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Title: Ritalin's Better Side
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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Ritalin's Better Side
by Anthony Kane, MD
A number of months ago someone accused me of this and I wrote
the article, The Stimulants: Ritalin and its Friends. I guess
that wasn’t enough because I just received another letter
accusing me of being anti-medication.
Rather than address this letter individually, I thought I would
publish a recent interview I did with a free-lance journalist.
The journalist was preparing an article for Parenting Magazine
about ADD ADHD treatment and wanted to know my thoughts about
the current treatments. Since she was on assignment
in Brazil and I wasn’t passing through Rio that week we decided
to conduct the interview by email.
Here is the case that she presented me to me:
A parent of a five year boy who is bouncing off walls
comes to you and says,
“I hear stimulants work but that they have side effects.
I also hear that researchers still don’t know a lot
about what stimulants do to a child’s health in the
long run.
“What do you recommend? Do you think stimulants are being
pushed too hard by many professionals?”
Here is my response:
Are Stimulants Being Pushed too Hard?
I don't think that stimulants are being pushed too hard, but I
do think that they are not being used properly. The main
advantage of stimulants, like Ritalin, is that they help control
the child's symptoms so that other interventions will be more
effective. For the most part, this is not how stimulants are
being used.
In conventional medicine the most reliable treatment for ADHD
is a combination of medication, like stimulants, and behavioral
modification. The advantage of stimulants is that they help
improve the ADHD symptoms better than any other conventional
treatment. Unfortunately, stimulants play no role in curing the
condition nor do they provide any long- term changes in the
condition.
Behavioral therapy helps the child work with the ADHD behavior
and improves his responses to situations. It doesn't make the
child into less of an ADD ADHD child. Rather, it helps direct
his behavior so that he is an ADHD child who functions better.
When used together as part of an over all treatment plan, these
two approaches are the most effective means of dealing with
ADHD currently recognized by conventional medicine. I want to
point out that they don't provide a cure, but they do help the
child function more normally in spite of the problems.
In many and perhaps most cases, these two approaches are not
being used together. The reason is the cost. It is fairly cheap
to give a pill. It also doesn't take a lot of time on the part
of the physician, and the parents see immediate results. Therapy
requires hours of intensive high cost professional intervention
and the results are not over night. Someone has to pay for this,
and it is usually the parents. Most medical insurance plans will
pay for doctor visits and medication, but they are less ready to
cover months of psychological intervention. As a result, most
children do not get behavioral therapy.
Side Effects of Stimulants
There are some problems with side effects from these medications.
However, we currently have a number of different products and
dosing schedules available. Basically, with the exception of
loss of appetite, every common side effect of these medications
can be eliminated either by changing the dose or by switching to
a different drug. This is one of the advantages of having a
psychiatrist who specializes in managing ADHD work with your
child. They are much more adept at using these medications than
the average family physician.
Health Risks of Stimulants
With regard to the long-term health risks of stimulants, I feel
this concern has been blown way out of proportion. We have been
using stimulants for almost 80 years. There is no other
medication used in psychiatry today that has been so thoroughly
studied. We know more about stimulants than any other
psychiatric medication and they are also the safest drugs used
in psychiatry. That doesn't mean that they are completely safe,
but it does suggest that there are going to be no new surprises.
After being used for 80 years, it is not likely that some
catastrophic consequence of taking Ritalin that nobody knows
about yet is going to pop up. It has been around too long.
An Approach to Treating ADHD in a Young Child
Given all that, concerning the theoretical child in question,
I would definitely not start with medication. Since the child
is only 5, then school is not a major factor yet. I would focus
on trying to find other things that might be contributing to the
behavior.
For example, iron deficiency has been linked to difficult
behavior. It is also very common in young children. I think that
there is strong evidence to link food sensitivities to ADHD
symptoms. There was a big debate in medicine about food
sensitivities thirty years ago. The research was pretty shabby
on both sides, but the evidence is strong enough to suggest that
in some children, food sensitivities contribute to their problems.
I also have personal experience with this. At one point we
suspected that our son, who had been on Ritalin for four or five
years, had sensitivities to certain foods. We took him off those
foods. At the end of a week he came to us and said that he
didn't need the Ritalin anymore. He has been off Ritalin for
four years.
There are lots of other things I would look into before starting
medicine in a child this age. Recently, I researched over two
hundred books articles and scientific papers to determine which
non-conventional treatments are effective. I found that of the
many things people say cure ADHD, about 35 treatments have good
support in the medical literature. I designed a treatment
program to help parents use these treatments. Information on
this program is currently available on my web site at
http://addadhdadvances.com/childyoulove.html.
How to Use Non-Conventional Treatments
Although it is clear that many non-conventional treatments are
effective, parents should not look for alternative treatments
blindly. There are over one hundred things on the market today
that people are selling and say will help. Even though they all
quote testimonies of people who have been helped by what they
offer, most of these treatments are completely worthless. Any
positive results they do get are due to the placebo effect.
These successes do not last long.
Even with things that do have scientific support, like certain
supplement combinations, you still have to be careful. Most of
the supplement combinations are dosed so incorrectly that they
are completely ineffective. Some of the things being used are
actually dangerous. The point is that you have to be careful.
People have a misconception that natural medicines are harmless.
They are not. There have been fatalities caused by taking
supplements and herbal remedies.
I understand that most parents will have no idea how and where
to start. Unfortunately, they will also have trouble finding
doctors who are well versed in all the options. That is actually
the reason I started my website. Anyone who has any questions
about this can contact me directly by email at
akane@addadhdadvances.com
The point is that medication would not be my first choice in
a child this age. In an older child where school performance
is an issue, I would opt for medication earlier in treatment.
Focusing on Behavior
I would start with counseling right away, particularly with
parent training and social skills training. The parents are
going to have trouble raising this child. Normal parenting
skills and parenting books are not going to work. They will do
their child and themselves a big favor if early on they learn
how to address their child's behavior. I realize that this is
going to be expensive. This is the reason I designed the ADD
ADHD child behavior program, How to Improve Your Child’s
Behavior. I wanted to provide parents with the tools to help
their children without having to pay the $3-4000 that therapy
usually costs. However, it is imperative that the parents learn
how to control and guide their child properly. And the younger
the child is when they start such a program, the happier
everyone is going to be.
Focusing on Social Skills
These children often have trouble making and maintaining
friendships. This is not the first thing on the parents’ minds
when they come to the doctor, but this is the biggest problem
that these children will have when they are adults. Once they
are out of school, most people can find some type of work
situation that is compatible with their ADHD. However, children
who never learn how to develop and maintain proper social
relationships are headed for life long misery. It pays to focus
on this as soon as possible.
Taking Action Early
I would like to emphasize that parents should not delay in
seeking help. We can do a lot to help a five year old. Not a
lot of damage has been done yet. It is much harder to start with
a 15 year old. You have to help mend all the years of suffering
that the child has had to endure as well as address the actual
ADHD problems.
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
================================================================
Anthony Kane, MD is a physician and international lecturer. He
is the author of a book, numerous articles, and a number of
online programs dealing with ADHD treatment
(http://addadhdadvances.com/childyoulove.html),child behavior
issues (http://addadhdadvances.com/child-behavior.html), ODD,
and education. Visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart
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