ADHD Treatment

Medications for ADHD have a negative public image –“I don’t want to drug my kid” – but there is no real reason for this. The basic medication, methylphenidate (Ritalin), has been used since 1937 and we have more experience with it than almost any other drug used today. We know its effects, its side effects and its long-term effects. It is cheap, safe, easy to dose and is effective in treating ADHD. Yet, people continue to be reluctant to use it.

     As with Autism and Downs Syndrome, many alternative therapies (vitamins, diets, etc.) have been tried to treat ADHD. Unfortunately, none of them have had any statistical success. Allergy therapy doesn’t work because ADHD isn’t an allergic disease. Diet therapy doesn’t work because ADHD isn’t a dietary problem. Behavioral therapy has been proven to improve the ability of ADHD children to function with about the same success rate as medication alone. The greatest success rate in ADHD therapy comes from a combination of behavior therapy, improved parenting skills and medication.

     Ritalin and most of the basic ADHD medications fall into the category of “stimulant medication”. It doesn’t seem to make sense to give a stimulant to a child who routinely bounces off the walls, but these medications improve ADHD symptoms without making the child more hyperactive. The current theory about how they work involves the concept of “inhibitory” nerves that cause other nerves to decrease their activity. These medications stimulate inhibitory nerves, which decreases the general neurologic output. The previous ADHD article spoke about external stimuli distracting a child with ADHD from the task he is trying to focus on. The medication helps to decrease this distractibility. It also decreases hyperactivity, inattention and impulsivity. Other ADHD medications do the same things in the brain but are not listed as “stimulants”.  When medications are used, it is best to start with one medication on a low dose and then increase the dose rapidly until the child, parent and teacher notice improvement. Doing a “blind study” where the pharmacy gives the parent both actual medication and sugar pills sounds scientific but I’ve only found that it is a waste of time. I prefer to work on finding the proper dosage as fast as I can. You don’t increase the dose every day because everyone has good and bad days, but, after three days on the medication, the effect the drug has on the child will be obvious. If the dose the child is on doesn’t seem to be having an effect, the morning dose should be increased. If the morning dose seems effective but doesn’t last long enough, the parent can increase the morning dose to see if it will last longer or can begin a dose at noon or when the morning dose wears off. There are also “long lasting” medication which could be tried. I don’t advise giving “drug holidays” on the weekend because children with ADHD don’t only need help at school and I’ve found it is difficult for the child to always be going on or off the medication. Find a dose that works and stick with it. As the child grows, the dose may need to be increased.

     The most common side effect is loss of appetite. Most people drink coffee after a meal because decreased appetite is a common side effect of any stimulant. This may be the cause of the slight decrease in growth that is sometimes seen when children are on these medications. Other side effects include trouble sleeping, headache, upset stomach and a peculiar zombie-like disconnected feeling that occurs when the dose is too high.

     In future articles I will discuss the behavior modification and parenting skills that are needed to give the medication its maximum benefit. What is important for parents to understand is that, when ADHD treatment works for a child, that child’s life is so improved (both short-term and long-term) that small side effects become unimportant.