The most common form of treatment for
has typically been medication. This has been the case, only since around the 1970s. Prior to 1970 in the early 1960s, the use of medication in the treatment of ADHD was not common.
ADHD medication does help about 40-70% of those who use the drugs, according to the most commonly quoted statistics.
On the other hand, about 90% experience serious side effects the first 6 months of use, which tapers off to about 15% after 2 years. The efficacy of drugs for ADHD lasts about 2 years for most people, which means, that while about 1/2 experience some improvement with symptoms the first few months, within two years, most no longer experience any difference in symptoms. The mind and body apparently get used to the drug, so that it not longer is effective.
Additionally, it is possibly that a good part of the efficacy of the drug is a result of the intervention and extra attention that has been given to the child. Placebo response is also high when compared to that of ADHD medication.
However, there are many other forms of intervention that can help (the medications most commonly used are stimulant medicines.) Not everyone agrees with the labeling system that classifies children as ADHD. So there are different ways of looking at mental health problems, especially with children. (Eide, B., Eide, F., 2006).
Increase in use of medication in treatment of mental health "disorders" from 1993 to 2003:
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ADHD Kids, Drugs and Experiences
"We had to take my son off of the medication [for ADHD, because of side effects]. He said that he felt like he was in 'a fog'". We made good progress with exercise, he went to the gym and worked out all day with my husband. It didn't leave much other time for other things [media time]. Also, we found that [my son] did better with structure. We had meal times together the same time every day, and a fixed schedule every day." Newark, NJ educator, 2006). Young teen.
"He stayed on the medicine for about 2 years, but his mother said it didn't help and he didn't like the side effects. His stomach hurt [among other things]." Newark, NJ public school social worker, 2008. Child, 10, 11 years old.
"Adderall XR and Adderall plain I've used before and they seem to give me a rush and a drop off that wasn't the best treatment." NAMI member, 2009.
"My stomach blows up every time I eat after I take the medicine. They say that this was going to help me get better grades, but my grades have gotten worse since I started taking the medicine." Newark, NJ, 2008. Child, 11, 12 years old.
ADHD and School
Better grades and ADHD Medication Fallacy
Medicine for ADHD rarely helps children to get better grades. Studies indicate that grades in reading and math remain fairly constant with or without medicine. In the cases where grades do improve, it is usually a very slight difference, and that difference can be more accurately attributed to the extra attention from social workers, psychologists, the teacher's and parent's awareness, as well as programs that the child might become involved with, rather than any attributes of the medicine.
What does make a difference with children as far as grades goes is watching R-rated and violent movies, time spent with video games and time and intensity of television.
A study conducted in the Bronx indicates that children who do not watch R-rated movies get significantly better grades than children who do watch violent and R-rated movies. This is an adjustment that teachers and principals should encourage for all parents, as a significant proportion of children do regularly watch violent
and R-rated movies of all types. This can be at the root of some of the behavioral problems for children with ADHD.
One boy in the first grade who was on medication for ADHD, described with zeal details from violent R-rated movies such as
Chucky, and Freddy Kruger
, whom he knew by name. His behavior in class (on medication) reflected that already formed lifestyle.
ADHD - ADD medication and treating symptoms
Parents and educators need to realize that medication for ADHD merely controls symptoms. It does not "cure" the problem, or address the underlying issues that are causing the disorder. In fact, most pharmaceutical treatment for mental illness, if not all, is symptom based, that is the medicine is addressing symptoms, not the disease, not the disorder itself. It might be likened to an aspirin. An aspirin helps the headache to feel better, but it does not address what has caused the pain in the first place. Medication prescribed for mental health disorders can be very accurately compared to an aspirin.
Side effects of ADHD medication
The most common side effects of stimulant medications are insomnia or depression. Also, jitteriness, facial tics
, and emotional sensitivity can also result from use of stimulant medications in children, and a feeling like one is going to "jump out of one's skin". (Ratey, J., 2005). Depression might be more common with prolonged usage. (Ratey, J., Hallowell E.).
