Attention-Deficit/Hyperactivity Disorder
Page Four
Seeking Medical Support
More children receive medication to manage AD/HD than any other childhood disorder. And more research has been conducted on the effects of stimulant medications on the functioning of children with AD/HD than any other treatment modality for any childhood disorder. Unfortunately, a great deal of misinformation has been perpetuated by the sensationalist, popular press. This extensive research, however, helps us to be fairly definitive about the benefits and liabilities of medication.
In general, we can say medication intervention is a significant help to AD/HD children. Between 70-80 percent of children with AD/HD respond positively to medication. Attention span, impulsivity and on-task behaviors improve, especially in structured environments. Some children also demonstrate improvements in frustration tolerance, compliance and even handwriting. Relationships with parents, peers and teachers may also improve. Medication will not make your child behave perfectly, nor will it make him smarter. What it can do is reduce many of your child's attention difficulties so that he can tackle his problems more successfully.
Recently, the National Institute of Mental Health released the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA). This study is the longest and most thorough study ever completed comparing treatments for AD/HD. The study found that medication in combination with intensive behavioral therapy was significantly superior to all other types of treatment.
Although medication alone was found to be more effective than intensive behavioral treatment alone, the combination of the two was necessary to produce a variety of improvements, and also led to the use of somewhat lower dosages of medication. Also, for the improvement of social skills and anger management, behavioral treatment was found to be very beneficial and necessary. Medication alone, in other words, does not help a child make friends or know how to resolve conflict in appropriate ways.
The primary benefits of the combined use of medication and therapy are improvement of the core problems of AD/HD– hyperactivity, impulsivity, and inattentiveness. Attention span seems to improve and there is a reduction of disruptive, inappropriate and impulsive behavior. Compliance with authority of figures is increased, and children's peer relations may also improve, primarily through reduction in aggression. If the dosage is carefully monitored and adjusted, medication has been found to enhance academic performance. Medication by itself will not rectify learning disabilities. If a child has visual or auditory processing deficits, for example, medication will probably not change the learning problem. But it may well help your child pay better attention, so that he can better apply his educational instructions.
The most important finding to emerge from the vast amounts of research about AD/HD is that no one treatment approach is successful alone. Neither medical, behavioral, psychological nor educational intervention is adequate by itself. We must be conscious of treating the whole child or adolescent.
Some parents feel guilty about having their child take medication because they mistakenly think they are tranquilizing him. This is simply not true. Medication actually helps stimulate the parts of the brain that are needed to concentrate. The decrease in external movement does not mean he has been tranquilized. It means he is able to focus more effectively.
All medical decisions, of course, need to be based on the comparison of the benefits and alternative treatments available, and any possible side effects. Although your physician can give you more details, here are a few of the possible side effects of medication.
 Remember that medication is never
the sole treatment program for AD/HD.
The primary side effects noted for stimulant medication is insomnia, anorexia or loss of appetite, weight loss and irritability. Most of these appear at the beginning of treatment and only last for about a week.
Appetite suppression is another possible side effect. Your child may be less hungry for a time. This affect may be less noticeable if the drugs are taken with or after meals, as the effects wear off before the next meal. Adjusting the dosage can usually alleviate this symptom over a week or two.
Other mild, but less common side effects, can include sadness, depression, fearfulness, social withdrawal, sleepiness, headaches, nail biting, and stomach upset. These symptoms will usually resolve spontaneously with a decrease in dosage. Some of these symptoms are mild and can be considered acceptable side effects in light of clinical improvement. You and your child's physician will need to make the decision regarding the advantages of decreased distractibility versus side effects such as nail biting. Alternatively, a trial of a different medication can be initiated.
There are no reported cases of addiction or serious drug dependence to date with these medications. Studies have also examined the question of whether children on these drugs are more likely to abuse other substances as teenagers, compared to children not taking stimulant medications. The results suggest there is no increase in the likelihood of drug abuse.
Another possible long-term side effect that has been considered has been the suppression of height and weight gain. Presently, it is believed that suppression in growth is a relatively transient side effect of the first year or so of treatment and has no significant effect on eventual adult height and weight. Nevertheless, it is wise for your physician to monitor your child's growth while they are receiving stimulant medications.
In ending this section, remember that medication is never the sole treatment program for AD/HD. What you do after the start of medication, and the other therapy and training he receives along with the medication will determine the lasting benefits. Medication is a very important aspect of a balanced treatment, but it cannot do it all.
Ensuring Appropriate Educational Assistance
It's no wonder an AD/HD student has problems with school. Nowhere else is your child required to concentrate so long in the face of so many powerful distracters. Students must learn class routines, conform to teachers' rules and inhibit their impulses to do otherwise. And they must control their body movements, maintain an appropriate level of arousal and delay gratification until report cards are issued. You can see why the AD/HD child experiences so much frustration and failure at school. This also explains why it is often the classroom teacher who raises questions that bring about referrals for an evaluation for AD/HD.
Unfortunately, while the teacher knows your child has a problem, he or she may not realize the problem is AD/HD and may not know what to do about it. Consequently, it may be up to you to initiate a thorough assessment and treatment plan, including seeing that some modifications are made in your child's learning environment.
 Continued on Page Five
|
