ADHD treated with meds, therapy

When Nancy B.’s only child began acting out on the playground of his elementary school, she realized his behavior was different from the other kids. His teachers noticed as well. Her 6-year-old son was inattentive and disturbed other children at work in the classroom, she said.

"Seeing him interact with other kids his age at school really showed us we might have to see somebody," she said. "He wasn’t concentrating, he wasn’t ‘there’"

The family’s pediatrician diagnosed her son with ADHD, a diagnosis that originally worried her.

"I had heard that the drugs were bad," she said. "We’d heard so much negative things about them for his future, but they’ve made a difference today."

What is ADHD and how do drugs play a part in its treatment, and can those medically assisted treatments become dangerous to the child in the form of substance abuse?

Dr. Lisa Glasser, pediatrician with Sunrise Children’s Hospital, treats and assists in the diagnosis of children with ADHD. She agrees parents should be on top of what medications their children are taking, but not to be afraid of ADHD medications, when used correctly.

According to the Center for Disease Control 4.5 million children age 5-17 years diagnosed with ADHD as of 2006. The CDC estimates 3 to 6 percent of school-aged chil dren in the United States have Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder. By state, Nevada falls in the middle range of 7.1-8 percent of ADHD diagnoses, with a low of 5 percent in Colorado to a high of 11.1 percent in Alabama.

While more boys than girls have it, across the board the disorder can persist into adulthood. The cause is unknown, however, environmental, neurological, and hormonal factors have been pointed to as possible culprits. The terms ADD and ADHD are often used interchangeably whether the patient has symptoms of hyperactivity and impulsiveness or not. ADHD is the official name used by the American Psychiatric Association.

The main medications used to treat ADHD are methylphenidate-based medications and Adderall or mixed amphetamines, Glasser said.

"There are a few newer formulations of the stimulant medicines in a patch form," Glasser said. "These new formulations contain a more pure medication without contaminant medication. This means that there are fewer side effects."

The main drugs used to assist ADHD, such as Ritalin, Adderall and Dexedrine, affect the regulation of the neurotransmitters dopamine and norepinephrine. The drugs regulate these chemicals in the brain in different ways so that the ADHD patient can focus his attention and control impulses, thoroughly think through plans and organize thoughts.

Some side effects include decreased appetite, difficulty sleeping, increased anxiety, nervousness or restlessness, irritability and headache.

If all goes well, the ADHD patient has a greater quality of life and is not dependent on the drugs forever, the CDC notes, as most children adjust on their own and tend not to show the symptoms of ADHD as they enter adulthood. The National Institute of Mental Health conducted a 10-year study that found the brains of children and adolescents with ADHD are 3 to 4 percent smaller than children who do not have ADHD. By their late teens the brains of children with ADHD have caught up with their peers and medication is no longer needed.

Some parents simply don’t want to start down a road of stimulant medication assistance in the treatment of ADHD, and for them there are milder alternatives, Glasser said.

"There is a non-stimulant medication called Strattera," she said. "Strattera is closer to an anti-depressant, however it is not actually an anti-depressant."

The medications themselves do not cure ADHD and often other stimulants outside of drug therapy do a world of good for a child.

"In addition to medications, behavioral therapy may be helpful," Glasser said.

This includes what she calls "green" time, in which the child spends time outdoors, actively playing and less "screen" time in front of a TV or computer.

"[These] are valuable additions to medications," Glasser said.

The current thinking that stimulant or medication therapy for ADHD in young children leads to future substance abuse with drugs, alcohol, and nicotine is off base, she noted. In fact, it’s just the opposite.

"Children with ADHD who are not medicated actually have a higher risk for substance abuse and problems with the law," Glasser said. "Without the proper medication, children or adolescents with ADHD tend to be more impulsive which may lead to su bstance abuse and poor choices in general."

That’s not to say parents shouldn’t be involved in the prescription, delivery and monitoring of medications in their children diagnosed with ADHD.

"Parents need to be their child’s advocate and have open discussions with their child’s physicians anytime medications are being prescribed," she said. "They need to talk to their doctor about side effects, alternatives, and risks and benefits to the medication."

At the same time, parents should be concerned about not putting their children on medication if needed.

"Parents should do their homework and research medications and also be aware of any changes in symptoms or behaviors when a child starts a new medication or stops taking a current medication, Glasser said.

Interestingly, children with ADHD do not become stimulated with stimulants, Glasser said.

"They become more focused," she said. "They tend not to become addicted to the drug itself. However, there is a greater potential for abuse in older adolescents who educate themselves about the potential recreational uses of medications. This is a problem that is not specific to ADHD medication."

The symptoms of ADHD regarding behavioral disorders and doesn’t in and of itself increase their risk for substance abuse.

"If not treated or if behavioral disorders are insufficiently treated they are at more risk for substance abuse," Glasser said.

Another important tip for parents is to keep a list of all their child’s medications and be sure to let all the child’s physicians and pharmacists know so that they are made aware of any drug interactions.

Dr. Glasser suggests that it takes vigilance on the parent’s part to explore the world of their child through those they interact with most.

"It is important for parents to keep the lines of communication open with their child’s physician as well as teachers, coaches, tutors, etc.

Curious to know if you or your child has ADHD? The website http://psychcentral.com/addquiz.htm has a 24 question quiz on how to know if you have ADHD.