The skinny on ADHD drugs
While parents often worry about the side effects of ADHD medication, the reality is that the impact of untreated ADHD is often much worse than any of the medication side effects.
The skinny on ADHD drugs
Mario Cruz, M.D.
I see a 9-year- old girl in my practice who is inattentive and hyperactive at school and at home. A thorough evaluation revealed that she has attention deficit hyperactivity disorder (ADHD). In our last visit I provided her mother with specific parenting advice that has not resolved the behavior issues. I then suggest that we start her child on an ADHD medication, such as Ritalin. The mother hesitates and says, “I don’t really want those medications. I heard that they have really bad side effects.”
In my last blog entry, I talked about how physicians are often too quick to “label” a child with ADHD. However, for those who really do have ADHD, appropriate treatment can dramatically improve the quality of life of a child and his or her family. While parents often worry about the side effects of ADHD medication, the reality is that the impact of untreated ADHD is often much worse than any of the medication side effects. For example, untreated ADHD can result in poor school grades, difficulty making friends, family stress, conflicts with siblings, low quality of life, poor self-esteem and an increased number of accidental injuries (due to carelessness and hyperactivity). During adolescence, children who were never treated for their ADHD symptoms are also more likely to abuse drugs … yikes!
When considering ADHD medications, here are a few of the common questions that come up:
Should ADHD medications be prescribed by a psychiatrist or can your general pediatrician do this?
Unfortunately, there is a huge shortage of child psychiatrists (especially for children on Medicaid) and frankly speaking, there aren’t enough child psychiatrists to treat all of the children with ADHD. Most children with ADHD can be managed by a primary care pediatrician. However, complicated patients (with multiple psychiatric issues or complicated home lives) are better off being managed by child psychiatrists.
Will my child become addicted to these medications?
This is very unlikely, but possible. Some of these medications (stimulants) have the potential to be abused. In some cases, teenagers may give or even sell their medications to friends. One way to avoid this problem is to use non-stimulant medications that have a lower abuse potential.
Do I have to give them to him all the time? Can he take the weekends off?
Many children with ADHD struggle most during school weeks because of the intense focus that is required to succeed. When school is not in session, many pediatricians will agree that “medication holidays” are appropriate. But each case is different and parents need to talk to their child’s doctor before stopping medication.
I know a child who took those medications and it turned him into a zombie!
I have seen this many times! If the medication dosage is too high, the child can become numb to the world and temporarily lose their typical playfulness. They won’t laugh or sing … instead they just sit there quietly. This is NOT what ADHD medications are intended to do. Fortunately, this will last for only a few hours and your child should be completely back to normal by the next day. Speak with your doctor about lowering the dose.
What are the most common side effects?
- Appetite suppression: One way to counteract this is to make sure that your child has a hardy breakfast before taking the medication. Throughout the day make sure that he/she eats high calorie meals and snacks such as peanut butter and full fat dairy products.
- Sleep interruption: Your child may not fall asleep as quickly as you’d like. Try giving the medications as early in the day as possible (so that the medication will wear off sooner). Some medications help ADHD symptoms and have the convenient side effect of causing drowsiness.
- Tics: These are movements (like blinking) or sounds (like throat clearing) that sometimes accompany ADHD. They are involuntary and can increase with stimulant medications.
- Mild belly pain
- Headaches
After starting any ADHD medication your child should be monitored regularly until all side effects have been identified and addressed.
I heard that ADHD medications can cause heart problems. Is that true?
Because stimulant medications may cause slight increases in heart rate and blood pressure, this has been a concern. In fact, stimulant medications carry a warning label about the potential risk of sudden cardiac death. However, a study of 240,000 children recently found that the risk of sudden cardiac death was the same whether or not children took ADHD medications. To be on the safe side, most pediatricians will ask about a family history of heart conditions. They may also recommend an EKG before starting medication.
