My son has a particularly obvious, hyperactive, and impulsive form of ADHD. His symptoms were so severe that many of his caregivers politely informed us that they thought he was autistic. He is not, but at times, he certainly can test the limits of our diagnostic categories.
This April 2020, I transitioned from a father and medical student, to a father and doctor. I had no sudden epiphany inviting me to my new role. I had been telling versions of this story to myself before the story unfolded in hopes that I might be able to make my imaginings real.
With a diagnosis like ADHD that often responds so well to medication, there is a risk of treating myself, my own desires for my son, or treating his teachers concerns for his behaviors in lieu of my son’s actual needs. In other words, I could easily give him as much medicine as it takes to make him less of a problem.
I do not write his prescriptions, but as a parent, I could say what it takes to get a higher dose, depending on how I viewed my son and his behaviors.
As a father and doctor, the risk of paternalism is vastly inflated. It is also inextricably intertwined the store of emotions, memories, and dreams in my mind that can confuse reason. In fact, paternal is what I am by definition.
But since I became Dr. Dad, nothing has changed. I have no new power to affect his future. Only a new title. And I’m still concerned.
He improves immensely with medication. He transitions from a jumping, interrupting, questioning, pushing, demanding unmanageable problem into a compliant, measurably intelligent kid. He slows down enough to listen and answer. His IEP is now is absent academic concerns… only behavioral ones.
The main question with which I struggle is this: How much medicine unleashes his potential, and how much is just making him what we want him to be? I know many millions of parents are in a similar relationship with a medicine that seems to change the future.
I don’t know the answer yet, and I’m not sure I ever will, but if I don’t ask it, I am a selfish parent, and possibly an even more selfish doctor.