When a child is diagnosed with ADHD, the second reaction of many parents is to ask "now what?" (The first may range from, "No way, not my kid!" to "Gee, all this time I thought I was a bad mother.")
The answer to "now what" involves education, changes in parenting tactics, and more often than not, a prescription for medication. Yet the decision of whether or not to give your child psychostimulants can be a daunting one, especially given the media explosion warning of a national overdependence on Ritalin.
It's important for parents who do choose to medicate to work closely with a trusted doctor who is well versed in the various treatment options, as there is no one-size-fits-all solution to medicating a child with ADHD.
To Medicate or Not to Medicate
Dr. Ned Hallowell, a child and adult psychiatrist and the founder of The Hallowell Center for Cognitive and Emotional Health, believes medication is advisable the moment a diagnosis is made. "There is no reason to hold back," he says. "Do you want to squint before trying eyeglasses?" He says that when used properly, medication is not only safe and effective; it is a godsend.
ADHD medications are known as stimulants, which seems counterintuitive for a child whose condition causes him to bounce off the walls. But according to the American Academy of Pediatrics, these medications work by "stimulating" the area of the brain that deals with executive function - focusing attention, controlling impulses, organizing and planning, and sticking to routines. Parents can take comfort in the fact that stimulants have been the widest and most studied of any group of medications for the behavioral and emotional problems of children.
What are the Medications?
These medications come in three classes - methylphenidate, dextroamphetamine and amphetamine compounds. And within these classes are varying dosages, from short-acting (4 hours) to intermediate (8 hours) to extended release (about 12 hours). Depending on the needs of the child, doctors can regulate these dosages to suit individual schedules. For instance, a child may take an intermediate dosage that will last throughout the school day, and then a short-acting booster on days when an afterschool activity might force her to stay up later to do homework. Stimulants do not build up in the body, but leave the child's system completely as they wear off at the end of each day.
How much of the medication should a child take? It all depends, and not on the child's weight as is the case with other meds like antibiotics or cold medicine. The optimal dosage is not the lowest amount that shows some benefit, but rather the one that most helps a child reach his target behaviors. It is recommended that doctors start low and slowly increase the dosage until either no further improvement is noted, or side effects appear, though this gradual increase may actually help to diminish some of the side effects.
Do Meds Work?
Studies show that when taken correctly, 80% of children respond well to medication. But sometimes the medications don't work. If there is still no improvement after tinkering with dosages or switching to another class of stimulants, parents may want to consider whether or not ADHD was indeed the correct diagnosis. There might be another underlying cause, like anxiety or a learning disability that manifests in the same behaviors as a child with ADHD.
As with practically any medication, stimulants do have side effects. The most common are a decreased appetite (until the medication wears off in the evening and you can expect your child to request a second dinner), stomachaches, headaches, jitteriness, difficulty falling asleep and social withdrawal. With the exception of a lowered appetite, most of these symptoms disappear as the body adjusts to the medication.
Some children (15-30%) experience motor tics after almost a month of starting medication. Though disturbing for parents to see, this usually goes away after about three weeks. This may give pause to parents of children with both Tourette Syndrome and ADHD. (Nearly half of all children with Tourette's have ADHD as well). Yet according to the American Academy of Pediatrics, recent studies have shown that stimulants, at moderate doses, have no effect on the severity or frequency of tics, while the benefits to the ADHD symptoms are measurable.
Recent studies also show that stimulants have no long-term effect on the ultimate height of a child as had been previously thought. Finally, in the beginning of treatment, a child may experience rebound as the medication wears off at the end of the day. This is when behaviors erupt and seem worse than what they had been before medication. Fortunately, this does not typically last long.
When a child takes medication for ADHD, he or she should be closely monitored - the parents should note daily behaviors, and the prescribing doctor should schedule frequent follow ups to monitor treatment and ensure that the dosage is optimal.
Dr. Hallowell cites the MTA (multi-modal treatment assessment) study, the largest study ever done on the treatment of ADD in children, and says, "While medication makes the biggest difference immediately, as time goes by other factors come significantly into play, including the positive connections within family and elsewhere that make a crucial difference in outcome."
In other words, there is no such thing as a magic pill. But used properly, medication can lay the foundation for success with other treatments as well.