Raising Kids:

Parenting Skills for the 21st Century

ADHD and Medications

It is important for me to offer a disclaimer up front on this page. I am not a doctor or a psychologist nor have I consulted with a doctor or a psychologist in writing this page. The details provided here on ADHD and medications are from my personal research and experience with my own children.

As with all of the content on this web site, the primary focus is providing advice from one parent to another.

ADHD stands for Attention Deficit Hyperactivity Disorder and is a diagnostic label given to children and adults who have significant problems in four main areas:

Inattention, Impulsivity, Hyperactivity and Boredom.

Some physicians and psychologists believe ADHD is a medical condition, caused by genetic factors that result in certain neurological differences in children.

ADHD is controversial for the following reasons:

1.      There are no medical tests to diagnose ADHD.

2.      Some physicians believe there is insufficient evidence of an underlying neurological condition.

3.      Some physicians believe the diagnostic criteria are too broad.

Below are characteristics of the disorder as observed by doctors who study it: 

1. It is seen in most situations, not just at school, or just at home. When a problem is seen only at home, some would suggest the child may be depressed or non compliant with the parents.
2. It is apparent before the age of seven – as it is thought to be a neurologically based disorder, it should be present from birth. The problem is believed to become more evident by the second or third grade when school work becomes more demanding but one would expect at least some symptoms to be noted before the age of seven.
3. It is not related to IQ. Children diagnosed with ADHD may have all ranges of IQ. Often times because they do not perform well in school, they are incorrectly labeled slow, or low IQ.
4. It affects roughly 5% of children and 3% of adults. You may see reports that state as high as 10-25% of children are affected, but these numbers are not really supported by research data and are probably inflated for the purpose of trying to sell you something.
5. Most children outgrow its symptoms by their 20’s. For a large number of children the effects begin to diminish after puberty and may disappear completely by the age of 20.

Diagnosis: There is no one "test" for ADHD. However, an experienced clinician can see how a child behaves during various tasks, some of which demand concentration and focus, and some that do not. Likewise, there are good tests for distractibility, which also goes with ADHD. And most importantly, an experienced clinician can observe a child in the classroom, talk with his/her teachers and parents, and get a good sense of a child's behavior.

Medical Treatment:  The most common medical treatment takes one of two forms.

1. Stimulants (such as Ritalin, Dexedrine and Cylert).  Doctors who prescribe stimulants for ADHD claim that it increases the ‘drive’ to accomplish as much as possible during the school period and to complete homework and that speed of comprehension and accuracy of performance are increased in most cases.
2. Antidepressants (such as: Imipramine, Tofranil TM and Desipramine). Doctors who prescribe these drugs do so to treat mood symptoms or if a child does not respond to stimulants. They are thought to be less helpful than stimulants for cognitive functions (ex., concentration) but may be better for behavior and mood in some children.

Drug Side Effects: All medications have side effects. Side effects of stimulants may include trouble sleeping, decreased appetite, “rebound” (a condition where exaggerated hyperactivity, irritability or moodiness return as the stimulants wear off), mood changes, headache, nausea and abdominal pain. Less common side effects include slow growth rate, depression, fatigue, lethargy, acting withdrawn or apathetic and in rare cases induced thought disorder.

Non Medical Treatments are often used to treat affects that are separate from the ADHD itself but often trouble children who have ADHD. Examples of these problems are learning disabilities, low self-esteem or depression, anxious feelings, problems making and keeping friends, negative or angry behaviors, and conflicts with parents. Some Non-Medical Treatments:

1. Common sense measures such as getting a good night's sleep, eating well, and keeping unnecessary stresses to a minimum, certainly help children with ADHD to feel and function better.
2. Behavior therapy or behavior management: It based on several simple and sensible notions about what leads children to behave in socially appropriate ways. One reason is that children generally want to please their parents and feel good about themselves when their parent is proud of them. When the relationship between parent and child is basically positive, this is a very important source of motivation. A second reason that children behave appropriately is to obtain positive consequences for doing so (i.e. privileges or rewards) or to avoid the negative consequences that follow inappropriate behavior. The goal of behavior therapy, therefore, is to increase the frequency of desirable behavior by increasing the child's interest in pleasing parents and by providing positive consequences when the child behaves. Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs.
3. Exercise: Studies show that exercise increases levels of two key brain chemicals — dopamine and norepinephrine — that help people focus and improve cognitive function for one to three hours after exercise.  What’s more, team sports may help children with ADHD because they benefit from following a regular schedule and coaching builds concentration and organizational skills.
4. Limiting Television, Computer and Video Games.  A study in 2004 found that infants and toddlers who watch a lot of television are more likely to have trouble concentrating in their early school years. According to one study every extra hour of TV significantly raised the odds of having problems with attention.
5. Diet restrictions: Diets which cut out artificial colors and flavors, as well as some naturally occurring substances, have been used and closely studied. Unfortunately, only one or two children out of a hundred, on average, really respond to the diet.
6. Sugar avoidance: Many, many parents report that sugar makes their children hyper, but no well-done study has shown that cutting out processed sugar effectively treats ADHD. Bottom line: Common sense says children with ADHD (and everyone else) should eat sugary foods in moderation.
7. Herbs and other dietary supplements: Various herbs, such as valerian or gingko, claim to calm the nerves or increase attention.
8. Traditional medicine: Before the 1900s, hyperactivity wasn't recognized as a problem. Therefore few traditional healing systems such as acupuncture have treatments for it.
9. Self-regulation techniques: Biofeedback and self-hypnosis are effective treatments for many childhood behavioral and medical problems. For example, self-hypnosis is as effective as the most widely prescribed drugs in treating migraine headaches. But the research for ADHD is less encouraging. Biofeedback using brain waves recorded from the scalp does seem to help in some cases, but treatment usually takes a long time, and there isn't enough good research to show that the technique really treats the underlying ADHD.

Summary:  ADHD is a serious disorder, which can have major consequences for learning and social skills. However, ADHD is probably grossly over diagnosed and many children are probably needlessly medicated because a pediatrician or social worker believes that a child who fidgeted in class must be ADHD. All too often, diagnoses are made by practitioners who are not qualified and have little real training and experience in working with ADHD children. Likewise, medication is often prescribed by doctors, who dole out pills and then do no follow-up. Many times, a physician will prescribe medication for ADHD without even checking with a child's school teacher to get her impressions of the child's behavior. Because there is no monitoring of a child's behavior, nobody knows if the medication is really effective.

ADHD should be carefully diagnosed, by an experienced and qualified professional. The diagnosis should be based on data gathered from a number of different sources (tests, behavioral observations, teacher reports, parent reports). The disorder should be closely monitored, especially if medication is prescribed. And teachers and parents should be given concrete strategies for helping the child.

The question is a deeply personal one. You owe it to your child to have them thoroughly evaluated by qualified professionals and to get second and third opinions before resorting to medication.

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