ADHD and Medication

First of all, I’d like to thank Kirsten for posting the email on the discussion board. Medicating children has been a hot topic of discussion in the realms of medicine and education for decades and for a few of the reasons stated in the email. Before delving in to pharmaceuticals, I think it is important to understand the basics about ADHD and why some people opt to medicate.

ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), and in some cases, are overly active (Center for Disease Control and Prevention, 2010).  It is often diagnosed as one of the following: ADHD-I (primarily inattentive), ADHD-HI (primarily hyperactive and impulsive), and ADHD-C (combination of both types).  In order to make a diagnosis, a child must exhibit six criteria for inattention OR six criteria for hyperactivity/impulsivity for a period of at least six months and to a maladaptive degree (DSM-IV). CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder) provides the list of characteristics for each category:

AD/HD - Primarily Inattentive Type:

• Fails to give close attention to details or makes careless mistakes.

• Has difficulty sustaining attention.

• Does not appear to listen.

• Struggles to follow through on instructions.

• Has difficulty with organization.

• Avoids or dislikes tasks requiring sustained mental effort.

• Is easily distracted.

• Is forgetful in daily activities.

AD/HD - Primarily Hyperactive/Impulsive Type:

• Fidgets with hands or feet or squirms in chair.

• Has difficulty remaining seated.

• Runs around or climbs excessively.

• Has difficulty engaging in activities quietly.

• Acts as if driven by a motor.

• Talks excessively.

• Blurts out answers before questions have been completed.

• Has difficulty waiting or taking turns.

• Interrupts or intrudes upon others.

Displaying six of the criteria is not the only element in determining a diagnosis. It is also essential to:

-    Determine that symptoms are present in two or more of a child’s settings (eg home and school)

-    Determine that the symptoms adversely affect the child’s academic or social functioning for at least six months

-    Ensure that the evaluations are initiated by the primary-care physician

-    Include assessment informationf rom both parents and scohol professionals

-    Include evaluation for coexisting disorders such as depression, anxiety, and learning disabilities (Webber & Plotts, 2008).

Once a diagnosis is made, depending on the severity of the disorder, one may choose to medicate.

But why medicate? Why do people with ADHD need to be medicated? What’s going on in their bodies that needs regulating?

Although there is no one cause to ADHD, the research shows a strong neurobiological basis with a focus on neurotransmitter disturbances (National Resource Center on AD/HD, 2010; CDC, 2010; Webber & Plotts, 2008; & CHADD, 2010). While most people think ADHD is caused by an overstimulation of the brain, it is actually linked to an UNDERarousal of the anterior frontal lobes which is caused by dopamine and/or norepinephrine depletion. For more information about cause(s) and risk factors, visit the National Resource Center on ADHD or the National Institute of Mental Health .

So what’s basically happening is that the brain is understimulated, causing the child to be overstimulated. How do you combat that? Stimulate the brain -- get the brain to function at the level it should. By stimulating the brain, it actually calms those with ADHD. It is because of this fact that doctors prescribe (can you guess what’s coming?) STIMULANTS. The National Institute of Mental Health (NIMH) has a fabulous chart regarding the various drugs commonly used for ADHD, click here: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml#pub6 .

However, medication is not the ONLY treatment of ADHD. Effective treatment of ADHD in children and teens requires a comprehensive approach that professionals call multimodal. This means that the best outcomes are achieved when multiple interventions work together as part of a comprehensive treatment plan. The elements of a multimodal treatment approach include:

• Parent training

• Behavioral intervention strategies

• An appropriate educational program

• Education regarding AD/HD

• Medication, when necessary

Positive behavior intervention can be critical. The most important techniques are consistency and positive reinforcement, in which the child is rewarded for desired behavior. Classroom success may require a range of interventions, from making minor adjustments in the regular classroom to requiring special education programs. For many children with AD/HD, medication may be an integral part of treatment. Both stimulant and nonstimulant medications are now available to physicians and parents.

So what’s the problem with medicating? Why do we keep seeing meds in a negative light?

In the email Kirsten presented, they listed the following as results that are “covered up”:

* Have a high potential for abuse

* Be habit forming

* Impair vision

* Cause serious heart problems

* Create blood-vessel problems

* Result in sudden death.

Which they aren’t. At all. Studies are always accessible and warnings are always on the label. In FACT, you can access medication guides from the U.S. Food and Drug Administration (FDA) as well as drugs.com. In my personal opinion, problems with medication arise due to:

-    Incorrect dosage

-    Lack of supervision

-    Lack of reporting effects (on part of the parent or child)

-    Contraindicated medication

-    Incorrect reporting of effects by parent(s) and/or teacher(s)

-    Lack of knowledge and/or awareness

-    Others

The common theme is that something is missed, intentionally or not, resulting in undesirable outcomes. Medication, if used correctly and under appropriate supervision, could most definitely be beneficial to a person with ADHD. Although it’s not listed under the area of treatment, I think it would be a great idea for these kids to undergo therapy before, during, and after taking a drug to have their behavior closely monitored as well as help walk them through and understand the changes they are experiencing.

For more information:

CDC ADHD Homepage
www.cdc.gov/ncbddd/adhd/index.html

Children and Adults with AD/HD
www.chadd.org

Drugs@FDA
www.accessdata.fda.gov/scripts/cder/drugsatfda/

Drug Information Online
www.drugs.com

National Resource Center on AD/HD
www.help4adhd.org/index.cfm?varLang=en

NIMH ADHD Homepage
www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml