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Treatments for attention deficit hyperactivity disorder.

Editor's note: "The double-blind, placebo-controlled study" described in this excerpt for use of psychostimulant medication is a clinical method that can usually be used to evaluate any medication desitned to change behavior.

Once a child has been appropriately diagnosed as possessing attention deficit hyperactivity disorder (ADHD), one or more treatments may be attempted. Although most research suggests that a combination of treatments is most effective, it is important to understand that no treatment approach is thought to "cure" ADHD. Rather, with the right combination of treatments, the frequency, intensity and duration of problems associated with ADHD may be reduced.

What treatments are available to help the child with ADHD?

The most comon treatment for ADHD is, and has been for some time, psychostimulant medication. There are many types of such medication; the most commonly used is methylphenidate, often referred to by one of its trade names--Ritalin. Other psychostimulant medications include d-amphetamine (or Dexedrine) and pemoline (or Cylert). Such medication is thought to exert is beneficial effects by simulating the brain areas that enable a child to sustain attention, delay impulsive responses, control motor activity and plan behavior.

Is it true that psychostimulant medications are mind-altering drugs?

The answer is yes, but only in terms of activating the attention, body movement, organization, motivation and planning ability centers of the brain. Psychostimulants are definitely not mind-altering drugs in terms of changing one's personality or one's perception of reality. In other words, although psychostimulant medications may help a child to better focus his attention, delay impulsive responding and organize himself in a more efficient manner, they do not casue him to experience distortions of reality.

If these medications are stimulants, why do they seem to claim children with ADHD?

Although the medications frequently given to children with ADHD are psychostimulants, they do not increase the child's activity level. Indeed, because these medications appear to have a claiming effect on such children,, some have called their effects paradoxical. However, in reality there is nothing paradoxical about the effects of psychostimulants on children with ADHD. This becomes clear when one recognizes that the psychostimulants primarily affect the areas of the brain that support focused attention, planning and organization. When the child with ADHD becomes better able to focus her attention and plan her behavior, she will appear less distractible, less impulsive and less disorganized. All of these changes will result in a decreased activity level--after all, if she is glancing around the room less, is better able to resist impulses to get out of her seat and is more organized in her efforts, she will be less physically active than if she is looking around, moving about and behaving randomly. In fact, recent studies have shown that children without ADHD are affected in exactly the same way by psychostimulants as are children with ADHD. That is, children without ADHD are also better able to focus attention and organize behavior when on small doses of psychostimulants.

Are you saying that my child will be fine once he takes the medication?

The answer is maybe. It appears that the psychostimulant medications are helpful for temporary control of ADHD symptoms but may not be helpful in the long run. In other words, psychostimulant medication seems to be effective for the immediate management of children with ADHD, but it may not be helpful in preventing future social and academic difficulties. One reason that the medication may not enhance future adjustment is that taking medication does not teach a child any skills; it only helps him to pay attention, as well as to control and plan behavior.

How do I know whether medication is the right treatment for my child?

After your child has received a comprehensive evaluation and been diagnosed as having ADHD, she may be referred to a physician to determine the appropriateness of the use of psychostimulant medication. Remember, only a physician, such as your child's pediatrician, can decide whether your child should be placed on psychostimulant medication. If so, the physician will ultimately be responsible for managing the medication treatment. Medication is generally not prescribed for children have not been well established. If medication is recommended, the physician should first give it on a trial basis to determine whether it is helpful and, if so, what the proper dosage is.

How exactly does the physician conduct this trial?

One popular means for conducting this trial is a double-blind, placebo-controlled study. By using this method, a physician can evaluate impartially whether psychostimulant medication is an appropriate treatment for a child with ADHD. The procedurers used in this kind of study are somewhat complicated and should be directed by the physician prescribing the medication, often with the aid of a psychologist. Most physicians typically do not perform double-blind, placebo-controlled studies because they are time consuming and require specialized knowledge. For this reason it is often helpful to have a knowledgeable psychologist involved--to help ease the time demands on the physician and to help coordinate and implement the procedures.

In a double-blind, placebo-controlled study the child with ADHD is given the psychostimulant medication on some days, whereas on other days she receives a placebo, a pill containing no medication at all. The child, her parents and her teachers will not know on a given day whether the medication or the placebo is being taken; only the physician (and psychologist, if one is involved) will have this information. Both the parents and the teachers then make daily ratings of the child's behavior. In addition to these behavioral ratings, certain psychological tests, which measure attention span and impulsivity, can be used to monitor the effectiveness of the medication. If the medication is helpful, the daily behavior ratings and the psychological tests will show improvement primarily on the days the child takes the psychostimulant medication, as opposed to the placebo. If the medication is not helping the child, either there will be no improvement regardless of the type of pill she takes or there will be an equal amount of improvement when she takes the medication and when she takes the placebo. The physician may also use different medication dosage in a double-blind fashion to determine the most appropriate dosage for a particular child. A double-blind, placebo-controlled study is useful in evaluating the effects of psychostimulants show immendiate effects, unlike certain other medications that show their effects only after some time has elapsed.

Can medication make children "crazy" when they are older?

There has been much recent debate about whether medications such as Ritalin cause future emotional or behavioral difficulties. Research has not substantiated such harmful future effects, although harmful effects have been reported in some cases when medication was administered in excessive doses over long periods or when medication was prescribed to children who should not have been receiving it. For instance, highly anxious children or those with muscular ties may not be particularly good candidates: Psychostimulant medication has been shown to be less useful with such children, and in some cases it may even aggravate their anxiety or muscular tics. Some alro believe that children with seizure disorders or epilepsy should not be prescribed psychostimulants because such medications may increase seizure activity. Another indicator against the use of psychostimulant medication is the presence of certain mental disorders such as thought disturbances. In addition, psychostimulants can interface with the activity of other medications; other medications, such as antihistamines, can also alter the effectiveness of psychostimulants. Be sure that your child's physician carefully rules out these indicators before prescribing any medication.

Should my child's medication treatment be monitored regularly?

Yes. The physician should be kept informed of any side effects, as well as observable benefits, that you think your child is experiencing. In addition to your regular reports, the physician can use a double-blind, placebo-controlled study to monitor the effects of the medication about every 12 months. Such re-evaluations are necessary because a child's attentional and self-control abilities may improve over time. Such improvement may lessen the need for continued psychostimulant treatment. Also, as children mature, they gain weight. Because the effects of psychostimulants are, to some extent, influenced by body weight, adjustments in the medication dosage may ber needed as your child becomes heavier.
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Title Annotation:book excerpt
Publication:The Exceptional Parent
Article Type:Excerpt
Date:Sep 1, 1993
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