| |
|
|
Ask Dr. Sue
ADHD AND THE USE OF RITALIN
Dear Dr. Sue,
I hear a lot about misuse and overuse of medicines for
children who have been diagnosed with ADD or ADHD.
Is Ritalin really the best treatment for them? I
hate the thought of so
many children being medicated with drugs such as that.
What are the pros and cons to medication for these
problems?
Dear Parent,
There are more children being diagnosed
with ADHD now than there were years ago. It is
believed that the true incidence of the disorder is
somewhere between 3 and 5 percent of all children.
Why are more children being labeled as ADHD these days?
One reason is that in previous generations children with
the same behaviors were given different labels, such as
"postencephalic disorder" or "minimal brain disorder."
Another reason, I believe, is that more children in
previous generations slipped through the cracks and
failed to be recognized as having a treatable disorder.
I remember a number of boys from my school days who were
just felt to be "stupid," "stubborn,"
"spoiled," "juvenile delinquents," and so on, some of
whom might have been successful in school if their
problems were looked into a little more closely.
Are there children on stimulant medications who should
not be? Definitely. Are there children on
medications or dosages that are inappropriate for them?
This is also true. It is extremely important that
the diagnosis of ADHD not be made on a whim, or simply
because the teacher can't seem to control a certain
child, or the parents have trouble making him mind.
Before the diagnosis is made, all other possibilities
that could explain the child's behaviors have to be
considered, whether those are medical conditions (such
as a subtle seizure disorder, vision problems or hearing
loss), poor parenting skills, boredom in school, a
learning disability or unrealistic expectations by the
teacher, depression, post-traumatic stress disorder or
anxiety disorder, or just a level of activity that is at
the upper range of normal.
There are four specific areas of treatment for children
with ADHD:
1. School - The parent and teacher must become a team.
The teacher can help by having the ADHD child sit in the
least distracting spot in the classroom, breaking
instructions into small steps,
writing directions on the board, allowing more time for
tests and writing assignments, reminding the child to
turn in his homework, allowing some children to use a
tape recorder to record lessons,
and limiting the number of repetitions of the same type
of work in an assignment. They can also reward
positive behavior and try to ignore negative behavior
when possible. Parents need to get to know the
teacher well, to stay closely in touch with their
child's performance at school, and to be an advocate for
their child.
2. Therapy - Many ADHD children need and benefit from
psychological techniques offered by counselors, support
groups or special classes, which may include behavior
modification, social skills training, anger management,
and support for their self-esteem, as well as help in
dealing with the frustration and anxiety that an
attention disorder can produce. Parents can
benefit from family therapy and/or parenting classes.
3. Home - Parents must look for and reward positive
behaviors, and do their best to avoid rewarding (even by
giving attention to) negative ones. They are the
ones who can best help their child understand that they
have a problem with concentration and impulse control;
and that they are NOT crazy or bad kids. They must
also reinforce the fact that their ADHD child will be
held responsible for all of his choices, but that every
attempt will be made to help him so that good choices
become easier.
4. Medication - Finally, to answer your question
specifically, many studies have shown that stimulant
medications are by far the most effective therapy for
ADHD at the present time; far more effective than the
items listed above without medication. Most
experts think these medications are helpful for at least
70 to 80% of children with ADHD. Stimulants (like
Ritalin) have been used for over 50 years to treat
people with attention disorders. The safety of
these medications has been proven beyond doubt (in spite
of false rumors you may hear about Ritalin causing drug
addiction
or other problems). The most common side effects
are loss of appetite and sleep disturbance, which are
usually mild and temporary. If other side-effects
such as spaciness, irritability or increased moodiness
occur, the medication (and perhaps the diagnosis) should
be re-evaluated, since these are not acceptable
side-effects. With medication, there is every
possibility that a child who might otherwise experience
school failure, rejection by his peers, poor
self-esteem, anxiety and depression, and maybe even
trouble with the law because of his lack of
concentration and poor impulse control can thrive and be
successful and happy.
 
|
|
