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ADHD: Treatment With Stimulants Safer than Expected
ADHD, The Basics
Attention deficit hyperactivity disorder is a common neurobehavioral syndrome which begins in childhood and can persist into adulthood. In childhood and adolescence, ADHD negatively impacts a child's ability to function at home, in school, in the community, and in a variety of social settings. ADHD can result in, or occur along with with, depression, anxiety, low self-esteem, and learning disabilities. If unrecognized and unaddressed, some affected children make poor and impulsive peer group choices, get in trouble more readily, and are placed in learning situations that underestimate their true cognitive abilities. They may use illegal substances either impulsively, or to self- medicate their negative feelings.
When a child is suspected of having ADHD a thorough evaluation is recommended which includes attention to developmental, emotional, learning, health, social, environmental and neurobiologic functioning. Clear testing and diagnostic criteria are specified by professional organizations and input from multiple sources is required. Treating ADHD
Children with ADHD benefit from multidisciplinary treatment, which is both school and home-based. Behavior management, psychotherapy, academic accommodations, and medications are among the most commonly recommended approaches. The most common medications currently prescribed are stimulant medications, which are available in immediate, intermediate and long acting preparation, as well as pill, liquid, and patch form. This has facilitated tailoring of dosing to individual needs.
Medication, a Work in Progress
Parents are often hesitant to start their child on stimulant medications because of concerns about side effects, the most common of which are changes in sleep and appetite. It is crucial to review all potential and developing side effects with your child's physician. Many side effects can be managed with changes in dosage and timing of medication. Scrupulous follow up and medication management is a mainstay of effective pharmacologic treatment. Additionally, monitoring a child's progress through new developmental stages and new environmental demands are equally critical as the symptoms of ADHD and its manifestations change through the life cycle.
The goal of treatment, pharmacologic and otherwise, remains to provide a child and family with a safe approach to a difficult problem that untreated can have lasting negative implications for a child's fulfillment of her potential. ADHD Drugs and Later Substance Abuse: Good News
The recently-reported Archives of Pediatric and Adolescent Medicine study will help to reduce a major source of concern to parents and physicians working with stimulant drugs: the impact of medication therapy on the development of substance use disorders in later life.
Dr Timothy Wilens et al, of Massachusetts General Hospital looked at the effect of prior stimulant therapy on the subsequent risk of cigarette smoking, alcohol, and drug use disorders in adolescents. They did not find an increased risk for cigarette smoking or substance use disorders associated with stimulant therapy. In fact, they found significant protective effects of stimulant treatment on the development of any substance use disorder (SUD). Treated patients were less likely than untreated patients to use other substances. They concluded that stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDS in adolescents with ADHD. Their study focused on female subjects ages 6-18 years who were diagnosed with ADHD using strict diagnostic criteria and who had active symptoms at the time of recruitment into the study. They compared girls with ADHD who did and who did not have a history of use of stimulant medication. They found that stimulant treated teens with ADHD were 73% less likely to develop a substance use disorder than teens who were not treated. Similarly, they found a significant protective effect of stimulant treatment on the rate of smoking in their study population. Subjects with ADHD who were previously treated with stimulants had a 72% lower risk and a later onset of cigarette smoking compared to subjects with ADHD without stimulant treatment. It is additionally compelling that this study focused on girls, who tend to develop substance use disorders almost 2-years earlier than boys. Other Findings
This study adds positively to a growing body of literature on the subject of substance use disorder risk and stimulant use. The study results were consistent with previously reported findings in boys with ADHD which suggested a protective effect of stimulant treatment against alcohol and drug use disorders.(1) This study is also consistent with epidemiological evidence from Germany which indicated delays in onset of s smoking and lower rates of smoking associated with stimulant treatment with subjects with ADHD.(2)
What Should Parents Do?
Based on this and other studies, parents and physicians can feel more comfortable when considering the risks and benefits of stimulant medication on future substance use.. This study adds to the growing literature which not only demonstrates that stimulant treatment does not lead to later substance use, but more importantly, that treatment has a protective effect and decreases the development of substance use disorders in treated adolescents with ADHD.
November 11, 2008
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