Medication

The Ritalin debate is as controversial in the field of AD/HD as the MMR vaccination is in the field of autism. There are few subjects within AD/HD more likely to create a heated debate than medication and whether or not we as parents should 'drug' our children. From reports of stunted growth, smaller brains, the likelihood of drug addiction in later life, even death, Ritalin and the use ofmedication for AD/HD children has had some bad publicity. The vast majority of people who have AD/HD use some form ofstimulant medication for their disorder and Ritalin has been in use for over forty years. However it is far more evident nowadays, due to both media attention and the increase in diagnoses of AD/HD.

Whilst I personally feel that it is our duty as parents to explore every avenue open in order to help our children, and so have undertaken many interventions and therapies in a bid to help Joe and his brothers, the nature of AD/HD and the severity of Joe's symptoms mean that he is extremely impulsive. When he wants to do something he does it without any regard whatsoever to the consequences. This includes eating any available 'off limit' foods. As I have mentioned before, I didn't just simply try dietary intervention with Joe, I threw mind, body and soul into researching it and implementing it to the last letter.

Dietary intervention has and does work and at the risk of being a diet bore (OK, I make no apologies for the fact that I am), dietary intervention is an important part of the way forward with many children. I have outlined the steps I took before trying medication. I tried everything possible before I trialled medication with Joe. For me that was the right thing to do because I would have always wondered if I had missed anything and if there was a way I could avoid medication. People's comfort levels differ with different interventions and whilst one parent may be quite comfortable with the notion that their child needs medication, they may not be so comfortable at the idea of restricting whole food groups. For me, I needed to be sure there was no other way before I felt a duty to Joe and us all, to trial medication. As a parent, you know your family situation, yourself and your child best and must do what is right for all of you.

One thing I will say about medications used to treat the disabling bits of AD/HD (there are many good bits that need understanding rather than treating) is that they vary from person to person. What works for one child may not work for another and the dosage for one child won't necessarily be the same for each child. As parents, none of us make the decision to try medication lightly. For me and I am sure, many others, it comes after years of other interventions, some helpful and some not, and after years of despair. Whilst medication is certainly not a cure, it can be used to great benefit and can provide windows of opportunity in order for all involved to work with the child and reverse the spiral of negativity. Research has shown that medication combined with behaviour modification and therapy is the most effective treatment for AD/HD.

Whilst battling through my own feelings of inadequacy as a parent, I saw medication as the very last choice. I had images of turning my bouncy little Tigger into a miserable, zombified Eeyore... I was wrong! Joe says that without his medication he keeps all the words people speak in his head and they bounce around and jumble up, but once he has taken his tablet the words go in properly and he understands them better. The difference medication has made for Joe has been tremendous. I still have my loveable little livewire who does crazy dances at 4am, but we now have the chance to work hard together in order for Joe to learn to recognize that there are consequences to his actions, and to work on his behavioural schemes that are so important. Joe's self-esteem has been increased tenfold and the whole family is benefiting from this new and improved Joe. I deliberately didn't tell the school for two weeks when he started so that I could know for sure whether they truly saw a difference in him. Two weeks after starting his medication, Joe won his first ever certificate at school for 'star of the week for improved concentration' - proof indeed.

The day I returned home from the consultant, clutching my prescription for Concerta, I was a turmoil of mixed emotions. Part of me was (and still is) eternally grateful for the fact that Joe's consultant had taken seriously the problems that Joe was evidently experiencing. He had read the psychologists' and school reports, watched Joe for himself and didn't hesitate in agreeing to trial some medication for a month. I was one of the lucky ones and I knew it. For a parent to reach the point where he or she feels the need to try out some form ofmedi-cation is hard enough in itself, but to then need to fight to prove that to doubting professionals can be devastating. Conversely, there are parents of children with symptoms of AD/HD who have not reached that point, or have other reasons for not wanting to use Ritalin for their child, and yet some schools are insisting that they must do so. Ultimately as a parent, it is your choice and only you and your family know your situation. If a consultant is unwilling to prescribe medication then seek advice from support groups and other parents and ask for a referral to an AD/HD friendly consultant. There are a lot of misinformed professionals around but there are also some very good ones.

MEDICATIONS USED TO TREAT AD/HD

Much research suggests that the brains of individuals with AD/HD have depleted levels ofthe neurotransmitter dopamine, resulting in an inability to utilize some brain functions correctly. It would seem logical, therefore, that to supplement the brain with the missing dopamine by using stimulant medications would rectify the problem. If only life were so simple!

Whilst I am certainly not a doctor, and advice about medication and other medical matters should most definitely be given by a medical expert, I thought this table may be of some use to those of you going through the anxious process of deciding whether to try medication to help your child, or those of you who have children on medication and yet feel that their medication needs a review. I make my humble apologies to any doctors reading this, and stress again that I am merely a parent, trying my best to make life easier for other parents like myself. I am aware that medications, dosages and research are being updated regularly (well at least I hope so!) and am not professing to know more than you, but a quick checklist is likely to benefit parents and enable them to feel empowered by some small degree of knowledge before consulting an expert.

