Parenting a Child With ADHD (cont.)
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Childhood ADHD facts
- What are the signs and symptoms of childhood ADHD?
- What should parents do if they suspect their child has ADHD?
- What are the causes of childhood ADHD?
- What should parents of children with ADHD expect from their child?
- What treatment options exist for a child with ADHD?
- What are the risks of the use of stimulant medication and other treatments?
- What are other therapeutic approaches for children with ADHD?
- Is childhood ADHD on the rise?
- What is the outlook for a child with ADHD?
- What can parents of children with ADHD do to help themselves?
- Find a local Psychiatrist in your town
What are the risks of the use of stimulant medication and other treatments?
Stimulant medications have been successfully used to treat patients with ADHD for more than 50 years. This class of medication, when used under proper medical supervision, has an excellent safety record in patients with ADHD. In general, the side effects of the stimulant class of medications are mild, often transient over time, and reversible with adjustment in dosage amount or interval of administration. The incidence of side effects is highest when administered to preschool-aged children. Common side effects include appetite suppression, sleep disturbances, and weight loss. Less common side effects include an increase in heart rate/blood pressure, headache, and emotional changes (social withdrawal, nervousness, and moodiness). Patients treated with the methylphenidate patch (Daytrana) may develop a skin sensitization at the site of application. Approximately 15%-30% of children treated with stimulant medications develop minor motor tics (involuntary rapid twitching of facial and/or neck and shoulder muscles). These are almost always short-lived and resolve without stopping the use of medication.
A recent investigation studied the possibility of stimulant medication used to treat ADHD and cardiovascular side effects. Concern focused on a possible association with heart attack, heart rate and rhythm disturbances, and stroke. At this time, there is no certainty in a proposed relationship to these events (including sudden death) when medication is used in a pediatric population screened for prior cardiovascular symptoms or structural pathology of the heart. A positive family history for certain conditions (for example, unusual heart rhythm patterns) may be considered a risk factor. The current position of the American Academy of Pediatrics is that a screening EKG is not indicated before the initiation of stimulant medication in a patient without risk factors.
"Diversion" is the transfer of medication from the patient for whom it was prescribed to another individual. Several large studies have indicated that 5%-9% of grade and high school students and 5%-35% of college-aged individuals reported use of nonprescribed stimulant medication, and 16%-29% of students for whom stimulant medications were prescribed reported being approached to give, trade, or sell their medication. Misuse was more frequently seen in whites, members of fraternities and sororities, and students with a lower GPA. Diversion was more likely with the short-acting preparations. The most common reasons cited for use of non-prescribed stimulants were "helped with studying," improved alertness, drug experimentation, and "getting high."
ADHD is a controversial diagnosis for several reasons. Many well-meaning individuals have spoken out against making children behave according to a norm or taking medications for the sake of improving grades. These individuals have expressed concern about addiction or drugging children. This kind of concern is valid. However, the following must also be considered:
- The negative consequences of not using medication for children with ADHD have to be weighed against the known risks. Long-term outcome studies have now been conducted with large numbers of adults diagnosed with ADHD as children, and one clear finding is that those who received medication for their disorder in childhood are more functional and have a better quality of life as adults than those who had the symptoms of the disease but did not receive medicine.
- Stimulants used for ADHD do not cause addiction. Although tolerance usually develops for the stimulant-associated effects of anorexia, insomnia, or mild euphoria, tolerance does not develop to the increased levels of neurotransmitters.
- These medications should not be used just to improve grades or quiet down classrooms. School performance should be looked at as a sign of how well the child is doing, just like other areas of health. These medications often improve school performance dramatically, which is linked to better social skills and heightened self-esteem.
- Studies that have examined whether taking a psychostimulant for ADHD in childhood contributes to future substance abuse have shown this to not be the case. In one very large study, in fact, children who received stimulant medication for ADHD had half the risk of future substance abuse of similar children with ADHD who did not receive medication.
The use of psychostimulants in children should be scrutinized carefully. Fortunately, methylphenidate (Ritalin [and its long active formulation, Concerta]) has been available since 1955. This long period of clinical experience has shown that this is one of the safest medications used in children.
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