Posted By: Dr. Robert Myers
Category: ADHD/ADD, Medication
Comments: 17
I fully understand the concerns of parents regarding medication for ADHD. My wife and I struggled with this when my son was 5. He had a great response to stimulant medication and remained on medication until he was 14. He suffered no observable side effects. He is a 6’4” guy who completed college with honors and has been employed for 5 years in the film industry and currently is an editor for a top rated cable network show. We were at our wits end and what we called “the small vitamin” was a miracle drug. At home we also used psychosocial interventions from time to time during his formative years.
During my years as a child psychologist, I have been able to help many children with mild to moderate symptoms of ADHD do well at home and school without medication using psychological interventions. However, children with more severe symptoms benefit greatly from medication. Current guidelines now state that behavioral interventions should be tried first for mild to moderate symptoms and also should be used for more severe manifestations along with medications which may reduce the dose needed to control symptoms and may reduce the length of time required to remain on medication.
With any physical or mental condition, a thorough work-up should be completed by a competent physician or psychologist. All possible physical and mental causes for the symptoms should be considered and ruled out prior to making the diagnosis of ADHD.
Medication should be monitored closely and growth and blood pressure should be monitored periodically as well as routine blood work performed annually. Stimulant medications when used appropriately are the most effective and safe of all psychiatric medications. For complete information on risks versus benefits please see Parent’s Medication Guide and Medline Plus Searchable Drug Data Base.
Probably at least 30% of children on medication would be fine with comprehensive behavioral treatment. Unfortunately, parents often are enticed by advertising to try very expensive supplements and programs using various electronic devices with no scientifically proven benefit. (I am often asked about alternatives, which is why I developed the Total Focus Program.) For more information on psychological interventions please see go to CHADD or ADHD.
Diets seem to help a few kids who react adversely to certain foods and food additives. While these kids may have ADHD-like symptoms, their true diagnosis is food allergy. The manufacture of supplements is not well controlled and while there is no proof of effectiveness for these substances there is, more importantly, NO PROOF OF SAFETY for any of the recommended substances. “Natural” is a poorly defined term and a number of “natural” products in wide distribution have been pulled off the market due to serious side effects including death or for unsubstantiated claims of effectiveness. For a more thorough discussion of alternative treatments please go to the National Resource Center for ADHD.
I hope this information is helpful. I frequently check the scientific and professional literature and will update this post when warranted. For now, parents must make decisions that are well informed and that meet the short-term and long-term needs of their children. These decisions should always be made with the assistance of a trusted healthcare professional.
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April 8th, 2008 at 12:54 pm
Dr. Bob: Thanks for this information!
April 9th, 2008 at 11:32 am
I have an 11 year old son who has been on Concerta since he was 5 years old. His doctor diagnosed him with the worst case of ADHD he has seen in 20 years! Lucky me! I want to know why Dr. Bob’s son stopped taking stimulant medication at 14? I have already prepared my son that he will most likely need to take it for the rest of his life. A person doesn’t outgrow ADHD. What were the factors that allowed Dr. Bob’s son to go off of it at 14?
April 9th, 2008 at 12:30 pm
Kirsten » Good question! Actually about 30% of children diagnosed with ADHD go into complete remission during adolescence. That means 70% will have some symptoms of ADHD as adults. Brain maturity is not complete until the mid 20s for males (somewhat earlier for females). As the brain matures, certain functions fully develop which may enable the ADHD adult to compensate and lead a fairly normal life without the need for medication or assistance. Some will still need medication or benefit from a support group. In adolescence, hyperactivity seems to decrease, while inattentiveness may continue to be a problem. At this point there is no basis for predicting how ADHD will affect a person as they mature.
April 9th, 2008 at 1:18 pm
I have a 7 year old son with moderate-severe adhd. he sticks out in a class, although he takes Concerta, 27 mg. Recently his meds have not been working as well in the afternoon, he is disruptive. he is also very skinny (50 lbs) and his meds have been giving him bad headaches after school - he is just miserable until about 7-8 pm. this is ruining his life! I made an appt to talk to his pediatrician. I’m just scared about this.
