by Dr. David Rabiner, Ph.D.

cont.

***SPECIAL OFFER***

If you are considering medication for your ADHD (Attention Deficit Hyperactivity Disorder) child, and would like to gather objective information about it's effectiveness, I will send you the program I have developed to conduct careful medication trials. This includes the forms and instructions needed to conduct the trial, which needs to be implemented in cooperation with your child's doctor. At the end of the trial, you mail me the completed forms and I will send a report of the results to your child's physician that will address the issues outlined above.

This program can also be used to re-evaluate the effectiveness of medication for a child already receiving it. It works best with elementary school children, but can also be used with middle school children if there are teachers who know your child well.

To receive the packet, send your name and address to:

Please include a check for $5.00 to cover the cost of the materials and postage. I will prepare the report at NO CHARGE. This will be helpful to you in deciding about medication for your child and will help me introduce this service to physicians around the country.

"How often do most ADHD children need to take medication?"

Because the effects of stimulant medication generally wears off within 3-8 hours, two doses per day - one before school and one at mid-day - is quite common. Some children are able to get by with only a single administration per day, while some may require a third dose to help with after school activities and homework.

"Do children with ADHD need to take medication on weekends and over vacations?"

For children whose symptoms are relatively mild, medication during the school day may be all they require. Unfortunately, some children have more severe forms of the disorder and may require medication to be successful in settings outside of school. In part, this will also depend on the effectiveness of other treatments that have been implemented. It is very unfortunate that changes in the insurance industry often prevent children from getting access to psychosocial treatments that can be very helpful.

"For how long do children with ADHD need to take medication?"

The best answer to this question is that a child should take medication for only as long as it is helpful and necessary. For some children with ADHD, symptoms dissipate over time to the point where medication is no longer necessary. Many other children struggle with ADHD symptoms into adolescence and young adulthood, however, and may benefit from medication during many years of their development. Because the need for, and effectiveness of stimulant medication may change over time, most experts recommend that this issue be re-evaluated on an annual basis.

"What other kinds of medication are used to treat children with ADHD?"

Tricyclic Antidepressants are also used in treating individuals with ADHD and the effectiveness and safety of these compounds has also been studied fairly extensively. Medications in this class of compounds include Imipramine, Desipramine, Amitriptyline, Nortriptyline, and Clomipramine.

In some cases, physicians may also prescribe other anti-depressants to treat ADHD including fluoxetine (i.e. Prozac), and bupropion (i.e. Wellbutrin). Although there is some research evidence that these medications can be helpful in treating ADHD, few controlled studies on their efficacy have been conducted to date.

"Why would antidepressants be prescribed rather than stimulants?"

In most instances, stimulant medication (generally methylphenidate) will be the drug prescribed initially. If the initial stimulant prescribed does not help, it is quite possible that another stimulant will.

Antidepressants would generally be tried if:

• stimulant medication was not effective - before giving up on stimulants, physicians may try several different types;
• even though stimulant medication reduced ADHD symptoms, there were adverse side effects that prevent the child from taking it;
• there is a clear indication of a co-occurring mood or anxiety disorder in addition to ADHD - there is some evidence that when these additional difficulties are present, stimulant medication may be less effective than antidepressants.

"What about using dietary changes to help with ADHD?"

The idea that ADHD symptoms reflected allergic reactions to food additives was popularized by Dr. Ben Feingold, a pediatrician and allergist. Dr. Feingold speculated that reactions to certain types of food additives accounted for many cases of ADHD and that dietary modifications would help many of these children.

Unfortunately, the data to support such a claim is lacking. There are probably a small group of children who respond negatively to certain food additives, however, and who will be helped by dietary changes. The odds that an ADHD child’s symptoms can be successfully treated by dietary changes would appear to be quite small.

"What about the use of natural remedies to treat ADHD?"

Over the years, a number of natural remedies to treat ADHD have been proposed. To my knowledge, however, no controlled studies documenting the effectiveness of these remedies have been conducted. This is a real problem, because in many cases, the apparent benefits reported by individuals may represent nothing more than a placebo effect.

Does that mean that these treatments do not work? Not necessarily. It does mean, however, that compelling scientific evidence for their effectiveness has not yet been provided.

* Stimulant medication has been shown to provide significant benefits to the majority of children with ADHD. These benefits include reducing core ADHD symptoms, enhancing academic performance, reducing disruptive and aggressive behavior, and improving relationships with peers and family members.

* The improvements resulting from stimulant medication are based primarily on the results of short term studies and more data on the long term effectiveness of this form of treatment is required.

* Even though a child may benefit from stimulant medications, there will often be remaining academic and/or behavioral difficulties that need to be addressed by other forms of intervention.

* Most children do not experience any prolonged adverse side-effects from taking stimulant medication when it is administered properly. It is very important, however, for parents to discuss their questions and concerns with their physician and pharmacist.

* Not all children benefit from stimulants, and it is important to use an objective procedure to determine medication effectiveness.

* A child’s response to medication can change over time, as can the child's need for medication. Re-evaluating these issues on a periodic basis is important.

* Tricyclic antidepressants have also been shown to be helpful in treating ADHD symptoms, and may be helpful if stimulant medications are not successful, if stimulant medications produce unfavorable side effects, or if the child has concurrent symptoms of anxiety or depression. Newer antidepressants like Prozac and Wellbutrin may also be helpful, although less work documenting their effectiveness in treating ADHD has been condcuted.

* Dietary changes and natural remedies currently lack scientific evidence of effectiveness in treating ADHD.

That's all for this month. I hope this information was useful to you in thinking about medication issues with your child. I want to thank Brandi again for giving me the opportunity to communicate with you all.

David Rabiner, PhD
Licensed Psychologist

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