News of children dying due to an overdose of ADHD medications and antipsychotics have made more parents aware about the issue of using such drugs to “cure” behavioral problems in children.  While these tragic occurrences show the most extreme outcome of the issue, they serve as a good reminder of the decisions parents must face, especially when their children receives the ADHD diagnosis.  Should you medicate your child in the hopes of getting good behavior? Here is a straightforward look at what these stimulants can do to your child.

It’s common for parents to turn to doctors when their children exhibit out-of-control behaviors they cannot explain.  They often breathe a sigh of relief when their child gets diagnosed with a psychological condition like ADHD or childhood depression. Now that you know what’s wrong and that there are medications available for it, your child will get all better, right?

Unfortunately, a receiving a diagnosis and prescription is not a complete solution to your child’s problems. In fact, pharmaceutical drugs targeted at behavioral improvements are a shot in the dark at best.  At worst, they cause nasty side effects that exacerbate the symptoms of the behavior or introduce new health problems; stimulant medications, for instance, cause cardiovascular complications in children if taken at high doses.   While certain drugs have been considered effective for specific disorders, keep in mind that the medicine that works for one child may not work on another.  You may have to go through a period of trial and error, which will require a lot of patience and time.

The matter of receiving diagnosis is also a problematic one, especially when it comes to children. Many health conditions share the same symptoms of ADHD and require treatments that have nothing to do with psychoactive medications.  It’s easy to misdiagnose ADHD and get treated for a condition that they don’t have, which does nothing to relieve the behavioral problems they experience.

The bottom line is that such medications aren’t designed to improve behavior in children. What they can do for your child is to restore balance to some brain chemicals that may be deficit, prolonging your child’s attention span or allowing them to gain better control of their impulses. Kids who exhibit behavioral problems turn to their “fight or flight” response when they feel threatened, and often pick “fight”. ADHD medications don’t change this tendency, but it may give your child more time to assess the situation and choose a different outcome.

The important thing is this: regardless of whether or not a child takes medication for ADHD, behavioral problems are best addressed by creating structured environments where appropriate behavior can be taught.  In order to function well in school and at home, kids need to learn problem-solving skills and coping skills. You can start by formulating make a behavior plan with your child’s doctor to be implemented at home. Create a routine, make expected behaviors clear, and enforce limits. Give your child incentives to behave well and provide positive reinforcement when he or she cooperates.

If you have decided to medicate your child, do manage your expectations about their effects. ADHD medications can help your child focus and calm down, but working with your child is the only way to overcome behavioral issues.

Pharmaceutical companies must be having a field day. A recent study conducted at the University of Pennsylvania found no support for the belief that ADHD medication like Ritalin and Adderall increased the risk of cardiovascular complications among patients. After reviewing the records of more than 241,000 children and adolescents on the drugs from five different states, Dr. Sean Hennessy and his team of researchers concluded that taking medication for ADHD did not increase the chance of heart disease or cardiac arrest among younger folk. In other words, this study effectively declared ADHD as safe for children.  But is it really as harmless as the study claims?

Many experts, including myself, remain skeptical about Dr. Hennessy’s findings. In the scope of pharmacological studies, Dr. Hennessy’s research is considered very small, and the findings may not be scientifically significant as a result. The study also does not encompass the long-term effects of drug use, as it used records from as late as 2007 for its data.

As I’ve pointed out in the past, Ritalin, Adderall and other similar drugs have consistently been found to increase blood pressure in patients taking them, as well as raise the patients’ heart rate. Both side effects could potentially lead to more harmful complications in the cardiovascular systems of those who take the medication. It is possible that early exposure to these conditions, as is the case when children take anti-ADHD medication, can significantly increase the odds of heart problems developing over time. As a result, further research is needed to confirm whether or not using these drugs will raise the chances that patients will suffer heart attacks or cardiovascular disease at an earlier age than the average.

Dr. Steven Nissen of the Cleveland Clinic is one of numerous experts who warn against the study giving parents and pharmacists false reassurance. He argues that any medication that increased both the patient’s heart rate and blood pressure was consistently found to cause long-term cardiovascular damage, and that there is no reason to think popular ADHD medications are any different. Like Dr. Nissen, I advise parents to take Dr. Hennessy’s studies with a grain of salt, and to consider the long-term health of their children before anything else.

