Attention-Deficit Hyperactivity Disorder Health Article

Allopathic treatment

Psychosocial therapy, usually combined with medications, is the treatment approach of choice to alleviate ADHD symptoms. Psychostimulants, such as dextroamphetamine (Dexedrine), pemoline (Cylert), and methylphenidate (Ritalin) commonly are prescribed to control hyperactive and impulsive behavior and increase attention span. They work by stimulating the production of certain neurotransmitters in the brain. Possible side effects of stimulants include nervous tics, irregular heartbeat, loss of appetite, and insomnia. However, the medications usually are well-tolerated and safe in most cases. But according to Carolyn Chambers Clark, R.N., Ed.D., 25% of the children with ADHD do not respond to stimulant drugs.

In children who don't respond well to stimulant therapy, tricyclic antidepressants such as desipramine (Norpramin, Pertofane) and amitriptyline (Elavil) are frequently recommended. Reported side effects of these drugs include persistent dry mouth, sedation, disorientation, and irregular heartbeat (particularly with desipramine). Other medications prescribed for ADHD therapy include buproprion (Wellbutrin), an antidepressant; fluoxetine (Prozac), an antidepressant; and carbamazepine (Tegretol, Atretol), an anticonvulsant drug. Clonidine (Catapres), a medication for high blood pressure, also has been used to control aggression and hyperactivity in some ADHD children, although it should not be used with Ritalin. A child's response to medication will change with age and maturation, so ADHD symptoms should be monitored closely and prescriptions adjusted accordingly.

In mid-2003, the first new drug for treating ADHD was about to become available. Called atomoxetine (Strattera), it was planned to offer several advantages over standard stimulants. First, atomoxetine is not a controlled substance, so physicians can write prescriptions for a larger number of pills and refills. Further, it doesn't have the potential for abuse that the stimulant drugs pose.

Expected results

Untreated, ADHD negatively affects a child's social and educational performance and can seriously damage his or her sense of self-esteem. ADHD children have impaired relationships with their peers and may be looked upon as social outcasts. They may be seen as slow learners or troublemakers in the classroom. Siblings and even parents may develop resentful feelings toward the ADHD child.

Some ADHD children also develop a conduct disorder problem. For those adolescents who have both ADHD and a conduct disorder, up to 25% go on to develop anti-social personality disorder and the criminal behavior, substance abuse, and high rate of suicide attempts that are symptomatic of it. Children diagnosed with ADHD also are more likely to have a learning disorder, a mood disorder such as depression, or an anxiety disorder.

Approximately 70-80% of ADHD patients treated with stimulant medication experience significant relief from symptoms, at least in the short-term. Approximately half of ADHD children seem to "outgrow" the disorder in adolescence or early adulthood. The other half will retain some or all symptoms of ADHD as adults. With early identification and intervention, careful compliance with a treatment program, and a supportive and nurturing home and school environment, ADHD children can flourish socially and academically.

BOOKS

Alexander-Roberts, Colleen. The ADHD Parenting Handbook: Practical Advice for Parents from Parents. Dallas: Taylor Publishing Co., 1994.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Press Inc., 1994.

Diller, Laurence H. Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill. New York: Bantam Books, 1998.

Hallowell, Edward M., and John J. Ratey. Driven to Distraction. New York: Pantheon Books, 1994.

Kennedy, Patricia, Leif Terdal, and Lydia Fusetti. The Hyperactive Child Book. New York: St. Martin's Press, 1993.

Maxmen, Jerrold S., and Nicholas G. Ward. "Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence." In Essential Psychopathology and Its Treatment, 2nd ed. New York: W.W. Norton, 1995, 419-457.

Osman, Betty B. Learning Disabilities and ADHD: A Family Guide to Living and Learning Together. New York: John Wiley & Sons, 1997.

PERIODICAL

"Complementary, Alternative Medicine Being Used by Parents for ADHD." The Brown University Child and Adolescent Psychopharmacology Update (August 2003):1-3.

Gaby, Alan R. "Essential Fatty Acids for ADHD." Townsend Letter for Doctors and Patients (April 2003):43.

Glicken, Anita D. "Attention Deficit Disorder and the Pediatric Patient: A Review." Physician Assistant 21, no. 4 (April 1997): 101-111.

Hallowell, Edward M. "What I've Learned from A.D.D." Psychology Today 30, no. 3 (May-June 1997): 40-46.

Monaco, John E. "New Drug for ADHD." Pediatrics for Parents (June 2003):7-11.

"New National ADHD Resource Center Opens in Maryland." Special Education Report (June 2003):12.

"Parents Increasingly Seek Alternative ADHD Treatments." Mental Health Weekly (September 22, 2003):7.

Swanson, J.M., et al. "Attention-deficit Hyperactivity Disorder and Hyperkinetic Disorder." The Lancet 351 (February 7, 1997): 429-433.