Attention Deficit Disorder – The Signs And Symptoms Of ADD

When your child has strep throat, the decision to give him antibiotics is a pretty straightforward matter. But when your child is diagnosed with ADHD, attention deficit hyperactivity disorder, the situation is much more complex and confusing. Questions must be raised about long-term issues as well as short-term treatment.

You may put your child on medication and it may help, but what can you expect over the long-term? Will he be on medication forever? What is known about long-term side effects? How will his condition and medication affect his future as he grows into an adult? Will therapy and behavioral treatments have any impact on his long-term outcome?

ADHD Drugs

The two main drugs used to treat ADHD are stimulants — Ritalin (methylphenidate) and Dexedrine (dextroamphetamine). It seems counter to logic that stimulants would help a distractible, hyperactive child to slow down and focus attention, but the evidence shows these drugs improve ADHD symptoms in at least 70 percent of cases.

Exactly how they work is still a mystery. Many researchers believe the stimulants alter the balance of neurotransmitters, the brain’s chemical messengers. But it will take much more study to figure out the precise action of Ritalin and Dexedrine on patients with ADHD. That is not unusual, though. Quite a few of our most effective drugs for a variety of diseases work in ways that we don’t yet understand.

Medication Side Effects: Short and Long Term

Ritalin and Dexedrine have been used to treat ADHD in children for many years. They are considered safe and effective when administered at the proper dosage levels and when their use is carefully monitored for efficacy and side effects. Possible side effects include insomnia, loss of appetite, nervousness and irritability. Less common side effects may include nausea, dizziness, headache, weight loss and changes in blood pressure.

Stimulants occasionally bring out tics in children who have a propensity for them, or in those who have Tourette’s syndrome in addition to ADHD. But some children have no noticeable side effects at all. In others, side effects can be eliminated or reduced by adjusting the dosage or switching medication. The decision to use stimulant medication over the short term has to be based on a comparison of benefits versus risks and side effects.

As to long-term use, there is simply not enough scientific evidence available to determine whether stimulants are safe or not. According to Dr. Michael Gordon, child psychologist and director of the ADHD program at the State University of New York Health Science Center in Syracuse, “To date, there’s no convincing evidence that are untoward long term effects. These are medications that have been used in one form or another since the 1930′s and one would think that if there were long-term effects, we’d have found them.”

Late in 1998, an expert panel convened by the National Institutes of Health (NIH) issued a consensus statement which also said there is no indication that careful, long-term use is harmful. But it will be years before we can say this with any certainty. “The problem is that it’s only been since the mid-80′s that it’s been common to give medication through adolescence and adulthood,” says Dr. Gordon. Before that, it was believed that ADHD subsided around the time of puberty.

Some doctors believe stimulants may be safe for long-term use because they don’t last long in the body. “The pharmacologists will tell you that the medication is metabolized so quickly that it’s unlikely that it would cause health effects because it just doesn’t hang around the body.” Still, Dr. Gordon adds that nothing has been proven or disproved about long-term side effects.

What Is ADHD?

While there are parents and health professionals who deny the existence or diagnosis of ADHD, most in the mainstream medical community view it as a neurological condition with a strong genetic component. The clinical diagnosis requires that at least eight of 14 possible symptoms be present for at least six months, and that those symptoms first appear before age 7.

The symptoms are better described as characteristic behaviors, rather than physiological symptoms. They fall into three general categories:

• inattention
• hyperactivity
• impulsivity

There is no cure for ADHD. Doctors generally think in terms of lessening the symptoms and managing the condition with a treatment program that allows the child to live a fully functional and normal life.

Diagnosing ADHD

Diagnosis of ADHD has multiplied to the point where it’s estimated that up to 6 percent of American children have this disorder.

ADHD (or simply ADD, for attention deficit disorder) has gotten into the popular language and culture. To put it bluntly, the disorder has become almost trendy and some people say it is being widely overdiagnosed and misdiagnosed as a result. Parents, teachers, child care providers and even some doctors may observe a partial profile of one or two symptoms in a young child and jump to a hasty conclusion that the child has an attention disorder.