I know what you’re thinking … Wow, those are a lot of side effects! Is it really worth it? Yes! Remember, untreated ADHD can be harmful to your child. Most of these medication side effects are temporary, predictable and easy to manage.
Do you know anyone who has been on ADHD medications? What was their experience like? Did they have any side effects?
Mario Cruz is is an assistant professor of pediatrics at Drexel University College of Medicine and an academic pediatrician at St. Christopher's Hospital for Children.
Comment removed.
Looks like someone needs his dose adjusted...— Doctor D- Looks like someone needs his dose adjusted...— Doctor D
- Mario - you doctors are the new drug cartels and you are turning children into drug addicts. This is a completely irresponsible article. You have done no study nor referenced any study that claims untreated ADHD is a big problem. Diagnosing ADHD is nothing but a cash cow for the medical profession and big pharma. ADHD is a diagnosis that is given by parents and physicians to a child and is a form of child abuse.— URANIUM235
- Amen!
It was bad enough that an entire generation of parents and teachers were given a free pass when it came to accepting responsibility for failing to bring up the children for whom they were responsible - Johnny/Suzzie can't sit still and it's not our fault.
Now the pop psychologists and the prescription drug industry have cloned their cash cow and are intent on convincing a bunch of irresponsible, lazy adults that their "problematic behavior" is also caused by the very same culprit that devils little children - Attention Deficit, ugh, duh?. - You obviously don't know what you are talking about. There are tons of well done studies. Do some good research before making such claims. — 5daisies
- "the reality is that the impact of untreated ADHD is often much worse than any of the medication side effects."
The reality is that the pharmaceutical industry and their enablers in the medical profession are creating a nation of prescription drug addicts who think that all of their problems can be solved with a little bitty pill. Like the tocacco industry figured out, hook em' while they're young and you'll have customers for life.
— KenzoJoe - Taking a pill for ADHD does not solve all their problems and any good pediatrician or psychiatrist would tell you that. The medicine just makes it easier for them to pay attention.
Many patients stop taking medicine after they learn how to effectively deal with the symptoms of ADHD (which they learn while taking medicine)
Have you ever heard of multimodal treatment plans??— 5daisies - Back in the mid seventies we found, and some of our friends found out that by eliminating chemicals such as msg from food, no artificial flavoring and colorings, much sugar and candy, plenty of outdoor play time, minimal tv each day, it all worked. ADHD is not a real disease, it is a money maker for drug manufacturers and so called doctors.— LJM
- Then what you saw in this very small, non-researched based observation is that these kids were sensitive to msg, sugar, artificial colorings, etc. It mimicked ADHD symptoms. That doesn't mean ADHD isn't real.
For some people with ADHD, a change in diet and all the other interventions you mentioned will not solve their problems.
— 5daisies - Then what you saw were food allergies or sensitivities. Those kids you spoke of had similar symptoms as kids with ADHD but it wasn't ADHD.
As an analogy, imagine two people of the same peer group. One wins the lottery, the other suffers some tragedy. They may both be crying but for very different reasons and, unless you knew the back story, you could come to the wrong conclusion.— 5daisies 
The blogger merely glances over the fact that these drugs are abused on high school and college campuses all over the country. Ritalin is black market pharmaceutical crank.— CCRichards- You have it backwards - Ritalin is 'white market' pharmaceutical crank. At least it's more pure than the stuff flooding over the border from Mexico. — bad joe s
- As much as I would like to trust the medical opinions of the philly.com posters I have seen this medicine completely change one of my relatives for the better... 15 years ago when he was in middle school. He immediately got his behavior under control and grades improved.— Honestabe71
- For all the posters who are still perpetuating the parental blame game, stop it. Do you honestly think parents:
1. embrace an ADHD diagnosis in their child?
2. beg to give drugs to their kids?
3. turn to medicine before exhausting other avenues first?
Come on. Think about what you are saying before you say it. (btw, that's a common ADHD trait)— 5daisies
