolicited parenting advice. Or your brother (with 0.5 children of his own) keeps sending you parenting articles in between rounds of golf and triathlon training.

I think somewhere deep down these people are trying to help. Either that, or they are just using your struggle as a way to feel better about their own life. Regardless of their motive, you must decide how you will respond in these situations. You must choose….

Fight vs. Flight

Unfortunately, these situations are common. People don’t realize that not all disabilities are apparent to the casual observer. Not every child struggling with a neurodevelopmental disorder requires a wheelchair, braces, or glasses. MOST children with developmental hurdles don’t "look" the part and DON’T get the benefit of the doubt from the community. They are just seen as bad kids…..with bad parents. Sound familiar?

So, what should we choose to do when confronted with these situations?

Honestly, most of us choose Flight. I know I do. It’s just easier. My oldest son has a severe form of Tourette’s syndrome. Flying on a plane with that guy is like taking a raccoon as a carry-on item. People stare. People make comments. People laugh. People record on their phones (no joke). And I typically just move on.

It’s not worth it…not here, not now.

Flight is not always wrong. It’s how you survive. It’s how you stay out of jail. Oaks are people who understand there is time for flight….and there is a time to fight.

Several years ago, I met a mother in the clinic who told me a story I will NEVER forget.

She was raising a son with Autism named Josh (details of this story have been changed to protect this innocent). Josh was a healthy, vibrant, and well-grown boy who loved the playground.

One sunny afternoon, they were playing at the park when a group of younger children came to play. Josh was doing what Josh loves to do: running around the equipment, stimming, humming, and smiling. Josh was living his best life.

The problem here was that Josh was 14 years old…and the other kids were 5. Not a big deal to Josh. Not a big deal to the other kids. But you guessed it…..a big deal to one of the moms.

Before I moved from the suburbs, we lived on a cul-de-sac….in a house with no window coverings. Just think about this.

No blinds.

No curtains.

Nothing but the unadulterated glory of the Noble family on full display.

It was not uncommon to have kids peer through our windows when we were having dinner…or when we were arguing. When we were sleeping. When we were sad.

Raising children with neurodevelopmental disorders is a lot like this. Everything is on display as the world peers through the window. But the view from outside gives a limited perspective. It doesn’t tell you about depression or death or divorce. It doesn’t tell the whole story.

If you are reading this….you know exactly what I am talking about here.

The only thing this playground mom could see through the "window" was a child who was too big and too wild to be on this playground. And so, she decided to "speak up."

“Your child is too big to be playing here. What is wrong with him? This is inappropriate. Please leave.”

It was at this point in the story that I leaned forward and said….

“Wow, I am really sorry to hear this. How did you handle it?”

I said this thinking I was going to get a nugget of graceful diplomacy that I could share with my patients and families.

Nope…..that’s not what I got.

She then leaned forward and said….

“I had heard enough…..so I punched her in the face."

Are you kidding me?

Are you kidding me?

Look…the point of this story is not violence. We all know that striking someone in the face at a play gym is not the ideal way to resolve a conflict, but there are times when you must choose to fight.

Fight the system.

Fight the legislature.

Fight the HOA.

Fight the status quo.

Fight for your right to party.

Sometimes going along to get along is NOT the way forward.

There is a time when you must fight…

Parents who are “Oaks” know when it’s “go time.” Here are some basic rules of thumb they have taught me over the last 20 years.

Go Time Guidelines

#1. Your child’s needs are not being met

If school, medical providers, or other systems are brushing aside real concerns — it’s time to press pause and push back. But please make sure you understand how to define "need." Your precious cherub does not “need” a pony to ride at school to learn math better. But they may “need” scheduled toileting breaks or an aide for transitions, etc….make sense?

#2. When your instincts are screaming at you

Parents often sense when something’s off long before professionals do. If your gut is telling you something’s wrong — listen to it. This has proven true time and time again in my career. If a parent has a deep-seated visceral concern that something is “off,” it should be taken seriously.

#3. When you’re told “we don’t do that here”

If someone shuts down a reasonable request because it’s “not how they operate” — it’s time to ask why not. Again, it’s important to understand what’s realistic in various situations (see the pony example above). Your child has needs and they are important. But these needs can’t always be met in the exact way you would like. Fight for a dialogue to better understand. Fight for a middle ground compromise. But please don’t just fight to fight. Sometimes rules are rules.

#4. When accommodations are offered but not followed

If your child qualifies for accommodations at school but doesn’t receive them, have a conversation. Keep in mind that schools are overworked and underpaid, so please be kind in your dialogue and patient in the process. No one is trying to intentionally withhold valuable interventions from your child. They may not be aware of the gaps. They may be trying to solve staffing problems. The point here is to have a conversation. Bring it up.