Strattera (atomexetine), a drug initially designed to treat depression, is now a popular medication for ADHD and thought to be a safer alternative to Ritalin. Unlike Ritalin, it’s not a stimulant, which means there’s little potential for abuse. It was also thought to be safe and effective for young children, although this has not been studied until recently. A new study published in the journal Pediatrics on March 21 reviewed the use of Strattera on 5- and 6-year olds with ADHD and found mixed results.

The study, which was led by Christopher Kratochvil MD from the University of Nebraska Medical Center, sought to investigate the side effects and efficacy of atomoxetine in young children with ADHD. This double-blind, placebo-controlled, randomized trail involved the participation of 101 children with ADHD aged 5 and 6.  They took their placebo or their atomoxetine for eight weeks, and changes in their behavior were measured using scales.

Although the drug was able to reduce instances of the core symptoms inattention, hyperactivity, and impulsivity, those taking atomoxetine did not show overall functional and clinical improvement.  Many of their symptoms continued to persist despite taking the medication. Side effects of the drug include gastrointestinal problems, poor appetite, and sedation.

The authors gave a contradicting conclusion to their study – they said the medicine was effective, yet significant symptoms remained for most of the children who took atomoxetine.  How can anyone call a treatment “effective” if it failed to alleviate most of the symptoms and problems plaguing these children?

But when it comes to Strattera, its lack of overall efficacy is not the worst part. Strattera has been found to cause liver injury in children, problems passing urine, fainting, stroke, heart attack, and increased blood pressure. Several clinical studies discovered that Strattera increases the risk of suicidal thoughts and behavior among 2,200 children and teenagers with ADHD.

There can be no doubt that Strattera has helped some children and teens manage their ADHD symptoms. But for those who do not benefit from this drug, all they experience are terrible side effects and none of the relief it promises to deliver. In addition, ADHD medications are not designed for long-term recovery; as soon as their effects wear off, the symptoms return.  Studies have also shown that they lose their beneficial effects after three years of use.

Medication might seem like an efficient and simple solution to ADHD, but this complex disorder requires much more than a pill. Instead of medicating your child, consider a holistic treatment program that will get to the root of the symptoms and give you child a proactive role in his or her treatment.

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As students struggled to study for their final exams before the holidays, I noticed that news reports about Adderall use in campus began to appear more frequently. Adderall is a long-acting amphetamine used to treat ADHD, with effects that last up to 10 hours.  It’s ability to boost focus, concentration, memory, and energy levels make it a popular drug among young professionals and college students, who need them to enhance performance. But does Adderall really work for this purpose?

Probably not, says findings from a study done by the University of Pennsylvania.  The paper, which was presented at the Society of Neuroscience’s annual conference last month, discovered that Adderall doesn’t always provide the effects desired by the user.

This study recruited the participation of 47 people, all in their twenties and without an ADHD diagnosis.  Various cognitive functions were tested, from raw intelligence, to memories of specific events, to working memory (the ability to hold information needed for tasks like reasoning and comprehension).  Every subject received a placebo and an Adderall, and they did not know which pill they were taking.

The results were very fascinating to say the least. Previous research has nothing but glowing things to say about Adderall’s effects on cognitive performance; effects include improved focus and alertness, even better judgment.  However, the University of Pennsylvania study reports that while most participants felt the inflated sense of productivity, others did not experience this boost.  In fact, many of the smarter participants showed reduced performance in some cognitive tests.  On the tasks that involved impulsivity and working memory, Adderall leveled the playing field, allowing the below-average performers to perform just as well as the others.

The most interesting finding was the final question they asked the participants – “How and how much did the pill influence your performance on today’s tests?” Those who took Adderall were more likely to say that the pill made them do better on the tests, even though the actual test scores do not reflect an improvement over the placebo score.

It is not known why Adderall benefits some and does not work for others, but the bottom line remains – do not take Adderall, Ritalin, or other ADHD medications unless prescribed by a doctor, especially if you suffer from high blood pressure, mood disorder, or psychosis.

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If ADHD medications like Ritalin are chemically similar to substances like cocaine and amphetamines, does that mean they are addictive? Technically, the answer is no.  Although both Ritalin (methylphenidate) and cocaine stimulate the production of dopamine, Ritalin takes longer to metabolize while cocaine works instantly. For pleasure-seeking recreational users who want the immediate gratification of stimulants, this makes all the difference in the world.  The effects of cocaine wear off faster than Ritalin, causing the user to crave for more drugs to sustain the high. Based on this major difference, experts conclude that ADHD medications metabolize too slowly to be habit-forming – as long as kids and teens take their pills as instructed by their doctor, that is.

