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Treatment Options for Children with ADHD

Posted Aug 24 2008 1:49pm

ANNOUNCER: When treating the symptoms of childhood ADHD, doctors will generally prescribe medications called stimulants.

MELVIN OATIS, MD: The benefit of stimulant medication is really targeting the three primary areas of ADHD, which are hyperactivity, impulsivity and inattention.

ANN ABRAMOWITZ, MD: There's been a huge amount of research looking at the effectiveness of stimulant medication with ADHD. And there's really no question that stimulants can be very helpful as part of the treatment for 70 to 80 percent, at least, of people who have ADHD.

ANNOUNCER: Although the name implies otherwise, stimulant medications actually have a calming affect on children with ADHD.

JAMES McGOUGH, MD: We now know, actually, that in truth, everyone gets calm and more focused on a stimulant and it has nothing to do with having ADHD or not. What's difficult for some people to understand is that while what we see overtly is that patients are overactive, they're fidgety, they're restless, or they have difficulty staying on a particular task or stimulus in terms of their attention, what they're really lacking is control of those areas. So it does seem paradoxical somewhat that they're giving kids stimulants and they're calming down. What we're actually doing is stimulating their control centers or their executive function centers and thereby gaining better overall control.

ANNOUNCER: There are two groups of stimulant medications prescribed for ADHD: the amphetamines, which include Adderall preparations, and the methylphenidate group which includes Ritalin, Concerta, Focalin and the Daytrana patch. As with all medications, there can be side effects associated with stimulants.

MELVIN OATIS, MD: The primary side effects associated with stimulant medication are common ones, are headache and stomachache, which are usually transient side effects that go away within a few weeks of treatment, but you need to be aware of them. Another common side effect is a decreased appetite. Also when children first start medication, it can have an impact upon their sleep, so you really have to monitor what time of day that you're giving it so that the medication is out of their system in order for them to have a successful, restful night of sleep.

ANNOUNCER: One side effect stimulants do not carry is the risk for addiction.

MELVIN OATIS, MD: In terms of addiction, the stimulant medications are not addictive. In fact, they have been shown from the research perspective that treating the child's ADHD symptoms will later in life decrease the chances of them becoming addicted to other types of medication. So it's actually something that is beneficial.

ANNOUNCER: The first available stimulants were short-acting medications that are taken several times a day.

ANN ABRAMOWITZ, MD: It used to be when only short-acting medications were available, kids would have to take that proverbial lunchtime trip to the nurse's office and line up in the school office and get their medication and then go back, and sometimes they would forget, and it was stigmatizing.

MELVIN OATIS, MD: Also with the short-acting medications, you have variability in terms of the amount of medication that's in their system. So they have a peak, and they have a trough where the medication goes up, it rises; it goes down. It goes up; it goes down.

ANNOUNCER: Healthcare professionals voice concern over possible abuse of short- and intermediate-acting stimulants. Children, siblings or adults can use these medications inappropriately for their stimulant effects.

M. CHRISTOPHER GRIFFITH, MD: One of the issues about abuse with these medications is, that is where the stimulants have gotten a bad name, because these medicines potentially can be abused. The immediate-release amphetamine preparations can be ground up, snorted, and are more likely to be abused. The newer medications have a lower abuse potential.

ANNOUNCER: Newer formulations of stimulants come in extended release versions that can last as long as twelve hours.

JAMES McGOUGH, MD: There's been a great emphasis now on once-a-day stimulant medications. We actually now have once-a-day stimulants both in the amphetamine group, which is the group of medicines which Dexedrine and the Adderall medicines belong to; and the methylphenidate group, which is the medicines like Ritalin, Ritalin LA, Focalin, Focalin XR, Concerta.

ANNOUNCER: Extended release medications are less likely to be abused than shorter acting drugs.

JAMES MCGOUGH, MD: Formulation of the medicines that is employed or formulations that are employed in the longer-acting forms are such that they release the medication into the body at a much slower rate than is usually necessary to get someone to have an altered state of mind.

ANNOUNCER: Proper treatment, often including the use of stimulants, can help young people navigate more successfully through life.

M. CHRISTOPHER GRIFFITH, MD: Many times, children will come into my office and they'll say, "Doc, you know, this medicine's great. I'm getting all A's now. I'm not getting in trouble. I'm getting along better with my brothers and sisters." And I say, "Great, that's great. It's great that this medicine has helped. But again, let's not give it all the credit, because what this medicine has done, it's helped with your inattention. It's helped with your distractibility. It's helped with your impulsivity. It didn't make you do your homework. It didn't make you open a door for your mom. Those are thing that you did on your own." So I basically have something I call a 50/50 rule. The medicine does 50 percent, but then you have to do 50 percent yourself.

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