#5. When “behavior” is blamed but no support is offered

If your child is labeled as “difficult” without a real plan to help, it’s time to intervene. I hear this one a lot. Someone calling you to report problematic behaviors is a part of the process. You need to know what’s going on at school, therapy, soccer, etc. But “knowing” is only half the battle (shout out to GI Joe). Once the information has been shared with you, it’s time to make a plan TOGETHER. Share some strategies on how to deal with the behavior. Don’t just be a “receiver” of information on bad behavior; make it transactional. Give some advice… and take some advice. Work together.

#6. When your child is losing confidence

If your child begins to feel ashamed, isolated, or believes they’re “bad” or “stupid,” it’s time to act.

Here is the hard truth. Kids need 4 times as much positive feedback as they do correction. They need to be celebrated more than rebuked.

So, what happens to a child when all they are told is “No”…”don’t”…”stop”? Bad things happen. In situations like this, it’s pretty easy for a child to come to the wrong conclusion about themselves, and this often leads to a loss of confidence in their value and worth. This is a time to fight.

#7. When your only feedback is the bad kind

Surely there is something good for us to discuss.

Summer ADHD Medications

Let’s close with some practicalities regarding this time of year. I want to make sure these newsletters are not all “chicken soup for the soul.” You need some beef jerky as well.

Many people are wondering what to do with ADHD medications as the over the summer. This conversation typically starts because the child in question is “struggling”. There are many reasons for this…but the most common reason is simple. The schedule has changed. 

Should the medications be increased….adjusted….changed?

This is the most common question I am getting right now…and my answer might surprise you.

For me, the better question is…..

Do we need to take these medications over the summer?

I like to refocus the question on the possibility of a pharmacologic garage sale. Not because the medications have become ineffective, but because, no matter what we do at this point, it probably won’t work.

The sun is out. The pool is calling. It's cannon ball season!

If we need to make changes to medications, let’s save those moves for the fall….in the new school year. New teacher. New IEP supports. New classmates. The school year is done, and there are only so many moves to make with medications. Let’s just save our moves for later.

While many kids need continual support over the summer months….many more do not. If you know that your child cannot be successful without medications, that's ok.  Cotinue as is...but do your best to leave things as they are until school starts.  

If you're not sure…here are some questions to help guide you:

What Are You Doing This Summer?

Every family’s got a different vibe. Some are in Lord of the Flies mode. Others are trying to learn chess and violin in one month.

• Summer school? Might need medications…at LEAST for a few hours per day. Maybe think about going to a short-acting medication over the summer. Your child can take it as needed, giving up to 4 hours of focus and attention during times when they most need it.

• Summer camps? Meds can help with self-regulation and ensure your kid gets to stay at camp and you get to stay employed.

• Chilling outside? Maybe a break is okay.

It’s not wrong to continue medications over the summer if needed.

Remember: You wouldn’t take glasses off your nearsighted kid for the summer just because they’re not reading as much.

What Side Effects Are You Dealing With?

• Growth concerns? Stopping meds over the summer can really help pack on some pounds…unless, of course, they sweat it all off.

• Sleep problems? They will go to bed later no matter what you do…but at least medications won’t be the cause. (PS…if they are on a sleep aid, you may be able to stop that too!)

• Irritability when meds wear off? Well, they will still be irritable, but it will improve off medications in many cases.

• Cost? Save some cash and spend it on vacation.

• Annoyance? No more calling every pharmacy to find meds…aka the endless game of whack-a-mole. Don’t forget about the medication shortage when fall comes around again. If you plan to restart medications in the fall, you will want to see your provider in early August to ensure you have enough time to get the scripts filled and medications restarted the week BEFORE school starts.

Would You Consider Medications Part Time?

• Weekends off? Just mornings? This is where the idea of a short-acting medication could be a better fit. If you only need 4 hours of support a few days/week, a short-acting medication could be just what the doctor ordered (I do this all the time).

• Low dose instead of none? You could drop the dose a bit. It’s not a bad thing. If you know your child will need medications over the summer but want to minimize side effects, try dropping the dose.

• Try a medication holiday trial and see how it goes. It will take 7-10 days for your child to return to baseline. Don’t go back on medications after 2 days (things will be bad but they don’t always stay bad).

Whatever you choose to do, make sure you talk to your provider. This is not a DIY situation. Not all ADHD medications are the same and require a slow taper to come off. Others can just be stopped.

Final Word

Fight vs. Flight – know what is required and when. As a general rule, I would recommend the 75/25 rule. Let it go 75% of the time….fight 25% of the time. If you have this percentage flipped for too long, you find yourself on a path that is unsustainable.

There are seasons when you need to fight….but let it be a season, NOT a lifestyle.

Summer ADHD Medications: Your child may need them....and they may not.  Take an account of what you are doing this summer and the side effects you're  dealing with.  Consider part time solutions, lower dosages or short acting strategies...but whatever you do, don't increase these medications. School is coming, save your moves until then. 

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