Children, ADHD and Stimulant Medication
A lot of controversy continues to swirl around the issue of ADHD and stimulant medications, such as Ritalin, Adderal and others. Parents worry about such things as their children suffering liver damage, addiction to stimulants, stimulant abuse or becoming involved in the use of illicit drugs as a result of using stimulants. These worries are not unrealistic. However, the dangers must be weighed against the potential benefits of stimulants in treating ADHD. In addition, the consequences of ADHD going untreated are also potentially dangerous. A new study support the fact that these medications are enormously beneficial for youngsters with this disorder.
The results of the research was published in a "Pediatrics," 2009; volume 124:pages 71-78. The title of the article is, "Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study."
This piece of research used the longitudinal method. The term longitudinal means subjects were followed over a ten year period. According to the authors, all the studies until now have been short term.
The authors were particularly interested in whether the medications would help prevent disorders associated with ADHD. For example, those with ADHD often develop such problems as: Major Depression, Multiple Anxiety Disorders, Conduct Disorder, Oppositional-Defiant Disorder or bipolar disorder and being held back in a grade due to poor academic performance. All of these are known as comorbid conditions of ADHD. In other words, left untreated, ADHD children are at risk of developing one of the diagnoses.
Subjects for the study were 140 youngsters, all with the typical symptoms of ADHD. They were followed 1, 4 and 10 years later. Ninety two subjects received stimulant medication while 39 did not. Those who did not had parents who refused medication treatment. On average, the medication group used stimulants for at least a six year period.
The researchers concluded that there is a much lower risk for developing comorbid disorders in the medication group with one exception, and that was Bipolar Disorder. This is probably due to the fact that BPD has very different causes at its roots.
There are psychiatrists who report that while many parents are reluctant to use stimulant medications they should at least give it a try. The "handy rule of thumb, they suggest, is that if a child improves academically and socially , its a good sign that the medication is helping.
Dr. David Rosenthal, MD and Psychiatrist in the Boulder Colorado area, is an expert on ADHD in children and adults. In an interview, he stated that many of the prison inmates with whom he worked in the past were people who should have or could have a diagnosis of ADHD. However, they had never been treated for the condition and, in his opinion, might not have become criminal if they had been diagnosed as children and received stimulant medications. He also reported that, in his work with ADHD children, there often a dramatic improvement in their behavior and academic achievement.
I would add to this my observation that, along with medication treatment, a specialized psychotherapy focused on skills development is enormously important. The important types of skills that need to be acquired by these children are such things as listening skills, impulse control or learning to delay gratification, thinking or cognitive skills, organizational techniques, taking notes in school and focusing attention, among others. There are psychologists and social workers who use particular coaching methods with ADHD children and adults.
Many of the comorbid conditions associated with ADHD result from both failure at school as well as frustration and a loss of self esteem and self confidence. It then becomes easy for children and teenagers include themselves with other children and form anti social groups who turn to drugs and alcohol by the time they get to secondary school For many of these youngsters, that then marks the start of what can become a criminal career. All to often, the criminality is the result of involvement with drugs. The same can be said for those who tend more towards depression and self hatred.
In my experience working with adults with ADHD is that there is a high incidence comorbid Major Depression. Dr. Rosenthal has stated to me that this stems from the deep sense of disappointment people with ADHD struggle with throughout their lives. It is difficult for them to feel good after they have been repeatedly told by teachers and loved ones that they are lazy, thoughtless, uncaring and unmotivated.
It is important to know that one of the symptoms that is part of ADHD is a lack of motivation. I do not believe the exact reason for this is known as yet. Also, low motivation is something that varies from one ADHD individual to the next. Suffice it to say that, by the time someone reaches adulthood without treatment, it is very natural for depression to set in.
Your comments, questions and experiences are encouraged.
Allan N. Schwartz, PhD.