But as it turns out, not all teens that use ADHD medications take them as prescribed.  In fact, many of them might not even have ADHD. According to a new study published in the journal Pediatrics, the number of teens who overdosed on ADHD medications rose 76% over the last seven years.

Researchers looked at data gathered by American Association of Poison Control Centers, which was based on calls from 13- to 19-year olds between the years 1998 and 2005. Throughout this time, nationwide calls for ADHD drug misuse increased from 330 to 581 yearly.  Around 42% of affected teens experienced moderate to severe side-effects such as aggression, seizures, personality changes, and psychosis. Most had to be rushed to the hospital for emergency treatment, while four of these cases resulted in death.

Indeed, abuse of Ritalin and other prescription drugs is a phenomenon college guidance counselors struggle with every year.  From the point of view of a teenager, the short-term side effects of ADHD medications are very desirable. Not only does Ritalin suppress appetite and cause weight loss; the drugs help students stay up all night while they frantically finish papers or study for exams. It’s common practice for teens to crush the tablets and snort the medicine as though it were cocaine; this makes the methylphenidate metabolize faster. Unfortunately, ADHD medications do have a strong potential for abuse if they are taken this way.

The study’s authors did not have information as to whether the abusers were diagnosed with ADHD or not. However, anecdotal evidence and previous research suggests that many of these teens did not have ADHD. According to a study by the University of Miami, students who were prescribed ADHD medications were least enthusiastic about taking them. On the other hand, non-prescribed students were more eager to use these drugs, which can be obtained from ADHD peers who are more than happy to sell or trade extra pills. It’s not uncommon for teens without ADHD to fake the symptoms so that they can obtain a prescription from a doctor.

Even though there are only hundreds of overdose cases compared to the millions of children who take Ritalin and other stimulants, the rising numbers are consistent and reflect a major increase in teenage substance abuse problems.  If your child or teen is taking medications for ADHD, make sure that you’re aware of where the pills are stored, how many there are, and who has access to these drugs.  Better yet, keep them in a place where your child can’t sneak them out.  Watch out for signs of abuse, which include difficulty focusing and increased agitation. You may also want to consider trying a non-medical approach to manage ADHD, especially if your child no longer shows improvements after years of taking medication.

It’s difficult to quantify what the most effective ADHD treatment is. Because a child experiences more problems than hyperactivity, impulsivity, and inattention, it’s not uncommon for parents to use more than one method to treat ADHD.   But which of these treatments have the most impact?  According to a new survey from Consumer Reports, stimulants are the most effective ADHD treatment for kids, but parents still think it’s not enough.  In fact, the survey notes that kids who tried alternative treatments besides medication did better than kids who were on medication only. As for the most effective non-medical treatment for ADHD, it turns out that sending children to a school better equipped to deal with ADHD made all the difference.

Consumer Reports spoke to 934 parents of children with ADHD and asked them about various topics, from the impact of ADHD medications to the effects of alternative treatments like behavior therapy and diets.  It was discovered that 84% of parents medicated their children at some point, and that 67% of them reported that the stimulants were helpful.  What’s surprising is that not all of the parents were satisfied with the effects of medication, even those who reported that they reduced hyperactivity and inattention.  Only 52% of parents believed that if they could do it all over again, they would medicate their children, whereas 44% also wished there was another way to treat ADHD.  It’s likely that these findings were due to the various side effects of stimulants, which were reported by 84% of parents.

As for treatments beyond medication, 45% of parents discovered that switching their kids to a school that can handle ADHD helped their children “a lot.” Hiring a tutor also worked for the 37% of parents who did so, as did providing a structured schedule of activities.

Diet and nutrition is another approach some families had success with. 17% of families found that adding multivitamins and supplements helped “a lot”, while fish oil supplements got very satisfied marks from 12% of families that tried them.  It looks like these parents might have found validation from the recent study that demonstrates the impact of Western diet on ADHD.  Fast food and junk food not only contain high concentrations of sodium, fat, and refined sugar; they drain the body’s nutrient stores when they get converted into energy.

Although there is no single ADHD treatment that is universally effective, natural remedies and alternative treatments are always worth looking into.  Medication will make it easier for a child to behave and learn because he or she is not as distracted, but popping a pill everyday is like applying band-aid to a wound. It won’t make the disorder get any worse, but it won’t treat the root of the problem either.  At the end of the day, ADHD is a complex condition that requires various treatment methods if you want your child to overcome the disorder for good.  As to what these treatment methods are, it depends on the possible causes of the disorder, what your child needs, and what your overall treatment goals are.