A number of problems that may cause behaviors that are similar to those of ADHD. According to the National Institutes of Mental Health, these include:

• learning disabilities
• seizures
• hearing problems caused by ear infections
• psychological problems, such as anxiety or depression

But there may be others, as well. These may not affect large numbers of children or be responsible for a great deal of misdiagnosis, but they warrant consideration when evaluating a child for ADHD.

• lead poisoning
• ourette’s syndrome and a few other genetic diseases
• veractive thyroid
• emotional or physical abuse, psychological trauma or severe neglect

You may hear of other possible sources of ADHD-like symptoms, such as food allergies, refined sugar, sensitivity to food additives and more. Over the years, scientific studies have not validated these as being sources of ADHD, nor has treatment the addressing the factors been proven to help children with the condition.

That said, it is important to note that research studies look at percentages and they seek to find what is true for most children. Your child may be the one in a thousand who does develop symptoms from sugar or food additives and those symptoms may contribute to a diagnosis of ADHD. Would that it were more cut-and-dried. But each child and each family situation is an individual, and medicine is often an art — not as precise a science as we would like it to be. Pulling clean and simple answers out of a textbook isn’t always possible.

ADHD Drugs

The two main drugs used to treat ADHD are stimulants — Ritalin (methylphenidate) and Dexedrine (dextroamphetamine). It seems counter to logic that stimulants would help a distractible, hyperactive child to slow down and focus attention, but the evidence shows these drugs improve ADHD symptoms in at least 70 percent of cases.

Exactly how they work is still a mystery. Many researchers believe the stimulants alter the balance of neurotransmitters, the brain’s chemical messengers. But it will take much more study to figure out the precise action of Ritalin and Dexedrine on patients with ADHD. That is not unusual, though. Quite a few of our most effective drugs for a variety of diseases work in ways that we don’t yet understand.

Medication Side Effects: Short and Long Term

Ritalin and Dexedrine have been used to treat ADHD in children for many years. They are considered safe and effective when administered at the proper dosage levels and when their use is carefully monitored for efficacy and side effects. Possible side effects include insomnia, loss of appetite, nervousness and irritability. Less common side effects may include nausea, dizziness, headache, weight loss and changes in blood pressure.

Stimulants occasionally bring out tics in children who have a propensity for them, or in those who have Tourette’s syndrome in addition to ADHD. But some children have no noticeable side effects at all. In others, side effects can be eliminated or reduced by adjusting the dosage or switching medication. The decision to use stimulant medication over the short term has to be based on a comparison of benefits versus risks and side effects.

As to long-term use, there is simply not enough scientific evidence available to determine whether stimulants are safe or not. According to Dr. Michael Gordon, child psychologist and director of the ADHD program at the State University of New York Health Science Center in Syracuse, “To date, there’s no convincing evidence that are untoward long term effects. These are medications that have been used in one form or another since the 1930′s and one would think that if there were long-term effects, we’d have found them.”

Late in 1998, an expert panel convened by the National Institutes of Health (NIH) issued a consensus statement which also said there is no indication that careful, long-term use is harmful. But it will be years before we can say this with any certainty. “The problem is that it’s only been since the mid-80′s that it’s been common to give medication through adolescence and adulthood,” says Dr. Gordon. Before that, it was believed that ADHD subsided around the time of puberty.

Some doctors believe stimulants may be safe for long-term use because they don’t last long in the body. “The pharmacologists will tell you that the medication is metabolized so quickly that it’s unlikely that it would cause health effects because it just doesn’t hang around the body.” Still, Dr. Gordon adds that nothing has been proven or disproved about long-term side effects.

Lack of Long-Term Treatment Data

Besides knowing little about long-term negative effects of stimulants, we also don’t know much about their long-term effectiveness. Yet we do know now that ADHD can be a lifelong condition. Dr. Larry Silver, professor of psychiatry at Georgetown University Medical Center and author of Dr. Larry Silver’s Advice to Parents on ADHD, says, “Statistics suggest that about 50 percent of children with ADHD will continue into adolescence and most of those will continue into adulthood.”

The 1998 NIH consensus panel noted “a paucity of data providing information on long-term treatment beyond 14 months. Although trials combining drugs and behavioral modalities are under way, conclusive recommendations concerning treatment for the long term cannot be made easily.”