To all parents considering medication or struggling with their child's current medication, remember that just as each medication is a slightly different preparation, just as each of our children is unique, so too will the effects the medication has on each child differ. Whilst reported side-effects obviously have to be listed, it does not necessarily mean that your child will experience all, or even any of such side-effects. As I have said before, in my opinion, a multi-model approach to intervention is the best way forward, medication being an option that some, but not all families and professionals may take in conjunction with other interventions.

Medication

Dosages

Possible

Advantages

Disadvantages

Side-effects

Ritalin

5mg, 10mg,

Stimulant

Short lived so it is

Only lasts for up to

Methylphenidate

20mg tablets

side-effects:

out of the system in

four hours so 'highs

- Central

Restlessness,

four hours or less if

and lows' are

Nervous System

insomnia, trouble

undesirable effects

experienced as the

(CNS) stimulant

falling asleep,

are experienced.

dose wears off.

appetite loss,

Tablets can be

Necessitates

headaches,

broken and dosage

lunchtime dose so

stomach ache,

adjusted more

children have to

dizziness,

readily.

either remember or

irritability,

be singled out, or

emotional

be reminded to take

sensitivity, tics,

it. Potential for

nervous habits.

abuse.

Ritalin SR

20mg tablet

As with Ritalin

Reduces the 'highs

Lasts longer than

and other

and lows' of

ordinary Ritalin so

stimulants.

ordinary Ritalin.

effect takes longer

Eliminates the need

to wear off, even if

for lunchtime dose

undesirable.

and evening dose.

Only lasts around

Ritalin LA

20mg, 30mg,

Ritalin LA capsules

six hours so for

Methylphenidate

40mg

can be opened and

those who

- CNS stimulant

capsules

sprinkled on food.

metabolize

medication quickly

evenings can still be

problematic.

Concerta

18mg, 36mg,

As with Ritalin

Lasts for up to

Long lasting effect

Methylphenidate

54mg and

and other

twelve hours so no

even if it is an

- slow release

newly

stimulants, though

need for 'top up

undesirable one.

released

appetite problems

dose'. Eliminates

Cannot be broken

27mg tablets

seem to be

'highs and lows'

or taken by children

reported less

associated with

who chew tablets.

frequently

Ritalin.

Can cause

difficulties getting

to sleep.

Metadate

20mg tablets

As with Ritalin

Another long acting

Same disadvantages

Methylphenidate

and other

form of

as other long acting

- CNS stimulant

stimulants.

methylphenidate so

stimulants. Drug has

eliminating need for

a peak level after

top up doses.

1.5 hours and

Capsule form so can

another at 4.5

be sprinkled on

hours so some

food.

'highs and lows'

can be experienced.

Dexedrine

Dextroamphetamine sulfate

5mg, 10mg, 20mg tablets

Agitation, irritability, insomnia, palpitations, dry mouth, tremor.

As with Ritalin, Dexedrine lasts for three to four hours so is out of the system fairly quickly if problematic.

Potential for abuse. Not recommended for those with anxiety or tics.

Adderall

Mix of four amphetamine salts

5mg, 10mg, 15mg, 20mg, 25mg, 30mg tablets

Possible growth inhibition. Caution needed for patients with even mild hypertension.

Adderall XR comes in a capsule form so can be opened up and sprinkled on foodstuffs for children who cannot swallow tablets.

Not available in UK. Not recommended for those with family history of tics or Tourette's Syndrome.

Tofranil

Imipramine Tricyclic antidepressant

10mg, 25mg tablets

Blurry eyes, dry mouth, constipation, fatigue and rapid heartbeat.

If given before bedtime it may induce sleep. Reduces anxiety. Used to treat bedwetting.

Takes at least two weeks before any benefits are seen. Small possibility of potential adverse effect on heart conduction systems and rare reports of liver and bone marrow toxicity.

Clonidine Catapres

Anti hypertensive medication

0.1mg, 0.2mg, 0.3mg tablets

Patches

TTS-1 TTS-2 TTS-3

Sleepiness (usually subsides within two to three weeks), dry mouth, nausea, nightmares, lowering of blood pressure, constipation.

Used if anxiety is a problem. Can cause sedation so is useful for sleep disturbances. An alternative to stimulant medication. Helpful for co morbid tic disorders or severe aggression.

Withdrawal must be undertaken gradually and under medical supervision. Sedative effect may not be desirable.

Strattera atomoxetine

10mg, 18mg, 25mg, 40mg, 60mg tablets

Decreased appetite, dizziness, upset stomach, insomnia, light-headedness.

An alternative if stimulants are not effective or are not the preferred choice. Not a controlled substance.

Contraindicated for those with high blood pressure or tachycardia. Can increase side-effects of asthma medication.

Parenting Teens Special Report

Parenting Teens Special Report

Top Parenting Teenagers Tips. Everyone warns us about the terrible twos, but a toddler does not match the strife caused once children hit the terrible teens. Your precious children change from idolizing your every move to leaving you in the dust.

Get My Free Ebook


Post a comment