As for narrowing down these treatments, Consumer Reports suggests that parents keep all copies of test results, psychological records, and other medical records related to their child’s ADHD.  It also helps to make a list of every professional who treated your child, the treatment strategies you have tried, and your child’s responses to each. That way, you’ll have an easier time figuring out the next step when you seek a new professional for your child.

Children who do not respond to stimulants for ADHD are sometimes given “off-label” prescriptions for other drugs to help them cope with the symptoms. “Off-label” use is when a drug is prescribed for a disorder other than what is approved by the Food and Drug Administration (FDA). This is a fairly common practice in Western psychiatry; for instance, until the ADHD drug Intuniv was approved by the FDA, some children were prescribed anti-hypertensive medications when stimulants failed them. Today we are going to talk about Abilify, an anti-psychotic drug approved to treat schizophrenia, bipolar disorder, depression, and irritability associated with autism. Abilify is sometimes used off-label for ADHD.

What is Abilify?

Abilify (generic name aripiprazole) was approved by the FDA in 2002 to treat symptoms of psychosis, including social withdrawal, blunted affect, inability to experience pleasure, and hallucinations in people with schizophrenia.  It is thought that these effects are due to Abilify’s complex effects on dopamine and serotonin receptors.  Essentially, Abilify is a “partial agonist” of dopamine receptors – it reduces excess dopamine activity, which is thought to cause delusions, hallucinations, and other symptoms of psychosis and schizophrenia.  It can also increase dopamine activities in areas where it is deficit, and balance out levels of serotonin on the brain.

How can Abilify treat ADHD?

The drug is thought to benefit children and adults with ADHD because of its positive effects on symptoms of bipolar disorder. These symptoms include impulsivity, irritability, and racing thoughts, which are also the hallmark symptoms of ADHD. However, researchers are still investigating Abilify as an ADHD treatment.  One study, which was completed in May 2009, concluded that “No significant treatment effect in ADHD symptoms was observed.”

What are the side effects of Abilify?

Like medications for ADHD, Abilify has side effects that may actually aggravate the symptoms of the disorder. The pharmaceutical website states that Abilify may cause akathisia (restlessness or the need to move), fatigue, constipation, or insomnia. Although Abilify is said to have a low rate of significant weight gain in adults, parents of children who took the drug reported excessive weight gain due to overeating. Although their ADHD symptoms did improve, parents eventually discontinued the use of medication for fear that the excessive eating caused by the drug will lead to serious health complications in the long run.

Severe side effects include an increased risk for neuroleptic malignant syndrome (NMS), a potentially fatal condition that is sometimes associated with the use of antipsychotic drugs like aripiprazole. Symptoms of NMS include irregular blood pressure, myoglobinuria (presence of myoglobin in the urine due to muscle destruction), excessive sweating, acute renal failure, and irregular heartbeat.

Another syndrome related to aripiprazole use is tardive dyskinesia. “Dyskinesia” is a condition characterized by involuntary, repetitive, and purposeless body movements, where as “tardive” means a “slow or belated onset.”  Movements associated with tardive dyskinesia include lip smacking, tongue protrusion, rapid eye blinking, and grimacing.  Anyone who develops tardive dyskinesia has a hard time staying still and not moving.  As if this is not bad enough, tardive dyskinesia is thought to be irreversible. The likelihood of developing this syndrome increases throughout the duration of the treatment and the total cumulative dose of the drug.

Since there are virtually no studies on the long-term effects of Abilify, the use of this drug as an off-label treatment might be too risky for children. Although Abilify is said to have fewer side effects than the average anti-psychotic medication, it may too dangerous to take this gamble, especially since children are more vulnerable to the neurological effects of medication.

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Stimulant medications are not the only drugs used to treat ADHD in children.  Over the last several years, doctors have been turning to antidepressant medications like Desipramine and Imipramine for various reasons. Sometimes, these drugs are prescribed because of a co-morbid mood disorder like depression or anxiety.  In other cases, anti-depressants are given when stimulants fail to yield positive results.  Many believe that the increase in the use of anti-depressants for ADHD is a response to popular media’s criticism of stimulant medications and its harmful side effects. But are anti-depressants necessarily more effective and safe than stimulant medications? Can mood disorders and behavioral problems be treated naturally?

