TREATMENT OPTIONS

Stimulants

Myth: Stimulants can lead to drug addiction later in life.

Fact: Stimulants help many children focus and be more successful at school, home, and play. Avoiding negative experiences now may actually help prevent substance abuse, addiction, and other emotional problems later. In fact, 3 of 4 recent studies suggest that such medications may in fact protect children with ADHD from future substance abuse.

Myth: Responding well to a stimulant drug proves a child has ADHD.

Fact: Stimulants allow many children to focus and pay better attention, whether or not they have ADHD. The improvement is just more noticeable in people with ADHD.

Myth: Medication should be stopped when the child reaches adolescence.

Fact: Not so! About 70-80 percent of those who needed medication as children may still need it as teenagers. Fifty percent need medication as adults.

Myth: Stimulant medications may cause fatal heart problems.

Fact: Despite a recent highly publicized anecdote by one coroner, these medications have over 30 years of well-established safety. For children suffering from ADHD, this treatment greatly reduces suffering and improves functioning. For some children with severe ADHD, it is likely to be not just life-enhancing, but even live-saving.

There are several stimulant medications available. The most commonly prescribed stimulants are dextro-amphetamine (Dexedrine), methylphenidate (Ritalin), and pemoline (Cylert). As a class of medications, stimulants are most widely researched and commonly prescribed for children with ADHD, but are also sometimes used to treat other conditions, such as narcolepsy, a sleep disorder.

Stimulant medications typically improve a child=s attention span, ability to follow directions and ability to think before acting. In addition, they decrease distractibility, hyperactivity and excessive motor activity. Initially, the child is given a small test dose that is gradually increased until the symptoms are in control. The dose usually takes effect within an hour, and its effects peak within two to three hours of administration, except for slow-release preparations which peak within four to five hours. Therefore, multiple daily dosages are necessary for consistent response throughout the day.

Side effects of stimulant medications are short-term (lasting about two weeks) after which they usually subside. Such side effects can be corrected by simply lowering the dose or stopping the medication altogether. Side effects include insomnia, weight loss, decreased appetite, abdominal pain, headaches, muscle twitches or tics. In some children, a slowing of growth in height and weight is temporarily noted, but longer-term use does not appear to affect longer-term height or weight.

One of the stimulants, pemoline, can cause liver problems, which in several instances has proved fatal. As a result, it is generally not used as a first-line treatment. When prescribing pemoline, the prescribing physician should obtain baseline liver function tests and then periodically re-test the child's liver function (serum glutamic-oxaloacetic transaminase [SGOT] and serum glutamic-pyruvic transaminase [SGPT]).