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Deciding to Use Stimulants for Treating ADHD
Stimulant treatment begins as a "trial," so you and your parents should tell the doctor regularly about improvements, such as handling school tasks better, and any side effects. The most common side effects are nervousness, sleep difficulty, and appetite loss. Less common are skin rash, nausea, dizziness, headache, weight loss, and blood pressure changes. Immediately report such serious effects as confusion, breathing difficulty, sweating, vomiting, and muscle twitches, which may signal too high a dose.
With this information and further examination, the doctor can determine the most effective dose that causes no, or only tolerable, side effects.
Patients who need stimulant medicine only for paying attention may not need it at all during weekends and summer vacations. If their difficult subjects are in the morning, a morning dose may be enough most days. Other patients need stimulant medicine much more often.
Stimulants are not for everyone with ADHD. For example, they shouldn't be used in someone with marked agitation, a twitching known as a tic, or the eye disorder glaucoma.
And like all medicine, stimulants pose risks. Whether to use stimulants is a case-by-case decision based on how the benefit stacks up against the risk.
In January 1996, FDA announced that in studies of rodents given methylphenidate, the drug produced a "weak signal" for the potential to cause liver cancer. The cancer occurred in male mice but not in female mice or rats. At FDA's request, Ciba-Geigy informed doctors and, along with other methylphenidate manufacturers, added the findings to their drugs' labeling.
Accompanying health problems like depression may require other medicines or psychotherapy.
"Individual therapy for ADHD may not be helpful," Sharp says. "Probably the most beneficial treatment for ADHD involves the entire family system, and behavior management is usually a large part of this treatment."
Some people have linked ADHD to sugar and food or color additives. "Research in this area has raised questions and contributes to understanding," says Catherine Bailey, an FDA science policy analyst. "But the idea that individual food substances cause ADHD is unproven. Still, if people want to avoid substances they perceive as problems, they should be sure to read food labels."
Moving Forward
Scientists don't know exactly what causes ADHD, but it tends to affect several in a family. When an identical twin has ADHD, the other usually does, too. Sharp had recruited twins for research to help clarify this.
While more males than females have ADHD, the gender gap is narrowing. Males taking medicine for the disorder outnumbered females 10 to 1 in 1985 but only 5 to 1 in 1995, the authors of the 1996 Pediatrics article stated.
Probably the hardest part of having ADHD is accepting the diagnosis, Quinn says. She stresses the importance of looking at everything else that's good in your life.
"The disorder is part of who you are and, yes, you have to control it," she says. "But it doesn't define you. It's okay to have attention disorder, so long as you know what to do about it."
Dixie Farley is a staff writer for FDA Consumer.
Helping Yourself
The first step toward dealing successfully with ADHD is to learn as much as you can about the disorder, the pros and cons of stimulant treatment, and strategies for self-help.
If you have ADHD, self-help skills can be critical to your success in high school and college, and later on with your career. In her book Adolescents and ADD, Gaining the Advantage, developmental pediatrician Patricia Quinn, M.D., advises, "Set realistic goals. Be honest about your strengths and weaknesses." These tips from her book may help.
Taking Responsibility
Talk to the school nurse.
- Bring up your concerns.
- Ask if students with ADHD meet to share ideas. If not, ask how to start a group.
- Ask the nurse to help your teachers understand your diagnosis and provide classroom support, such as more time for tests and a front seat away from distractions. People with disabilities or certain impairments are entitled to free, appropriate public education under the Individuals with Disabilities Education Act of 1990, Section 504 of the Rehabilitation Act of 1972, and the Americans with Disabilities Act of 1990. If your ADHD isn't being accommodated under these laws, ask the school nurse how to find out if it can be.
Be careful taking medicine.
- Ask about your school's policy on taking medicines at school.
- When parents deliver your medicine, be sure the prescription label lists your name, diagnosis, medicine name, dose, and, especially, when to take it.
- Until taking doses on time gets routine, make notes to yourself or set your watch alarm.
- To prevent mix-ups, always tell the person giving you the medicine your full name, see that the bottle is yours, and make sure you get the correct number of tablets.
- Report side effects to your parents or the nurse.
- Never "help out" someone else by sharing your medicine.
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