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"Helping you to help your ADD ADHD child"

by    Anthony Kane, MD
 
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The Stimulants: Ritalin and its Friends

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Recently, a mother accused me of being anti-medication. She looked at ADD ADHD Advances and saw that I discussed natural treatments and concluded I must be against medication. I told the mother that she was mistaken.
    “In How to Help the Child You Love, I devoted several sections to the appropriate use of medications. The problem is that very often, the medicines aren’t being used properly.

    “If your child is having negative side effects from Ritalin or Dexedrine or any of the other ADHD medications, I discuss at great length in How to Help the Child You Love, why that is and what you should do to eliminate those side effects.

    “For example, let’s say the medicines don’t control the ADHD properly. Or say the medicine does help, but your child has trouble sleeping or has stomach problems. What if your child has terrible mood swings or rebound affects? What if your child develops tics? Someone who is anti-medication would say, ‘I told you so’ and then recommend that your child have his auras readjusted or something like that.

    “I don’t do that,” I explained. “I devote a large section of How to Help the Child You Love to explain what you can do so that the medication will work without the side effects. No child should have these side effect,” I told her. “You can get the medicines to work well.”

    “So,” I concluded, “I am clearly not anti-medication. I just discuss non-conventional treatments in How to Help the Child You Love, because you as a parent need to know all their options when you are trying to find the right treatment for your child.”

    Anyway, to dispel any other misconceptions that I am anti-medicine, I have decided to write this article on medication for ADHD.

The Stimulants: Ritalin and its Friends

Whenever you consider the proper approach to treating ADHD, drugs are always on the agenda. The reason is that they work. They work very well. The current research shows that between 75-95% of children improve on stimulant medication. No other treatment, whether conventional or alternative is that effective. Because of these results, methylphenidate, known commercially as Ritalin, has become the treatment of choice for many patients with ADHD. Ritalin is but one of a number of short-term stimulants used to treat ADHD.

Ritalin and the other members of this group are central nervous system stimulants. They share many of the chemical and pharmacological effects of cocaine. These stimulants appear to boost available levels of neurotransmitters, such as dopamine. Although it seems paradoxical that a stimulant would help a child who has difficulty sitting still, this is in fact what they do.

The good news about these drugs is that they work very well. Stimulant medications are the most powerful means that we have to control the symptoms ADHD.

These drugs:
  • Enhance attention
  • Control impulsive behavior
  • Improve physical coordination
  • Reduce hyperactivity
  • Reduce aggression
  • Reduce disruptive behavior
  • Decrease activity
  • Improve peer acceptance
  • Increase parental praise

These drugs are a godsend. They give ADHD children and adults a chance to function somewhat normally for at least a short time during their day. That’s the good news.

The bad news is that they are short acting. These drugs work for only three to four hours. There are some extended release preparations that work longer.

There is another problem. Although the current recommendation is that these drugs be used in conjunction with behavioral training and other forms of psychotherapy, in practice this combination is not so common. It seems that the insurance companies don’t feel they should pay for this.

These drugs have side effects. These include:
  • Depression
  • Anxiety
  • Tics
  • Decreased appetite
  • Rebound affects
  • Insomnia
  • Nervousness
  • Growth retardation
  • Stomach pains

Don’t get scared. The list looks long, but most lists of medication side effects look like this or are even longer. In fact, for those of you who like reading Stephen King or gothic novels, you should try reading the list of side effects of the medicines you are taking. Now that’s frightening!

You can eliminate almost of the side effects of these medications and still use them effectively. What disturbs me is that I don’t see most physicians doing this, which I why I felt I had to explain to you what you should do in How to Help the Child You Love. In this area, you definitely have to take charge of your child’s care.

Safety

These drugs are safe. Ritalin is the most studied of all psychiatric medications. It has been around since the 1933, and there is no evidence of any long-term side effects or problems. Does that mean it’s completely safe? No. However, I am much more comfortable giving my child Ritalin, than some of the “natural” treatments that have never been studied and whose long-term effects are completely unknown.

Overuse

It is generally felt that we as a society are too free when it comes to giving out Ritalin to our children. 1-2% of all children and 10% of school-aged boys in the United States are on Ritalin. The International Narcotics Control Board observed that Americans consume 90% of the Ritalin in the world. These numbers suggest that we as a society are carelessly drugging our children.

I am not well versed in social commentary, and I am not going to voice my opinion on this issue. But I would like to point out that it is estimated that up to 15% of children have ADHD. Ritalin and the medications in this category are still the most effective proven way of at least temporarily helping them with their problem. Yet only 2% of the children are receiving the drug. Are we, perhaps, under treating our children?

Conclusion

If your child is on Ritalin or one of the other stimulants, you should not despair. It could be your child would benefit more from one of the others treatments we will be discussing, but Ritalin is a good start. However, you as a parent should not sit back if there are unpleasant side effects. As we discussed before, there is a lot you can do to get rid of them. It is up to you to take charge and be your child’s advocate.

Now, am I anti-medication?


Anthony Kane, MD

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