At times, there have been a very serious side effects with medicines for ADHD, such as deaths associated with heart failure for children who have undetected heart problems. The testing for such congenital heart defects is expensive and cost prohibitive, so testing for heart defects is generally not conducted when stimulant medications are administered. Also, in 1 out of 1,000 cases, schizophrenia like symptoms have resulted from usage of stimulant medications, bizarre behavior, voices, delusions.
See: http://www.rxlist.com for a complete list of side effects.
An honest and balanced look at side effects
for medications in treatment of ADHD
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are two common stimulants. Adderall being an amphetamine and Ritalin being something close to an amphetamine, but not a true amphetamine.
Why do many parentsnot pursue pharmaceutical treatment for ADHD?
In a study involving 850 families, the conclusions reached were:
1. Side Effects
2. Assessments lack "objective" procedures, that is, assessments are largely subjective, or, opinion based, rather than scientific or definite.
"The reason cited most often for not beginning medication treatment - reported by 92% of parents in the sample - was fear of medication side effects. Concerns about side effects and an assessment process that lacked "objective" procedures - were far and away the leading reasons that parents chose not to try medication with their child. What about parents who were willing to initiate such treatment but who discontinued it within 3 months?
In this case, the most frequently cited reasons were the development of side effects - reported by 49% of parents - and continued problems at home or school despite medication - reported by 48%. (Monastra, V.J., May 31, 2005)
Information on side effects was also obtained at each follow-up assessment.
At the 6-week time point, reports of side effects were relatively common. In fact, over 90% of parents reported observing appetite loss and sleep difficulties, over 80% reported that their child had lost at least 5 pounds, and over 50% reported that their child was showing increased irritability. Increased symptoms of depression were reported by 25%.
Such side effects are what lead many families to discontinue their child's medication therapy. By 6 months, reported side effects had declined by approximately 50% and by the 2-year follow-up, the only side effect that continued to be reported by 15% of parents was appetite suppression.
Thus, parents clearly observed a substantial decline in medication side effects for their child over time. (Rabiner, D., January 2006. Attention Research Update. Summary of longitudinal study. http://www.helpforadd.com/2006/january.htm)
Conclusions on side effects of ADHD medication
For most children, (50%-90%) there will be serious side effects, with medication use:
It is thought that within six months, only about half of children on medications for ADHD will continue to have serious side effects. (Rabiner, D., Based on longitudinal study of side effects for stimulating medications). Within two years time, a recent study indicated, only 15% of those on medications for ADHD will have serious side effects. (see David Rabiner, helpforadd.com.)
There would appear to be a tolerance
that develops in children who are on medications for ADHD. It might also be true, however, that, as in the case of Prozac, the effectiveness of the medication decreases in time as tolerance builds. While some children do benefit in the ability to concentrate in the short term, long term benefits of stimulant medication is disputable.
Notes: In What way is methylphenidate (Ritalin) like
Washington: Advanced imaging research has answered a 40-year-old question about methylphenidate (Ritalin), which is taken daily by 4 million to 6 million children in the United States: how does it work? The answer may unsettle many parents, because the drug acts much like
, albeit cocaine dripped through molasses (J Neurosci. 2001;21:RC121).
Taken orally in pill form, methylphenidate rarely produces a high and has not been reported to be addictive. However, injected as a liquid it sends a jolt that "addicts like very much," said Nora Volkow, MD, psychiatrist and imaging expert at Brookhaven National Laboratory, Upton, NY. "They say it's like cocaine." (Vastag, B.)
Tics-How Serious a Concern?
Summation on ADHD drugs, side effects and efficacy
Some children do experience some improvement of symptoms associated with
when they begin taking drug therapy. It would seem that, like drug treatment for depression, about half of the children who are prescribed stimulants do experience some improvement.
The improvement may be do in part, however, to the involvement of
and extra attention being given the child.
It has been noted that
can affect a similar and greater improvement for the majority of
The positive affect medication contributes to a child's mental state is temporary, and usually, within 2 years, the positive affect on the mood of a child will no longer be noticeable.
Serious side effects are apparent in about 1/2 of children who take ADHD medication. The number of those who experience such serious side effects usually tapers off gradually, to about 10% by the end of 2 years, about the same time period for the positive affect of stimulant drugs.
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