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Medication For ADHD

Monday, July 30, 2012 - 17:50

Contributing Author: Guy Slowik FRCS

Medication is never the first resort for the treatment of ADHD. Educational strategies and behavioral strategies are almost always tried at school and at home before turning to medication. Often, these measures will help considerably.

 

But if problems still remain, the doctor may suggest using medication. Treatment with medication can often be very successful. Unfortunately, too many children have been prescribed medication for ADHD when they have not needed it. But in the appropriate setting, when a child really does need medication, it can be helpful.

Need To Know:

How the medication works

The medications most often used in ADHD are stimulants. They don’t sedate the child, or make him or her sleepy. Rather they help the brain work in the way that it would if the child didn’t have ADHD. They wake up the brains “braking system” – the parts that are responsible for self-regulation.

 

 

 

 

Does Your Child Need Medication?

Many parents are reluctant to start medication, feeling that they would be “drugging” their child. They may also feel that giving the child medication means that they, as parents, have failed. This is not true.

 

In mild cases, children can do well without medication. They can be helped through changes in the way their lives are structured in school and at home.

 

But if a child has moderate or severe symptoms, medication can make a huge difference to the child’s ability to live a normal life.

 

 

What Medication Can Do For Your Child

Medication can make a dramatic difference in the lives of children with ADHD who need it. For example, it allows them to:

  • Become more aware of the consequences of their actions and words by making them less impulsive

  • Stay with tasks for longer periods by reducing their ability to be distracted

  • Concentrate longer at school by increasing their attention span

  • Increase their ability to stop and think about what they want to do

 

Medication also reduces hyperactive and aggressive behaviors, helping children to get along better with others at school and at home. Children become more calm, focused, and successful in their day-to-day lives. Self-esteem is increased.

 

Medication will help your child be more receptive to learning, paying attention, and controlling impulses — but it can’t teach those skills. You will still need to follow a strategies at home and at school, to help your child succeed now as well as later in life.

 

Often, the improvement after a medication is given can be dramatic. The child is better able to pay attention, to concentrate, and to sit still. It’s tempting for adults to praise the medication for the change — but if you do that, you might be short-changing the child.

 

It’s important to help the child see that it’s not the medication that is magically turning him or her into a “good kid.” Rather, it is the child’s own effort that is now able to come into focus — thanks to the medication. In other words, it enables children to do what they already know they need to do.

 

 

Questions About Medication

Common questions asked about medication for ADHD include:

  • Does my child really need medication? Most children with ADHD will benefit from medication – but whether or not to start medication is a decision that should be made carefully after discussions with the doctor.

  • Will my child become addicted? Research shows that people with ADHD don’t become addicted to their medication, and often develop a healthy disrespect for drugs.

  • Does the teacher just want children to be medicated to keep them quiet? The medication will probably help your child behave better in class, but it shouldn’t make children feel sleepy or doped up. It’s a stimulant that helps them to concentrate and do their work better.

  • What if my child is teased for taking medication? Very few children are teased for taking medications. With your help they can learn to cope. They are more likely to be accepted by their peers once they are on medication because they are better able to follow the rules of games and take part in conversations without constantly interrupting.

  • Will my child have to stay on medication for life? Some children need medication for only a short time, but others stay on it for a long time. Adults who don’t grow out of ADHD usually choose to keep taking the medication. They appreciate how much it helps.

  • What about side effects? Side effects [hyperlink to “Side Effects of Medication” subhead below] are usually mild.

 

 

What Are The Types Of Medication Used?

There are four types of stimulants that may be used for children with ADHD:

  • Adderall (Dexedrine salts)

  • Ritalin (methylphenidate)

  • Dextrostat (dextroamphetamine) and Dexedrine (dextroamphetamine)

 

Need To Know:

Medication

Remarks

Adderall

Adderall’s effects lasts for about 4 to 6 hours; it is taken once or twice a day.

Ritalin

Ritalin is available in a short-acting form, which lasts about 3 to 4 hours. It is most often taken 2 to 3 times a day. A slow-release form can be effective for 6 to 8 hours.

Dextrostat and Dexedrine

Dextrostat’s and Dexedrine’s effects last about 4 to 6 hours and are usually taken twice daily. A slow-release form works for longer (6 to 8 hours) and can usually be taken once a day.

Other Medications

In some cases, a child with ADHD may be given a different type of medication, either because the stimulants don’t work or because the child needs help with coping with other problems, such as depression or anxiety. These medications might include imipramine, desipramine, buproprion, fluoxetine, or buspirone.

 

In 70% of cases, the medication that is first chosen works well. Almost 90% of children with ADHD respond to one of the four stimulants, so if the first one doesn’t work, another probably will.

 

The type of medication chosen will depend on your child’s needs and his or her response to it. For example, if the main problem is behavior in the classroom, a short-acting medication would be appropriate. However, if the school day is long, a longer-acting medication might be preferable.

 

 

Side Effects Of Medication

For those who benefit from medication, the advantages far outweigh the disadvantages. However, in the short term, stimulants may produce side effects such as:

  • Difficulty sleeping

  • Lack of appetite

  • Upset stomach

  • Headache

  • Irritability

  • Tics (involuntary movements; and if the child has them already, they may get worse)

 

Usually the doctor will suggest staying with one medication for a least a week to see if side effects bother your child before adjusting the dosage.

  • If adjusting the dosage does not correct the problem, a switch to one of the other medications might work.

  • If switching doesn’t work either, your child may be helped by another type of medication

 

In some cases, the stimulants may slow growth slightly, but usually this effect wears off, and the child’s final height is unlikely to be significantly reduced. In very rare cases, some medications may cause liver or other problems, so make sure your child has regular medical examinations.

 

 

The Rebound Effect

As stimulant medication wears off, some (but not all) children experience a “rebound” effect. It is not a side effect of the medication, but rather the result of the medication wearing off. As the medication wears off, the child’s behavior is like a spring bouncing back to normal levels; behavior may worsen for a short time, and an increase in irritability or hyperactivity may also be seen.

 

For some children, this pattern can be reduced by adding an afternoon dose of medication. For others, reducing expectations and required tasks during this period of irritability can also be helpful. If this is a persistent problem, it is important for you to speak to your physician and work out an effective plan.

 

 

Need To Know:

Final Checklist Before Beginning Medication

  • Before your child begins medication, ask yourself these questions:

  • Has your child been thoroughly evaluated by experts?

  • Have you tried other treatment options?

  • Do you understand how the medication works?

  • Have you been told what side effects your child might expect?

  • Is the school prepared to give your child the medication?

Have the reasons for using the medication been explained to your child?

 

If you answered “no” to any of these questions, you may want to delay starting medication until everyone (including your child) knows what to expect.

 

 

 

Follow-Up Visits With The Doctor

Follow-up by the doctor is necessary once your child is on medication. The doctor will:

  • Make sure the drug is the right one and is not causing any side effects

  • Make sure the dose is correct as your child grows

  • Answer all your questions about your child’s problems and progress

 

In some cases, doctors might recommend a “holiday” from medication — for example, during the summer months or even over weekends. But you and your child shouldn’t feel you have failed if your child needs to keep taking medication daily.

 

There’s no point trying to tough it out if your child really needs help.

ADD AND ADHD