April 9th, 2008 at 1:27 pm
Thank you for this article. I have a 7yr old son which we have tried Ritalin, Adderall, Concerta and now just started Vyvanse. I am so paranoid of the side effects it is not funny. His ADHD is severe along with ODD and fetal alcohol syndrome. I hope one day that my son will come of all of these medicines. Thank you very much.
April 9th, 2008 at 2:06 pm
We have two children who take medadate. My son infirst grade was getting pulled out of class because he was disruptive and the teacher did not know what to do with him. He was on a few different meds he actually had some side effects which was pretty scary. Now he’s on the medadate and oing good. He is in fith grade and he’s less impulsive but does need it.
My daughter is also on it, more for attention. If a fly flew by it distracted her. Since the meds she has grown accedemically which she really was behind. Pray about it if you feel your child needs meds because they might need it and benefit from it. Dont worry about what other people think.
April 9th, 2008 at 4:08 pm
I have a 7 year old who takes Concerta, and has since he was 5. We had tried absolutely everything, counselors, pshychologists, psychiatrists, read every book we could get our hands on, took parenting classes, and implemented every behavior modification that was suggested. We even had one doctor tell us that we just needed to start putting hot sauce on his tongue when he misbehaved! We did not want to medicate him, until we finally got with a doctor that really understood what was going on, and explained the psysiology of ADHD, and why medication was really needed in this extreme case. Medication is not a “magic bullet” that will cure all behavioral problems. It just gives the child a chance to learn from behavior modification without flying into a blind rage, kicking and screaming, when he disagrees.
April 9th, 2008 at 7:48 pm
Our 8 year old grandson came to live with us in December. He had been in foster care for 15 months and had gone through some very awful things. He was in another state, so it took sometime to go through all the hoops to get him to be with us.
He was on lots of medications but he is now on concerta and what a wonderful gift that has been. He can focus and is doing very well in school and in learning day to day living. We also bought the Total Transformation and I don’t want to sound like an advertisement, but that was a wonderful gift too. Expensive, but worth every penny.
Good luck to everyone.
April 11th, 2008 at 11:33 pm
My 5 year old son was diagnosed in January of this year. He started on Concerta, which did nothing for him. Now on Adderall, and we are finding that it might not be the right drug for him either. Trial and error is what our doctor says. Since he has started medication I have seen a DRASTIC change in his behavior. He is a very compassionate child, and before the meds he was bouncing off the wall so badly his Dad couldn’t teach him how to play catch. We also purchased the Total Transformation, which we find to be a huge help. We had done everything we knew to do before we medicated my son, but I am so happy we finally did. There is peace in our home now, where there wasn’t before. My brother has ADHD, and growing up with it I learned the signs - and my son shows them all. My brother, now 24 years old, has returned to his medication due to his job - he is a Marine. But he was off of them for nearly 6 years. Knowledge is what got us to where we are now, I am so great full for it too!
April 12th, 2008 at 7:34 am
My son will be turning 18 soon, and he has been medicated since he was 6. We started off with Ritalin, but he experienced headaches and this was in the days before the extended release Ritalin, so he needed a dosage each day while in school to get him through the afternoon. In second grade he went on Adderall XR and it worked so well, and dosing him once a day before school helped take the stigma away of having to visit the nurse daily. A new pediatrican recommended Concerta when he was in sixth grade, as that didn’t interfere with appetite. We found after months of frustration that Concerta didn’t work at all. Our son has been back on Adderall and he still takes it. It was recommended that for evenings where he had lots of high school homework that another dose of Ritalin help him get through the night.
April 14th, 2008 at 7:05 pm
i adopted my 6 year old grandson. he was diagnosed with fas, severe adhd, and behavior disorder. he weights 48 lbs. he is on risperdal twice a day, carbamazepine 3 times a day, and dextroamphet 3 times a day. i cannot really say that any of them work. he is also pretty slow and test out between 3 1/2 and 4 years old. nothing works. he is in a special needs small classroom setting (4 children with 1 teacher and 2 parapros) with the focus on behavior difficulties. the assistant principle has suspended him 3 times this school year. i am at my wits end. by the time he gets home he doesn’t have a clue why i am upset.