The lowdown on anti-depressants

The type of anti-depressants used on children with ADHD is called serotonin reuptake inihibitors (SSRIs). SSRIs promote the circulation of serotonin, the feel-good neurotransmitter, by preventing certain nerve cells from re-absorbing (reuptake) this chemical.   By increasing the level of serotonin in the brain, moods and emotions become more stable. However, because some of the neurotransmitters are contained in neural pathways in other parts of the nervous system, antidepressants can have side effects.  Antidepressants can also interfere with other functions like sleep and appetite.

Research shows that in between 1995 and 1999, the use of Ritalin for children under 7 increased by 23% and the use of SSRIs went up by 580% – even though these drugs were not approved for anyone younger than 18.  Like stimulant drugs, SSRIs contain a lot of harmful side effects.  According to Dr. Ann Blake Tracy, author of the book Prozac: Panacea or Pandora, SSRIs can do more damage than good. The high levels of serotonin caused by these drugs can produce an “initial euphoria, psychosis, mania, aggression, organic brain disease – especially mental retardation at a greater rate in children.”  Ely Lily, the manufacturer of the SSRI Prozac and a number of pharmaceutical drugs, also reports that ADHD patients who take Prozac are twelve times more likely to commit suicide than ADHD patients who are not taking it.  It doesn’t get better when the child stops taking this drug; the withdrawal symptoms of SSRIs usually cause violent side effects.

Drug-free alternatives to SSRIs

Knowing that SSRIs aren’t good is just half the battle. The tricky part is to come up with effective drug-free solutions to the depression, anxiety, and behavioral problems experienced by children with ADHD. The good news is that there are a lot of options – it’s all a matter of finding one that will work best on an individual child.

Children and adults with ADHD have been able to overcome depressive symptoms and mood problems with the right diet. Allergic reactions to certain foods often manifest themselves as bad behavior and mood swings. In fact, you can see this at work through Dr. Doris Rapp’s videos, where she shows how the wrong foods can make a dramatic change in a child’s personality.

The herb St. John’s Wort has not been found to be of any help in treating ADHD symptoms, but studies show that it can alleviate co-morbid depression in individuals from ADHD. Ask your doctor for advice on the right dosage.

Other options that might help include cognitive-behavioral therapy, sports, play therapy, and chiropractic care.

While stimulant medications have helped some children reduce their hyperactivity and inattention, we cannot ignore the fact that a number of children need a more comprehensive treatment for ADHD. Not only do ADHD medications fail to work in the long run, but they also carry serious long-term side effects. Unfortunately, it’s a lot easier to get children and parents to agree to use stimulant drugs. According to a study published in Pediatrics, one in 20 American children received free drug samples from their doctors a year. As for those who decided to take prescription medications that year, almost one in 10 received a free sample. However, the study points out that these free samples may be unsafe.

These conclusions were drawn based on data from 10,295 children and adults in the2004 Medical Expenditure Panel Survey. Four of the fifteen most distributed drug samples were identified by the United States Food and Drug Administration as having serious safety concerns. Among the top four were are Adderall (amphetamine/dextroamphetamine), Strattera (atomoxetine), and Ritalin (methylphenidate) – stimulant medications used to treat ADHD. These stimulants belong to the same drug family as cocaine and pose the same long-term risks as this drug. While they are not addictive by themselves, free samples don’t usually come with clear instructions on how to take them, giving them lots of potential for abuse or recreational use.

Some physicians argue that free drug samples are a cost-effective way to provide medications to those who could not otherwise afford them. However, the study’s findings indicate that most of these free samples never reach their intended market. Only 16% of those who got free samples had no health insurance, and less than a third of these children came from families with low incomes (less than $38,000 a year for a family of four).

Another concern worth noting is that free samples tend to be for new medications that have just been introduced to the market. These new drugs have been released even though their safety profile has yet to be fully studied. And with stimulant ADHD medications, you can’t be too careful about their short-term and long-term side effects.

Treating ADHD with medication seems like the most convenient and practical approach to this disorder and free samples only encourage the casual use of these drugs. But we have to remember that medications alone are not enough to address the full spectrum of ADHD’s causes. In the long run, a comprehensive and holistic approach to ADHD management can circumvent the side effects of stimulants while providing results that last.

Chiropractic and dietary changes are possible alternatives, according to Dr. Ashton

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