 | | | | Medical Health Encyclopedia | | It should be noted that a major study reported that children with ADHD will benefit to some degree from any treatment, whether behavioral therapies, medication, or simple mental health intervention. Combinations of behavioral therapy and medications appear to be best, however. Stimulants are not a cure-all, and children should not grow up believing that taking a pill will solve life's problems without their having to make self-efforts. Help for Families and TeachersResearch increasingly supports the view that interventions for the ADHD child must also include the parents if they are to be successful. Teachers and school officials should also be educated and involved in the process. Parents who feel they have the most control over their child's situation also experience the least psychological stress and depression. Parents who are responsive in a positive way also help reduce the chances for their child developing oppositional behaviors. But it can be very difficult, particularly for parents who have ADHD themselves. In fact, parents who have severe ADHD symptoms are less likely to respond to parent training programs unless they get help for themselves. Text Continues Below
In addition to behavioral therapy for the child, family therapy may help ADHD children and their parents and siblings cope with the emotional conflicts that nearly always arise in the lifelong process of managing the condition. Separate psychological therapies for specific family members might be needed, particularly in light of the high incidence of psychiatric and other emotional problems in families with ADHD children. Ritalin and Other Psychostimulants for ADHD: Pros and Cons | |
Arguments For Medications
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Arguments Against Medications
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Effect on ADHD Symptoms
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The effectiveness of Ritalin in improving ADHD symptoms has been established by more than 160 controlled studies, the largest amount of evidence on any subject involved with childhood behavioral disorders. They are equally effective in boys and girls with ADHD.
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Positive results in many studies are most evident in children with severe symptoms, particularly those who suffer from aggression. The benefits with less severe conditions tend not to be as pronounced.
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Effect on Intelligence and Academic Achievement
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Some studies suggest that medications raise intelligence test scores, even in children who have accompanying disorders, such as autism, pervasive developmental disorder, and mental retardation.
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There is no definite proof that drugs improve academic achievement. Psychostimulants, for example, do not improve a child's ability to memorize facts by rote. In fact, in a major study there was no difference in academic achievement between children taking medications and those being given behavioral therapies. A 2001 study reported that only low doses improved academic functioning in adolescents. In some young people higher doses was associated with worse performance.
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Effect on Social Functioning
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A 2000 study reported that medications had some positive effect on self-esteem, which was greatest in highest doses. (Presumably, then, children with the most severe symptoms felt the greatest improvement in self-confidence.)
One of the few long-term studies on ADHD children reported that patients who were effectively treated and responded well were more likely to be living independently as adults, to be either married or to be engaged. They had higher IQs and were less likely to have substance abuse problems or have attempted suicide. (Patients who were closely monitored for treatments as children, however, may also have had more positive parenting, which could also account for the better outcome.)
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A child may still have social problems after taking psychostimulants. Medication alone rarely helps aggressive children with ADHD. And a major study found no difference in oppositional behavior or relationships with peers between children taking psychostimulants and those being given behavioral therapies.
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Side Effects
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Most young people report mild side effects, most often loss of appetite.
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Some children report distressing side effects that include a "zombie" like effect, tics, and moodiness. Weight loss may be a problem for some children. Even in young people who abuse Ritalin, however, less than 1% experience severe side effects (rapid heart rate, hypertension).
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Effect on Bone Loss and Growth
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The drugs do not cause bone loss, as some people have feared.
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These drugs may affect growth, although most studies suggest the impact is not significant and that children catch up later on.
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Effect on the Brain
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There is some recent evidence to suggest that medication may enhance growth of brain white matter--which consists of insulated nerve fibers that make up the core of the cerebral hemispheres.
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No major studies have been conducted on the long-term effects of stimulant use in preschool children. Studies on animals being given such drugs during equivalent developmental periods report negative effects on memory, on important neurotransmitters, and other adverse effects.
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Risk for Addiction
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Studies on both animals and humans suggest that Ritalin lacks the properties that create addiction, particularly in doses used for treating ADHD. Furthermore, a major 2003 analysis of six studies suggested that the use of stimulants may protect against drug abuse in ADHD young people.
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An emerging and serious problem is the sale of stimulants to non-ADHD peers, who are in danger of over-use and severe side effects. It should be noted that crushing the pills and inhaling them nasally can also provide a euphoric state.
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Choosing Candidates for Drug Treatment
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When used correctly, questionnaires and other screening tests for ADHD symptoms are proving to be very accurate for determining the best candidates for drug treatments.
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There are no objective tests for diagnosing ADHD, so it is unclear if the appropriate people are being treated or not treated.
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