May 8th, 2008 at 12:56 pm
Hello,
I have a 7 yr old son whose behavior has affected his academics. He is in 1st grade and I was told by a tutor that he is not at grade level. His behavior at home is disruptive, he gets easily distracted with any little noise. He is constantly hitting his sister for any little thing that does not meet his approval. His behavior in the classroom involves excessive talking, disruptive behavior, and I have been told that the other children in his class do not want to associate with him, because he gets them in trouble. It seems no matter what punishments we give him, speaking to him about the same thing over and over and reminding him that that kind of behavior is not allowed, it just does not seem to register. As his mother, I thought maybe it was his age, but as I research a little more I find that this maybe a ADD or ADHD situation. I have made an appointment for him this summer with a Pediatric Neurologist and it is possible that he may have to repeat the 1st grade again. Sorry this so long, but has anyone else experienced this and if so, what steps did you take that seemed to make a difference?
Thank You, Jennifer
May 14th, 2008 at 10:25 pm
I have a 9yr old boy. He has been on ADD Meds since 2nd grade (now at the end of 3rd grade). I have tried Metadate, Concerta, Stratterra, Focalin XR and Vyvanse. The Metadate and Stratterra calmed him down but did nothing for the focus issue. The Concerta, Focalin Xr and Vyvanse gave him upset stomach, not eating, and no sleep. He just started the Vyvanse but I am now trying to find another Med that does not upset his stomach (it has only been 5 days on this med). I want to find a med that will calm him and help the focus, I just have not found the magic one yet.
I did purchase the Total Transformation CD w/ADHD CD kit. I love this program, I have alot of changing to do. I think Dr. James Lehman has good points in his training. I hope it works in time. I do recommend the parent support line to get started with the program (I have used it a couple of times). Hopefully with the right Med and changes in the house I will get through parenting.
July 5th, 2008 at 8:19 pm
Dr. Bob,
My daughter was diagnosed with very severe adhd at age 5,(she is now 10) at age 7 was hospitalized for three months after behavior that was dangerous to herself, and her emotional state has bounced around ever since then.
Before hospitalization,she tried almost every stimulant medication and was then given a dual diagnosis of adhd with early onset bipolar disorder,and partial complex seizure disorder which introduced more medications.
When she was hospitalized, a combination of Dexedrine (that she had never had before) and Trileptal and Amantadine were given. This instantly stabilized her.
We read many times that stimulants would in the long term increase the mood swings for bipolar patients and could decrease the seizure threshold.
At our request, over a year later, her psychiatrist took her off the Dexedrine and we went to an anti-psychotic mood stabilizer but everything has worsened, even her superior level academic abilities, and she is on the brink of hospitalization again. In your opinion, did we make a mistake removing the Dexedrine?
To be less specific, do you have the opionion that stimulant medications worsen the bipolar symptoms if a patient has that too?
Thank you very much.
July 5th, 2008 at 8:32 pm
I see that several of you posted that your children had headaches in the afternoon and had a hard time eating when on Concerta. My daughter experienced the very same thing with every stimulant she took, but I was never sure if it was the stimulant.
She is not on the stimulant any more, and she might return to it, but, seeing that others have the exact situation I’ve described to our psychiatrist is very helpful. (The stimulant may have been too, I’d just like to find one that doesn’t make her feel bad physically)
July 14th, 2008 at 12:52 pm
anna hobbs » I just wanted to jump in here and let you and other readers know that unfortunately, we cannot give specific advice on medicines via EP. It’s actually a matter of medical ethics–a doctor would have to see your daughter as a patient in order to determine whether or not her treatment was appropriate. The important thing is to talk to your doctor and have an ongoing dialogue with him or her about what is best for your child. Thanks Anna, and I’m sorry we couldn’t be of more help with your situation.
August 19th, 2008 at 10:33 pm
Valerie***I may have read your post before, but had no experience with the meds you described. My 7 yr old is now on Concerta. Everything I’ve read states that the stimulants are the way to go for ADHD. It seems that stomach upset/”belly ache” are common side-effects of these meds. Our Dr. has suggestted that if they continue, to try half of a Zantac. If you are still trying the stimulants, please ask your Dr. if this may help. Please be sure to ask how long it can be taken, and ask about any medical reason your child can’t take it…current medical condition, etc. We’ve “run the gammitt” for 5 1/2 yrs now…hang in there!