Father and Son, Image Courtesy of Ambro, FreeDigitalPhotos.net
Most children who take medication for Attention Deficit Hyperactivity Disorder (ADHD) will continue to require it in adolescence, and more than 50% will need to take it as adults. While the majority of ADHD medications are stimulants, a more recent introduction to the market, Strattera® (atomoxetine), significantly reduces ADHD symptoms and is not a stimulant. However, recent research indicates that this medication can have serious side effects, including dizziness, severe nausea, and suicidal ideation, as well as potentially damaging the heart and liver.
Effectiveness of Stimulants
Overall, stimulants produce significant reductions in impulsivity and hyperactivity for most children with ADHD, and in some cases even enhance physical coordination. Research indicates that children do not become addicted to the medications, and teenagers who take ADHD medication are less inclined to abuse substances than those with ADHD who do not take medication.
Non-Response to Medication
Sometimes the first medication tried does not work and the doctor has to switch the child to a new one. Approximately 10% of children do not respond to medication at all. There are also children who cannot tolerate stimulant medications.
Side Effects
Fifty years of research supports the safety of most ADHD stimulant medications when prescribed by a medical professional. Of all the stimulant medications, only Cylert (pemoline) has serious side effects, potentially damaging the liver. While most children do not feel “high” when taking ADHD medications, some feel slightly odd or different. Mild side effects that may occur with commonly used ADHD medications include:
- Insomnia
- Anxiety
- Irritability
- Decreased or fluctuating appetite
- Mild head or stomach aches
Side effects are usually minor if they occur at all, and are more likely with higher doses than lower doses of medication. A small number of children develop tics (involuntary movements), in which case medication dosage can be changed to remedy the problem.
Combination Therapy is Best
Extensive studies funded by the National Institute of Mental Health have found that a combination of medication and behavioural therapy works far better than behavioural therapy or routine community treatment on their own. Combined treatment has proven particularly effective for addressing certain related issues, such as poor academic performance, anxiety, troubled child-parent relations, and social skills deficits.
Another advantage of combined treatment is that children do not need to take as much medication. However, it should be noted that individual children respond differently to treatment; thus, a treatment that works for most children with ADHD will not work for all, whereas a treatment that is ineffective for the majority may work well for certain children. Also, because some children experience more side effects than others when taking medication, pharmacological remedies are not the best intervention for all children.
There are additional benefits to combination therapy. Medication only treats the symptoms of ADHD without addressing many of the accompanying issues. As well as enabling the child to take a lower dose of medication, adding behavioural therapy and emotional counselling can improve self-esteem and enhance coping skills and self-control. Such benefits will last long after medication has been discontinued. It is also beneficial for the family to receive counselling in order to eliminate patterns of blame, anger and frustration that may have been established.
Behavioural Therapy and Strategies
Behavioural therapy provides children with ways of dealing with intense emotions and stressful events. It teaches children to monitor themselves, to reward themselves when they behave in positive ways, and to think before speaking or acting. Behavioural therapy may include social skills training (taking turns, sharing, etc.) and learning how to break tasks into manageable chunks.
Behavioural therapy should be supplemented with home-based coping strategies. The organizational skills of children with ADHD can be improved by having a clearly defined place for each household item and ensuring that things are always put away in their proper places as soon as members of the household are finished using them. Graphic organizers placed in prominent areas (such as on the refrigerator) are also useful for both children and adults with ADHD. Such organizers may include large calendars, lists, and reminder notes.
Other home-based strategies include structuring situations, such as allowing just one playmate to visit at a time and maintaining fixed household routines including scheduled playtime and homework time to prevent overstimulation. Additionally, token reward systems for good behaviour and the use of time-outs in a quiet space can be helpful.
Support for Parents
In addition to counselling, parents may benefit from joining support groups that give those raising children with ADHD the opportunity to voice concerns and to share information and successful strategies. There are also special classes and individual therapists offering training in parenting skills for those whose children have ADHD.
For more information about ADHD, including symptoms, causes, treatments, and related conditions, see the main ADHD page.
References:
- Canadian ADHD Resource Alliance. (n.d.). “What is Attention Deficit Hyperactivity Disorder.” Caddra.ca.
- Centers for Disease Control and Prevention, Department of Health and Human Services. (2005). “Symptoms of ADHD.” Cdc.gov.
- Flynn McCarthy, L. (2007). “Top 10 Questions About ADHD Medications Answered.” ADDITUDE: Living Well with ADHD and Learning Disabilities. Additudemag.com.
- National Institutes of Mental Health, U.S. Department of Health and Human Services. (2008). “Attention Deficit Hyperactivity Disorder.” Nimh.Nih.gov.
- Silver, L., MD. (2007). “Diagnosing Related Conditions in ADHD Children and Adults.” ADDITUDE: Living Well with ADHD and Learning Disabilities. Additudemag.com.