ADHD-Medical Management Concepts

15 Apr

Ok, for those of you out there who disagree with using medicine…save your comments for yourself.  I am usually very open minded to people who disagree with me on various topics, but this is an issue I feel have to protect my well meaning parents from.

If you have a child with ADHD and have chosen to go for a non-medical route…more power to you and if it is working well for you, that is awesome.  However, I also have families that have stressed for years because of something they have heard in the media or from their friends and suffered because they didn’t want to place their child on medicine for whatever reason.

Let me first address some of the most common concerns about the medicines:

Won’t They Get Addicted to the Medicine?

Children on ADHD medicines are not addicted and are not more likely to have addictions later in life.

Here is the definition of addiction: “compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly   : persistent compulsive use of a substance known by the user to be harmful.”

ADHD medicine do not form compulsions in children who actually need them and they are not habit forming.  Just like any other medicine, parents will forget from time to time and the only effect they see from missing a dose is that their child’s behavior is not as good that day.  There are no other side effects.

Tolerance is the effect whereby a person develops a bigger and bigger need for a substance in order to develop the desired effect.  While there are times when I do have to increase a dose of medicine it is typically more related to the size of the child increasing and the changing stressors (increasing difficulty, etc) at school that require the increase.

There is no withdrawal symptoms when a person comes off their stimulant ADHD medicines.  In fact, the child comes off their medicine every night and can take weekends or summers off without issues.  By definition, this means that there is no withdrawal.

So, without compulsion and habit, tolerance or withdrawal, there is no single characteristic about these medicines that make them addictive.

As for the question about children with ADHD going on to have more addictions later in life, it seems that this is more related to the ADHD than the medicine and adequate treatment may actually help prevent some of these later behaviors.

I Don’t Want Them to Act Like a Zombie!

I hear this complaint or concern with just about every consult that I see.  Understandably, parents don’t want their children to act differently or have a change in personality because they are on medication.  Guess what? Me neither.  If I were to see personality changes in my patients, I would change their medicine or come up with other treatment strategies.  However, this is a very uncommon complaint.  In fact of my 4 years of practice, I have seen it only twice and both of the parents were extremely worried about this prior to starting medicines, which makes me wonder if they weren’t looking too hard for it.

It is my opinion that this was a bigger problem earlier with the short acting medicines as you saw a more rapid peak and fall than with our newer/better treatment options that allow for a more gentle change the drug levels over the day.

Will This Stunt My Child’s Growth?

While there have been some studies showing a slight decrease in weight and height growth over the first years of starting a medicine but these differences disappear when you recheck the children at 2 and 3 years out from starting medicine.

So, What are the Common Side Effects?

The most common side effects I see from the ADHD medication (primarily stimulants) are loss of appetite and difficulty going to sleep.

Loss of appetite-This symptom typically starts right off the bat and can improve over time.  The child usually has the biggest problem with lunch time as that is the when the medicine is at it’s highest level in the blood stream.  Usually, you can make up for this problem by making sure the child eats a good breakfast and dinner and eats what they can at lunch.  I follow my patient’s weights closely especially when there is a concern about the child’s appetite.

Difficulty with sleep-Occasionally, we will have a child who has a difficult time going to sleep especially when they first start the medication.  My first treatment for this is to make sure that are taking care of doing the right things to help themselves go to sleep: no food or drink with 1-2 hours of bed time, no screens on in the room 1 hour prior to bed time, etc.  If that doesn’t work we can do a trial of melatonin or other options are available if this doesn’t work.

Some more rare side effects that I want to discuss are mood instability and tics.

Some of the medicines are worse that others about this but we will sometimes have a child who is very emotional and tearful when first starting the medicines.  This typically happens in the afternoon or evening as the medication is wearing off.  Usually, with just a period of observation, this will improve after about 1 week on the medicines so I first have my families continue trying for a bit to see what happens.

Tics are involuntary movement disorders that result in a short jerking of the head, lip smacking or some other short, quick motion.  These medicines do not cause tics but in a child who is already predisposed to them for some reason can cause them to become much more obvious and frequent.  If the tics are disruptive or concerning, we will usually need to switch medicine to something else as this does not usually improve over time.

Summary

1) Children do not become addicts because of ADHD medicines.

2) Children do not become zombies because of ADHD medicines.

3) Children do not become short because of ADHD medicines.

 

Here is the full table of contents for the ADHD Series:

ADHD-What is it?

ADHD Behavioral Treatment-8 Tips

ADHD-Medical Management Concepts

ADHD-Medication Types and My Thoughts

Preschool Child with ADHD Symptoms

Why Is ADHD On The Rise?-My Opinions

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