A number of months ago someone accused me of being against
medicine so I wrote an article about Ritalin and other
stimulants. I guess that wasn't enough because I just
received another letter accusing me of being
anti-medication.
Rather than address this letter individually, I thought I
would publish a recent interview I did with a free-lance
journalist. The journalist was preparing an article for a
parenting magazine about ADD ADHD treatment and wanted to
know my thoughts about the current treatments. Since she
was on assignment in Brazil and I wasn't passing through
Rio that week we decided to conduct the interview by email.
Here is the case that she presented to me:
A parent of a five year boy who is bouncing off walls comes
to you and says,
"I hear stimulants work but that they have side effects. I
also hear that researchers still don't know a lot about
what stimulants do to a child's health in the long run."
"What do you recommend? Do you think stimulants are being
pushed too hard by many professionals?"
Here is my response:
Are Stimulants Being Pushed too Hard?
I don't think that stimulants are being pushed too hard,
but I do think that they are not being used properly. The
main advantage of stimulants, like Ritalin, is that they
help control the child's symptoms so that other
interventions will be more effective. For the most part,
this is not how stimulants are being used.
In conventional medicine the most reliable treatment for
ADHD is a combination of medication, like stimulants, and
behavioral modification. The advantage of stimulants is
that they help improve the ADHD symptoms better than any
other conventional treatment. Unfortunately, stimulants
play no role in curing the condition nor do they provide
any long- term changes in the condition.
Behavioral therapy helps the child work with the ADHD
behavior and improves his responses to situations. It
doesn't make the child into less of an ADD ADHD child.
Rather, it helps direct his behavior so that he is an ADHD
child who functions better.
When used together as part of an overall treatment plan,
these two approaches are the most effective means of
dealing with ADHD currently recognized by conventional
medicine. I want to point out that they don't provide a
cure, but they do help the child function more normally in
spite of the problems.
In many and perhaps most cases, these two approaches are
not being used together. The reason is the cost. It is
fairly cheap to give a pill. It also doesn't take a lot of
time on the part of the physician, and the parents see
immediate results. Therapy requires hours of intensive high
cost professional intervention and the results are not over
night. Someone has to pay for this, and it is usually the
parents. Most medical insurance plans will pay for doctor
visits and medication, but they are less ready to cover
months of psychological intervention. As a result, most
children do not get behavioral therapy.
Side Effects of Stimulants
There are some problems with side effects from these
medications. However, we currently have a number of
different products and dosing schedules available.
Basically, with the exception of loss of appetite, every
common side effect of these medications can be eliminated
either by changing the dose or by switching to a different
drug. This is one of the advantages of having a
psychiatrist who specializes in managing ADHD work with
your child. They are much more adept at using these
medications than the average family physician.
Health Risks of Stimulants
With regard to the long-term health risks of stimulants, I
feel this concern has been blown way out of proportion. We
have been using stimulants for almost 80 years. There is no
other medication used in psychiatry today that has been so
thoroughly studied. We know more about stimulants than any
other psychiatric medication and they are also the safest
drugs used in psychiatry. That doesn't mean that they are
completely safe, but it does suggest that there are going
to be no new surprises. After being used for 80 years, it
is not likely that some catastrophic consequence of taking
Ritalin that nobody knows about yet is going to pop up. It
has been around too long.
An Approach to Treating ADHD in a Young Child
Given all that, concerning the theoretical child in
question, I would definitely not start with medication.
Since the child is only 5, then school is not a major
factor yet. I would focus on trying to find other things
that might be contributing to the behavior.
For example, iron deficiency has been linked to difficult
behavior. It is also very common in young children. I think
that there is strong evidence to link food sensitivities to
ADHD symptoms. There was a big debate in medicine about
food sensitivities thirty years ago. The research was
pretty shabby on both sides, but the evidence is strong
enough to suggest that in some children, food sensitivities
contribute to their problems.
I also have personal experience with this. At one point we
suspected that our son, who had been on Ritalin for four or
five years, had sensitivities to certain foods. We took him
off those foods. At the end of a week he came to us and
said that he didn't need the Ritalin anymore. He has been
off Ritalin for four years.
There are lots of other things I would look into before
starting medicine in a child this age. Recently, I
researched over two hundred books articles and scientific
papers to determine which non-conventional treatments are
effective. I found that of the many things people say cure
ADHD, about 35 treatments have good support in the medical
literature. I designed a treatment program to help parents
use these treatments.
How to Use Non-Conventional Treatments
Although it is clear that many non-conventional treatments
are effective, parents should not look for alternative
treatments blindly. There are over one hundred things on
the market today that people are selling and say will help.
Even though they all quote testimonies of people who have
been helped by what they offer, most of these treatments
are completely worthless. Any positive results they do get
are due to the placebo effect. These successes do not last
long.
Even with things that do have scientific support, like
certain supplement combinations, you still have to be
careful. Most of the supplement combinations are dosed so
incorrectly that they are completely ineffective. Some of
the things being used are actually dangerous. The point is
that you have to be careful. People have a misconception
that natural medicines are harmless. They are not. There
have been fatalities caused by taking supplements and
herbal remedies.
The point is that medication would not be my first choice
in a child this age. In an older child where school
performance is an issue, I would opt for medication earlier
in treatment.
Focusing on Behavior
I would start with counseling right away, particularly with
parent training and social skills training. The parents are
going to have trouble raising this child. Normal parenting
skills and parenting books are not going to work. They will
do their child and themselves a big favor if early on they
learn how to address their child's behavior. I realize that
this is going to be expensive. This is the reason I
designed an ADD ADHD child behavior program. I wanted to
provide parents with the tools to help their children
without having to pay the $3-4000 that therapy usually
costs. However, it is imperative that the parents learn how
to control and guide their child properly. And the younger
the child is when they start such a program, the happier
everyone is going to be.
Focusing on Social Skills
These children often have trouble making and maintaining
friendships. This is not the first thing on the parents'
minds when they come to the doctor, but this is the biggest
problem that these children will have when they are adults.
Once they are out of school, most people can find some type
of work situation that is compatible with their ADHD.
However, children who never learn how to develop and
maintain proper social relationships are headed for
lifelong misery. It pays to focus on this as soon as
possible.
Taking Action Early
I would like to emphasize that parents should not delay in
seeking help. We can do a lot to help a five year old. Not
a lot of damage has been done yet. It is much harder to
start with a 15 year old. You have to help mend all the
years of suffering that the child has had to endure as well
as address the actual ADHD problems.
----------------------------------------------------
Anthony Kane, MD is a physician and international lecturer
who has been helping parents of children with ADHD and
Oppositional Defiant Disorder online since 2003. Get help
with Oppositional Defiant Disorder child behavior
(http://addadhdadvances.com/bbsya.html), help with defiant
teens (http://addadhdadvances.com/teenhelp.html ) ADHD
treatment (http://addadhdadvances.com/cylsya.html ) and
ADHD information.
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