Medication for ADHD?

Raymond Shred, PhD

What treatments are available for ADHD? There are a variety of options. Family therapy may help a family adjust to the stresses that are related to having a family member with ADHD. Social skills training may be useful for a child to get along better with his peers. Classroom management may help to reduce the impact of potential distractions for a child. Insight-oriented therapy (cognitive-behavioural, EMDR, etc.) may help repair damaged self-esteem.

One of the more effective ways of changing one's attention style is stimulant medication. This is also the most controversial. People are reluctant to consider medication for their children and there is much misinformation about how it works.

In this article, I will explain briefly how these medications work. This is not meant to be a comprehensive review of the medications available; I focus primarily on the mechanisms and effects of Ritalin or methylphenidate. However, most of this information will apply to all the stimulants currently used whether in quick release or slow release formulations.

I have found myself in a strange position because, as a psychologist, I do not prescribe medication. However, one of the treatment options available for children (and adults) is medication. Therefore, I have recommended that a parent to consult with their physician about a trial of stimulant medication. A trial is necessary because it does not work for everyone and there are side-effects.

What would I do if my child had ADHD? First, I would likely have him or her complete the Cogmed Working Memory Training program. After that, if problems remained, I would likely ask my physician to prescribe a trial of stimulant medication. In part, that is because I know that children with ADHD don’t fit in to many classrooms or other settings with their friends.

Once it has been tried, children themselves often remark about how much better they are able to attend, behave, etc. I would count up all the positive effects and carefully monitor for any negative side-effects. If there were no serious side effects, then I would want my child to have a happier, more productive life.

How does stimulant medication work? It seems kind of ironic to be prescribing a stimulant for a "hyperactive" child. However, once you know what it does then it’s not so strange. Ritalin or Dexedrine speed up the processing in the frontal lobes, thus making the child better able to decide not to pay attention to things that aren’t important.

Also, Ritalin is quite user friendly. Because of the way it works, all the medication taken one day has been eliminated from the body by the time a child takes their dose the next morning. The technical reasons for this are related to the pharmacokinetics and the half-life of Ritalin. It moves through the system quite quickly so that the user does not build up a tolerance. Unlike other medications it can be stopped at anytime, the only result would be that the user will not benefit from the positive effects.

The speed at which Ritalin works makes it difficult to determine the best dosage and timing of administration. Because different children’s bodies work differently, some children need a higher dose or need it sooner than the standard rules state. The appropriate dosage for each child is usually determined through a process called titration. The child is given a low dose initially and the dose may be increased until the most effective dosage is found. In all cases, the goal is to give no more of medication than is required to obtain the desired effect.

Further information can be obtained from the following documents published on the internet: Canadian Psychological Association ADHD Factsheet, the American Academy of Pediatrics -- Diagnosis and Evaluation of the Child with Attention Deficit Hyperactivity Disorder, the Canadian group Children and Adults with Attention Deficit Disorder or CHADD Canada, there is also CHADD in the US, and the ADD association.

Dr Raymond Shred
Nanaimo, British Columbia
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