Treating ADHD in Children
Medications can be very beneficial in the treatment of Attention Deficit/Hyperactivity Disorder (ADHD). It is a disorder that is diagnosed in the United States often in young children. Between 1997 and 2006, diagnosis increased 3% in Americans. Medication is not the only treatment. Along with psychotherapy and diet, people can effectively cope with ADHD.
What is ADHD?
ADHD is a neurodevelopmental disorder characterized by an individual’s inability to pay attention. They are disorganized, and/or have hyperactivity-impulsivity. They are unable to remain on a task, seem not to listen, and lose things more often than others their age. Symptoms of hyperactivity-impulsivity include fidgeting, inability to remain seated, nosiness, and a lack of patience. These symptoms are excessive for the person’s age and developmental level. ADHD generally persists into adulthood. To be diagnosed with ADHD, a child must have six symptoms from both or either the inattention criteria and/or the hyperactivity-impulsivity criteria. Individuals over 17 years of age need only five symptoms. Examples have been included in the Diagnostic and Statistical Manual Five. These descriptions make it easier for health care professionals to identify symptoms at different life stages.
Treatment of ADHD
Throughout the world, treatment of ADHD is vastly different. Highly active children in Israel are accepted, which makes it difficult to tell the difference between high activity and ADHD. In Brazil, minor physical punishment is thought to be therapeutic and physical exertion is thought to be a useful alternative to medication. Health care professionals in Canada see ADHD as something a patient suffers with their entire life and is a disorder that requires careful assessment and several different modes of intervention.
One medication that has been used extensively in the treatment of ADHD is Adderall. First approved by the United States Food and Drug Administration (FDA), it is given to children six years and older in an oral form. The initial dosage is 5-10mg with a maximum of 30mg. The most common adverse effects are anorexia, insomnia, headaches, abdominal pain, nervousness, and emotional instability. It is thought to work by blocking the re-uptake of norepinephrine and dopamine into the area before the synaptic neurons and increases the release of neurotransmitters in the extra-neuronal space. Adderall is a time release form and is more potent than other medications. In comparison to a newer drug such as Lisdexamfetamine, it takes less of the Adderall to achieve similar effects as Lisdexamfetamine. In randomized 24 month trials, Adderall was well tolerated and side effects were mild to moderate. As of December, 2013, 5.2 million children under 17 years of age have been diagnosed with ADHD in the United States.
Many people have been prescribed drugs such as Adderall and Ritalin. These medications have helped many people and are used today. But there are other side effects not mentioned that can affect the takers of the medication. A study conducted in 2009 prompted the FDA to require drug manufacturers to put new labels on drugs such as Adderall. The study showed that 1-2% of children taking medication for ADHD experienced hallucinations. These hallucinations stopped after the medication was discontinued. The children in the study were younger than 11 years and nine out of ten of the children had no reported history of psychiatric events. Most of the hallucinations involved snakes or bugs as well as sensations of such crawling on their skin. Because of this study, manufacturers must now include psychiatric side effects on their labels. Other possible issues include heart problems, such as high blood pressure, death, and stroke, and circulation problems in extremities, such as in the fingers and toes.
Besides medications, there are other therapies that have proven useful in relieving the symptoms of ADHD. The American Association of Pediatrics has recommended behavioral therapy as only one of two evidence-based therapies for ADHD, the other being psychopharmacology. Several studies have shown that while behavioral therapy takes longer, it is also longer lasting. Students with ADHD who engaged in cognitive and behavioral therapies formed better study habits and were able to concentrate better. They were able to lower their medication doses as well. Performances were boosted and long-term positive reinforcing behaviors were learned, allowing afflicted children to raise grades and retain attention when needed. There is also no fear of drug abuse by children in later life. Scientists are asking for a renewed interest in cognitive and behavioral therapies in handling ADHD in children.
There are other remedies, but not as effective as psychopharmacology and behavioral therapy, but they are worth mentioning as not all patients respond to these therapies. Many of these remedies are recommended only after medications and behavioral therapy have proven ineffective. Elimination diets are popular for removing additives or foods that may bring the onset of ADHD. They are recommended for patients with documented reactions to certain additives, such as red dye. However, there must be close monitoring with an elimination diet. A nutritional imbalance can occur if parents or guardians are not careful and patient. Essential fatty acids (Omega-3’s) have been used and are helpful to people who do not often eat fish as a staple of their diet. There exists the possibility of mercury poisoning and if fish is a staple, the added fatty acids will have little to no effect. Combinations of micronutrients have shown to help patients who fail to respond to medication and have comorbid factors such as depression or mood issues. Mods must be monitored in the patient as they may fluctuate until the body stabilizes itself. There are other homeopathic and herbal remedies, but they have not been FDA tested and approved. They should only be used when all other forms of treatment have failed.
Over 8% of children in the United States have been diagnosed with ADHD. Colorado has the lowest percentage of diagnosed children with only 5%. It is one of the most diagnosed disorders for children and many will carry it on to adulthood. But there are treatments available for these afflicted individuals. Medications and behavioral treatments have been proven as effective evidence-based therapies, yet others are available as well. Adderall has been a trusted medication in the curbing of ADHD symptoms; behavioral therapy has proven to lower the need for medication and increased performance in children with ADHD. Until we totally understand what causes ADHD, we have treatments that can help people afflicted with ADHD to be productive individuals.
Paul Gross, MFTC
411 Lakewood Circle Drive
Colorado Springs, CO 80910