Why do many parentsnot pursue pharmaceutical treatment for ADHD?In a study involving 850 families, the conclusions reached were:
1. Side Effects
2. Assessments lack "objective" procedures, that is, assessments are largely subjective, or, opinion based, rather than scientific or definite.
"The reason cited most often for not beginning medication treatment - reported by 92% of parents in the sample - was fear of medication side effects. Concerns about side effects and an assessment process that lacked "objective" procedures - were far and away the leading reasons that parents chose not to try medication with their child. What about parents who were willing to initiate such treatment but who discontinued it within 3 months?
In this case, the most frequently cited reasons were the development of side effects - reported by 49% of parents - and continued problems at home or school despite medication - reported by 48%. (Monastra, V.J., May 31, 2005)
Information on side effects was also obtained at each follow-up assessment.At the 6-week time point, reports of side effects were relatively common. In fact, over 90% of parents reported observing appetite loss and sleep difficulties, over 80% reported that their child had lost at least 5 pounds, and over 50% reported that their child was showing increased irritability. Increased symptoms of depression were reported by 25%.
Such side effects are what lead many families to discontinue their child's medication therapy. By 6 months, reported side effects had declined by approximately 50% and by the 2-year follow-up, the only side effect that continued to be reported by 15% of parents was appetite suppression.
Thus, parents clearly observed a substantial decline in medication side effects for their child over time. (Rabiner, D., January 2006. Attention Research Update. Summary of longitudinal study. http://www.helpforadd.com/2006/january.htm)
Conclusions on side effects of ADHD medication
For most children, (50%-90%) there will be serious side effects, with medication use:
· Weight loss
· Insomnia
· Depressionand others
It is thought that within six months, only about half of children on medications for ADHD will continue to have serious side effects. (Rabiner, D., Based on longitudinal study of side effects for stimulating medications). Within two years time, a recent study indicated, only 15% of those on medications for ADHD will have serious side effects. (see David Rabiner, helpforadd.com.)
There would appear to be a tolerance that develops in children who are on medications for ADHD. It might also be true, however, that, as in the case of Prozac, the effectiveness of the medication decreases in time as tolerance builds. While some children do benefit in the ability to concentrate in the short term, long term benefits of stimulant medication is disputable.
Notes: In What way is methylphenidate (Ritalin) like cocaine?Washington: Advanced imaging research has answered a 40-year-old question about methylphenidate (Ritalin), which is taken daily by 4 million to 6 million children in the United States: how does it work? The answer may unsettle many parents, because the drug acts much like cocaine, albeit cocaine dripped through molasses (J Neurosci. 2001;21:RC121).
Taken orally in pill form, methylphenidate rarely produces a high and has not been reported to be addictive. However, injected as a liquid it sends a jolt that "addicts like very much," said Nora Volkow, MD, psychiatrist and imaging expert at Brookhaven National Laboratory, Upton, NY. "They say it's like cocaine." (Vastag, B.)
Tics-How Serious a Concern?
Summation on ADHD drugs, side effects and efficacy
Some children do experience some improvement of symptoms associated with ADHD when they begin taking drug therapy. It would seem that, like drug treatment for depression, about half of the children who are prescribed stimulants do experience some improvement.
The improvement may be do in part, however, to the involvement of professionals and extra attention being given the child.
It has been noted that lifestyle changes can affect a similar and greater improvement for the majority of children.
The positive affect medication contributes to a child's mental state is temporary, and usually, within 2 years, the positive affect on the mood of a child will no longer be noticeable.
