Before Winnie Frable agreed to start her child with attention deficit disorder on an ADHD medication three years ago, she did a lot of reading — and agonizing. She worried about long-term effects a stimulant medication might have on her 8-year-old son, as well as the insomnia and appetite loss the medication may cause.
"Ultimately, it came down to whether I wanted Christian to remember his childhood as being full of failure and antagonism due to his untreated ADHD," says the Bethesda, Maryland, mom of three. "When I looked at it from this perspective, there was nothing else I could do."
Although alternative ADHD treatments are used to manage attention deficit, research shows that pairing therapy with medication dramatically increases the odds of improving ADHD symptoms in both children and adults.
For children in particular, the results have been promising. In fact, according to the American Academy of Pediatrics (AAP), 80 percent of the children who use stimulant medications, either alone or combined with behavior therapy, increase focus and decrease impulsivity. What's more, a study in the July issue of the Journal of the American Academy of Adolescent Psychiatry suggests that, for children under age 10, medication alone may offer the best results. The majority of children who use medication report having increased self-esteem, fewer disruptive behaviors, and improved relationships with parents, siblings, and teachers. And adults with ADHD have seen similar results.
Contrary to what the word suggests, stimulants don't excite or rev up those who take them. This class of medication works by normalizing chemical neurotransmitters in the brain responsible for regulating attention. And while no clinical studies have tracked the long-term safety of stimulants, doctors say that there aren't any known disabling or lasting side effects. Ritalin, they point out, has been used for more than 40 years. Shorter-term studies, involving two-year follow-ups with patients using stimulants, have shown the drugs to be safe and effective.
Making meds work
Successfully treating ADHD with medication isn't as simple as filling a prescription and living happily ever after. Winnie's pediatrician told her that it would take several weeks to fine-tune the dosage for her son, during which she'd be responsible for monitoring her son's symptoms. Christian, like many ADHD patients, switched medications, starting out on Ritalin and moving to Concerta. There is no one right medication or dosage for everyone with ADHD. Prescribing involves trial and error. "Christian has done well on Concerta, except for the fact that he doesn't seem to sleep as well," says Winnie. "We're trying to figure out whether it's due to the drug, or if he's just nervous about school."
William W. Dodson, M.D., a Denver-based psychiatrist specializing in ADHD, wishes more parents and ADHD adults would be patient about side effects. "There's a tendency for people to throw up their hands at the first difficulty instead of working with the physician as they would with the treatment of any other disorder," says Dr. Dodson. "Getting ADHD meds to work to their optimal benefit requires patience."
Here are five key steps for using stimulants effectively, as well as advice on managing some potential side effects.
Rule #1: Find a doctor who will closely monitor your or your child's medication.
This is critical to your success on medication. According to a study published in the April 2004 issue of Pediatrics, researchers who observed the therapy outcomes of 579 children with combined-type ADHD concluded that those who were closely monitored showed the greatest improvement in their symptoms.
For parents, The AAP suggests starting out with a general pediatrician to deal with ADHD. But if your child has a comorbid condition, such as depression or a learning disability, or if she doesn't respond to initial drug therapy, a parent should consider seeking specialized care, says Andrew Adesman, M.D., director of developmental and behavioral pediatrics at Schneider's Children's Hospital in New Hyde Park, New York. In these instances, a developmental pediatrician, child neurologist, or child psychiatrist can offer a deeper working knowledge of the newest medications and more experience with drug therapy, as well as the time available to work with your child.
Carol Fitzgerald of Warren, New Jersey, says that it took a visit to a neurologist to determine why her son wasn't responding to Ritalin. "It turns out that Gregory also has a mild form of Asperger's syndrome," says Fitzgerald. "He explained that we also needed to treat the mood changes associated with this condition."
While the frequency of visits during the startup phase of a medication may vary from office to office, your doctor should be willing to see your or your child at least every two to four weeks during the first couple of months. These informative meetings will enable you to discuss how the meds are working, whether there are noticeable or troubling side effects, or, for children, if the medication is affecting height or weight. A doctor should always measure your child's height and weight during the initial office visit and then at evenly spaced intervals — once a month, perhaps — afterward.
This article appears in the October/November issue of ADDitude.
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To share strategies for managing ADHD symptoms, visit the ADHD Medications support group on ADDConnect.