Return to ADDvisor Volume 2 2000 Index 

Number 1 January 1, 2000

1. CHADD’s Homework Heroes

2. 7 WAYS TO IMPROVE YOUR ADHD CHILD’S BEHAVIOR - A Free Teleconference on Wednesday, January 26, 2000, 11:30AM Chicago Time; 12:30PM New York Time

3. Personal Comments

4. ADHD – What Do We Do After the Diagnosis – Medications

CHADD HOMEWORK HEROES

HOMEWORK HEROES, a program developed by CHADD as a fund raiser for the organization is under way. If you are a member of CHADD, you have received a brochure describing the program. What is so special about this program is that it provides an extra incentive for kids to do their assignments and fosters their altruism.

If you want more information, go to www.chadd.org

7 WAYS TO IMPROVE YOUR ADHD CHILD’S BEHAVIOR

To register for this FREE teleconference, send an e-mail to Alan@ADDvisor.com with your name, E-mail address, city and state, phone number, and the ages of your ADHD children. We will send you information along with the special phone number for you to call in to be connected to our conference call. Space is limited to 25 participants.

PERSONAL COMMENTS

"Things which matter most must never be at the mercy of things which matter least." Goethe

I’m sure with you, as it is with me, one of the things that matters most is your children. As the parent of an ADHD child or adolescent, you have to work extra hard to get to where you want to go. As this new year begins, I wanted to be sure to take time to commend all of you for all of the hard work you are doing on behalf of your ADHD child. Many others don’t realize the endless time, energy, and effort you put into parenting. You are to be commended for your continual searching for what will help your child and your family. Your reward will come (really it will) in seeing your child master the hurdles he/she faces and seeing their growing sense of mastery, satisfaction, and pleasure. Keep up the good work!

ADHD – WHAT DO WE DO AFTER THE DIAGNOSIS – MEDICATIONS

For the full report by the Surgeon General, go to:

http://www.mentalhealth.org/specials/surgeongeneralreport/home.html

The use of stimulant medications in the treatment of ADHD has been called, by  the National Institute of Health, "the mainstay in the contemporary management of ADHD." Although it has not always been the case, stimulant medication is now the first treatment of choice for individuals with moderate to severe ADHD symptoms.

There are four types of stimulant medications most commonly prescribed for the treatment of ADHD; Ritalin (methylphenidate hydrochloride), Adderall (amphetamine composite), dexedrine (dextroamphetamine) and Cylert (pemoline). Most recently, Cylert has been indicated to have the potential for serious liver toxicity or even liver failure despite the careful following of recommended periodic liver enzyme studies. This problem has prompted it’s manufacturer (Abbott Labs) to issue a warning for its use. This problem has made Cylert a fourth choice medication.

Each of the stimulant medications acts on the brain in a somewhat different manner. According to Zametkin, "Stimulants are all very different drugs. People respond differently on each medication because each affects the brain and nervous system differently." Meaning, that is the individual does not have the desired response to one stimulant medication, it is worthwhile to try another.

How do these medications work? In ADHD, norepinephrine and dopamine are thought to be released in deficient quantities within the prefrontal cortex of the brain. This impedes the transmission of impulses important for attention, concentration, impulse control and appropriate activity level. All of the stimulant medications act to increase the availability of neurotransmitters, dopamine and norepinephrine, thereby normalizing brain function (Copeland, 1995). As indicated in a recent article in the Journal of the American Medical Association (JAMA, 1998), and contrary to theories developed much earlier, the response to stimulant medications in those with ADHD is not "paradoxical". The types of changes in behavioral measures in those with ADHD and those with conditions other than ADHD (e.g., learning disabilities, depression) and normals is the same. Therefore a favorable response to stimulants does not confirm the diagnosis of ADHD.

This article goes on to say about the medications’ effectiveness: "Medications have been unequivocally shown … to reduce core symptoms of hyperactivity, impulsivity, and inattentiveness. They improve classroom behavior and academic performance; diminish oppositional and aggressive behaviors; promote increased interactions with teachers, family, and others; and increase participation in leisure time activities." There have been more than 170 studies involving more than 6000 school-aged children using stimulant medication for ADHD. Up to 90% of children will respond positively to at least one stimulant medication without major adverse effects if drug titration (adjustment) is done carefully. Part of this careful adjustment should include follow-up evaluations with teachers and parents one to two weeks after each new dose level has begun. If significant, positive change is not evident a new dose level should be tried. Because of their broad range of positive effects (e.g. social and behavioral), it is strongly recommended that medication be administered seven days a week.

There can be a down side to using stimulant medications. Their common side effects include; insomnia, decreased appetite, headache, irritability, and stomach ache. Another inconvenience of stimulant use is their relatively short period of effectiveness, about 3-5 house in most cases. This means that mid-day doses are required in most cases. Finally, most people don’t realize that the stimulant medications are classified as a "Schedule II controlled substance" with legal restrictions on usage and prescription renewal. This means a written prescription is necessary from the physician. Therefore, the medication cannot be called into the pharmacy. Parents who do not know this can be frustrated by insufficient planning ahead for refills.

What about the statements that we sometimes hear about the possible over use of the stimulant medications? Perhaps the easiest way to analyze this is to look at the prevalence of the disorder and to compare it to the prevalence of prescriptions. Most national surveys indicate that the prevalence of ADHD in the population is around 5%. National surveys also indicate that stimulant medications are being prescribed to approximately 3% of US youth between the ages of 5 and 18 years. The over use notion is false. A recent national study found no evidence of over diagnosis of ADHD or over prescription of stimulant medication.

Although medication is often the first treatment recommended, it is only effective enough in a small percentage of cases to be the only needed treatment. I call the problems not helped by medication "leftovers". Leftovers can be dealt with in a number of ways including; behavioral therapy, parent education, parent management training, classroom environmental manipulations (special classes, special seating, etc.), daily report cards, individual psychotherapy for co-occurring depression, anxiety, and low self esteem and parent support groups. All of these and other possible interventions will be explored in the next article.

CONTACT INFORMATION

_______________________

Alan R. Graham, Ph.D. 

Bill Benninger, Ph.D.

ADDvisor.com

Voice: 1-866-ADDvisor

Fax: 847-824-2386

Email: Alan@ADDvisor.com

Bill@ADDvisor.com

Web: www.ADDvisor.com

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