Further, the panel said, “There is no information on the long-term outcomes of medication-treated ADHD individuals in terms of educational and occupational achievements, involvement with the police, or other areas of social functioning.” The panel concluded that several important questions about treatment remain unanswered, including the lack of information about the efficacy of current treatment methods for adolescents and adults with ADHD.

Short-term studies confirmed the beneficial short-term effects of stimulants on some of the central symptoms. But the consensus panel found that the drugs don’t necessarily affect the full range of effects. “Of concern are the consistent findings that despite the improvement in core symptoms, there is little improvement in academic achievement or social skills”

Addiction and Substance Abuse

Critics of stimulants as treatment for ADHD say the drugs are addictive and may lead to substance abuse problems in adults. The National Institute of Mental Health (NIMH) says the stimulants are not addictive in children and that Ritalin doesn’t create a “high” when used therapeutically. As to addiction in teens and adults, Dr. Silver says “To date, there’s no data showing that these medicines, used at the appropriate [low] doses, become addictive.”

Of course, the drugs are not always properly used and there is a potential for abuse and illicit use. Dexedrine is used as a recreational drug and Ritalin will provide a high when the pills are ground up and snorted. There are teens that fill their prescriptions and sell their ADHD medications to others for illegal use.

Some people believe that use of stimulant drugs by children with ADHD increases their risk of developing a substance abuse problem when they get older. They point to a recent long-term study which found a link between stimulants given in childhood and cigarette smoking and drug abuse in teens and adults. But this study did not uncover a causal relationship between substance abuse and stimulants.

What seems to be true is that ADHD itself can be a risk factor for substance abuse. Some experts believe that proper treatment and control actually reduce that risk, not increase it. Unfortunately, this question is one of several that remain unanswered in a definitive way.

Nonpharmaceutical Treatment

Therapies that help child with ADHD and their families cope with the condition in day-to-day life are sometimes called psychosocial treatments. They may include some form of psychotherapy aimed at promoting self-esteem, as well as educational or behavioral programs that teach practical coping techniques and skills to children, families, schools and teachers.

One recent study comparing medication to psychosocial programs found medication provided the greatest degree of improvement, and that medication combined with psychosocial treatment did no better than medication alone. But this kind of study looks at ADHD symptoms in a vacuum, without accounting for the possibility of co-existing conditions, such as learning disabilities, or for the destructive impact that years of unmanaged ADHD can have on a child.

That’s why, despite the studies, Dr. Silver says most doctors don’t — and shouldn’t — just prescribe drugs. “When you work with a kid, you can’t use medication alone, you have to use the various psychosocial programs. We still recommend psychosocial treatments, even though they don’t seem to enhance improvement, because of the high preponderance of co-existing conditions and problems.”

Medication Forever?

Even when the psychosocial programs are helping, doctors often prescribe stimulants with the expectation that some children will stay on them forever. As you can imagine, that’s not the most appealing notion to many parents, who may want to give their child or teenager a drug-free trial or hope to eventually discontinue the drugs as their child gets older.

Should you take your child off medication at some point, to see if it is still necessary? Possibly. After all, if up to 50 percent kids will have ADHD forever, that means there’s a good chance that either it won’t persist in your child or that the medication can be reduced or eliminated.

“It seems like a bad idea to withdraw something that?s helpful,” says Dr. Gordon, unless there’s a good reason for it, either because there’s side effects or because the youngster no longer needs it. You can tell if the youngster no longer needs the medication by discontinuing it, seeing how they function and making decisions. And that can be done, again, in systematic, sensible ways.?

Don’t play doctor yourself. Always discuss any changes in medication should be discussed with the child’s physician. Dr. Gordon says drug withdrawal is not an issue. “You can discontinue Ritalin and Dexedrine cold turkey, immediately. There’s no reason to believe that discontinuation of Ritalin and Dexedrine leads to any withdrawal effects. The body doesn’t become physiologically dependent on this medication.”

Conclusion

I wish I had some better answers for families coping with ADHD. We still have so much to learn about diagnosing and treating this disorder. Parents need to recognize that this is a chronic disorder which will require years of advocacy for their child and involvement in all aspects of the child’s life and treatment. Getting informed on this topic is no easy task, because there’s an enormous amount of misinformation that’s readily available, some of it very well-meaning, but just not accurate. So gather as much information as you can, but verify its accuracy before taking any action.