The Good News, Bad News, and Good News of ADHD- What can be done!
Posted on Thu, Oct 27, 2011 @ 09:22 AM
The Good News, Bad News, and Good News of ADHD- What can be done!
Dr. Pat Thrasher, M.D., Founding Board Member and Current Chair of the Board at Chesapeake Bay Academy
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobiological disorder of the frontal lobes of the brain which control our executive functioning processes. “Executive functions” include: problem solving, attention/concentration, reasoning, and planning abilities. The good news is that significant advances in recent research have proven that it is a neurobiological disorder, even though the exact cause of ADHD remains unknown. Thus far, scientific evidence suggests that ADHD is genetically transmitted and in many cases results from a chemical imbalance or deficiency in certain neurotransmitters, which are chemicals that help regulate brain activity and behavior.
The bad news is that ADHD is estimated to affect between 3-8 % of the school-aged population. Typically children with ADHDhttp://www.chadd.org/ exhibit symptoms such as poor attention skills, poor vigilance (paying attention over time), poor planning and organizational skills, easy distractibility, impulsivity, and hyperactivity. These characteristics usually are evident in early childhood, typically before age 7, are chronic, lasting at least 6 months, and may continue into adulthood. The child is likely to have difficulty with one or all parts of the attention process: focusing (picking something on which to pay attention), sustaining focus (paying attention for as long as is needed), and shifting focus (moving attention from one thing to another). Many children with ADHD experience great difficulty in school, where attention, impulse and motor control are fundamental requirements for success. A thorough evaluation is necessary to make an accurate diagnosis of ADHD.
The good news is that there are a variety of treatment interventions to address ADHD that can, if necessary, be used in combination. Behavior oriented approaches help some children. For example, most children with ADHD tend to overreact to changes in their environment. Whether at home, or in school, children with ADHD respond best in a structured and predictable environment. Rules and expectations should be clear and consistent. Consequences should be set forth ahead of time and delivered immediately. By establishing structure and routines, parents and teachers can cultivate an environment that encourages the child to control his or her behavior and enhances success at learning. Participation in sports such as Karate/Taekwondo provides an appropriate outlet for the excess energy, while teaching discipline, self control, mindfulness (awareness of self) & relaxation. Sometimes dietary adjustment can reduce hyperactivity. However, research has show that the most effective treatment intervention for ADHD is the use of medications that stimulate the frontal lobe of the brain where our executive functioning processes take place.
The most medications most commonly prescribed for ADHD are stimulants:
Methylphenidate (Ritalin, Metadate, Concerta, Daytrana)
Amphetamines:
- Dextroamphetamine (Dexedrine, Dextrostat)
- Mixed amphetamine salts (Adderall)
- Lisdexamfetamine dimesylate (Vyvanse which does not become an active amphetamine until swallowed and absorbed from the intestinal track which may reduce its potential for some kinds of abuse.
More good news is that the medications have been found to be quite effective and safe for most of those diagnosed with ADHD. Of course, individual responses are as varied as the individuals themselves; not all medications have the same effect on everyone who takes them. Therefore, it is vitally important that all medications be prescribed by and utilized under the supervision of a physician.
As with any medication prescribed for any medical problem in addition to the benefits there can be unwanted side effects. Common side effects are listed below followed by possible management strategies.
- Reduced Appetite, Slowed Growth Rate or Weight Gain------(nutritionist consultation, milk shakes or Ensure for weight loss)
- Upper abdominal pain or nausea---Take with food
- Addictive potential---( The fact is that kids with ADHD on medications are less likely to abuse meds because it helps them to feel “normal” rather than high. Parental management of medication supply and administration can prevent diversion and abuse. Vyvanse is an option for kids with a history of drug abuse.
- Tics could develop ------- (stop medications; try different class of medications)
- Insomnia-----(Melatonin; trazadone or some other medication to aid with sleep might be an alternative to discontinuation)
- Increased Anxiety or irritability------(possibly decrease dosage; Cognitive Behavioral paychotherapies)
- Possible increase in aggression ---- (change of meds or decrease the dosage)
- Down-feeling when stopping medications
- Long-term implications----(for example: joining military may require being off the medications for a specified period of time prior to enlistment)
With any medication the amount of benefits must be weighed against the side effects. Always consult the prescribing physician for any unexpected or problematic side effects.
It is important to remember that medications do not “cure” ADHD, but simply help to control the symptoms. Most experts in the field suggest using medications in combination with behavioral therapies/counseling and practical support. Best news: ADHD does NOT have to define who you are as a person or what you can accomplish with your life! What has helped you to cope/deal with issues of ADHD? What has been helpful to address possible side-effects you might have experienced? Share your knowledge on our blog!
Chesapeake Bay Academy: ADHD: wavy.com