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Medications
Attention Deficit Hyperactivity Disorder - ADHD is often treated with stimulant medications such as Ritalin®, Dexedrine® and Cylert®. A recent study states that an estimated 3 million children with Attention Deficit Disorder - ADD are taking Ritalin® which is double the number in 1990. You will find information on how these medications are used as well as their side-effects. You will also find information on other medications used to improve behavior, mood and learning in children and teens.
Parents of children with Attention Deficit Disorder - ADD need to have full information. Alternatives to medication will be covered as well. A protocol for prescribing these medications is provided for physicians. The information is based on the latest research and guidelines related to the use of medications in the }treatment of Attention Deficit Disorder.
Stimulant Drugs
Overview
The history of stimulant drug use dates back to the discovery by Bradley in 1937 of the therapeutic effects of Benzedrine® on behaviorally-disturbed children. In 1948, Dexedrine® was introduced, with the advantage of having equal efficacy at half the dose. Ritalin® was released in 1954 with the hope that it would have fewer side effects and less abuse potential. Although initially used as antidepressants and diet pills, stimulant drugs are not used for these purposes today.
In 1957, Laufer described the "hyperkinetic impulse disorder," which he believed was caused by a maturational lag in the development of the central nervous system. He asserted that stimulant drugs were the treatment of choice for this disorder and postulated that they acted by stimulating the midbrain, placing it in a more synchronous balance with the outer cerebral cortex. This was an oversimplification but the exact mechanism of action of these drugs is still unknown.
The most frequently used of the stimulant drugs is Ritalin® followed by Dexedrine®, Desoxyn®, Adderall®, and Cylert®. Dexedrine®, Desoxyn®, and adderall® are amphetamine preparations. Ritalin® and Cylert® are non-amphetamines. Cylert® works differently than the other drugs, taking 2-4 weeks before therapeutic effects are noted. Also, due to its potential for causing serious liver function problems, Cylert® should not be used as the first drug of choice to treat ADD. It should be used only after the trial of several other stimulants. SEE FDA WARNING. Also, recent studies and clinical experience is beginning to favor the use of Adderall® over Ritalin® in treating children and adolescents with ADHD. For more discussion of this issue, we refer you to a recent article in the Doctor's Guide to Medical & Other News.
Mode of Drug Action
It is postulated that the stimulant drugs act by affecting the catecholamine neurotransmitters (especially dopamine) in the brain. Some believe that ADD develops from a dopamine deficiency which is corrected by stimulant drug treatment. Recent research indicates that there is a group of individuals (up to 10% of the population) that have a lowered number of dopamine receptor sites. These individuals may exhibit ADD symptoms and are also prone to drug and alcohol addiction. At one time it was felt that the stimulant drugs created a paradoxical (opposite and unexpected) reaction (calming and sedation) in ADD youngsters and that this response was diagnostic. This is no longer believed to be the case as the response to stimulant drugs is neither paradoxical nor specific. Children with conduct disorder and no evidence of ADD may also respond to these drugs. Likewise, studies with normal and enuretic (bedwetting) children have shown that many experience a calming effect rather than the expected stimulation.
Because of their relative safety, the stimulant drugs remain the treatment of choice for many children diagnosed with ADD. The drugs are unquestionably successful in decreasing hyperactivity, lessening impulsivity and improving attention span in approximately 70% of those treated. As a result of improved interactions with family members, peers, and teachers, the drug-treated children feel better about themselves and self-esteem rises. At the present time, however, there is some controversy as to the degree of learning and memory improvement resulting from the treatment of ADD-children with stimulant drugs. Overall, the ideal approach is one in which the children are involved in psychological treatment methods along with medication. Focus, a psychoeducational program, is an excellent adjunct to medical treatment of ADD.
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