NYC Child, Adolescent and Adult Psychiatrist Diary: ADHD, the Parent, and the School

In a previous article, we discussed the fact that kids with ADHD are increasingly prescribed not only Ritalin and Adderall (which are FDA approved for ADHD), but also antipsychotic medications (which are not).


Why?  Here’s the typical story:

A parent comes to see me saying, “The school is really concerned about Johnnie’s behavior. The teachers and school psychologist are calling me every day about how aggressive and disruptive he is. They want me to speak to you about his medications. They feel that being on Ritalin is not enough and that he may need something like Risperdal. The school staff told me that this is a safe and effective treatment for ADHD and that other kids in his class are taking it.”

They said WHAT? No,  no, no!  Risperdal is NOT a treatment for ADHD. It is an antipsychotic medication FDA approved to treat Bipolar disorder, Schizophrenia, and irritability in children with Autism.

Risperdal is by no means a benign medication. It is in the category of major tranquilizers and carries with it the risk of weight gain, as well as elevated blood sugar and cholesterol.

I don’t want to sound like I am placing blame on our parents, teachers and schools. Many of our schools are  inundated with too many students and have too few resources. I have the utmost respect and admiration for them, and I’m truly inspired by the work they do.

But we need to educate our parents, teachers and schools about psychotropic medications,  their indications for use, and their side effects.  Many parents and  educators have unrealistic expectations about these medications and misunderstand their role in treatment.   Too many  in the mental health field are either quick to start or to  advocate for the use of these powerful medications before more beneficial alternatives are utilized.

I often have to explain to parents that psychotropic medications are only a piece of the overall treatment. Behavioral interventions, programs, and other school activities are in my opinion a much larger and effective piece of the puzzle.

Applied Behavioral Analysis (also known as ABA) is  a scientifically validated approach to modify problem behaviors. ABA is nationally recognized as safe and effective and is endorsed by many state and federal agencies including the U.S Surgeon General and the New York State Department of Health.

ABA therapy has demonstrated improvements in learning, reasoning, communication and adaptability in children with Autism. Many of these same principles are also being applied to help treat kids with other behavioral disorders including ADHD.

I would love to receive phone calls from teachers and parents asking me about ABA therapy rather than pushing for the use of powerful medications like Risperdal.

As I  discussed in a previous article commenting on Dr. Richard Friedman’s New York Times article, often all that  is needed is a reassessment of the child’s individual education plan, classroom setting and size.

Let’s not forget the power of talk therapy. Kids need to have someone to talk and share their feelings with.  They may be depressed or anxious over conflicts in the house, parents separating and divorcing,  or perhaps even domestic violence.

Sometimes aggression in school is due to a child’s feelings of inadequacy about having learning difficulties and not being able to comprehend the material like the other children.

So please let’s not be so trigger-happy with psychotropic medication. Save the Big Guns for when there are no other alternatives.

And let’s not forget  the various scientifically validated behavioral therapies that we have at our disposal.  As far as I know, ABA therapy has yet to be associated with weight gain or diabetes.

©Roey Pasternak, MD
New York City