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Allan Schwartz, Ph.D.Allan Schwartz, Ph.D.
Dr. Schwartz's Weblog

Children, ADHD and Stimulant Medication

Allan Schwartz, LCSW, Ph.D. Updated: Oct 2nd 2009

family wooden figuresA lot of controversy continues to swirl around the issue of ADHD and stimulant medications, such as Ritalin, Adderal and others. Parents worry about such things as their children suffering liver damage, addiction to stimulants, stimulant abuse or becoming involved in the use of illicit drugs as a result of using stimulants. These worries are not unrealistic. However, the dangers must be weighed against the potential benefits of stimulants in treating ADHD. In addition, the consequences of ADHD going untreated are also potentially dangerous. A new study support the fact that these medications are enormously beneficial for youngsters with this disorder.

The Study:

The results of the research was published in a "Pediatrics," 2009; volume 124:pages 71-78. The title of the article is, "Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-Year Follow-up Study."
Biederman J,et.al.

This piece of research used the longitudinal method. The term longitudinal means subjects were followed  over a ten year period. According to the authors, all the studies until now have been short term.

The authors were particularly interested in whether the medications would help prevent disorders associated with ADHD. For example, those with ADHD often develop such problems as: Major Depression, Multiple Anxiety Disorders, Conduct Disorder, Oppositional-Defiant Disorder or bipolar disorder and being held back in a grade due to poor academic performance. All of these are known as comorbid conditions of ADHD. In other words, left untreated, ADHD children are at risk of developing one of the diagnoses.

Subjects for the study were 140 youngsters, all with the typical symptoms of ADHD. They were followed 1, 4 and 10 years later. Ninety two subjects received stimulant medication while 39 did not. Those who did not had parents who refused medication treatment. On average, the medication group used stimulants for at least a six year period.

The researchers concluded that there is a much lower risk for developing comorbid disorders in the medication group with one exception, and that was Bipolar Disorder. This is probably due to the fact that BPD has very different causes at its roots.

There are psychiatrists who report that while many parents are reluctant to use stimulant medications they should at least give it a try.  The "handy rule of thumb, they suggest, is that if a child improves academically and socially , its a good sign that the medication is helping.

Discussion:

Dr. David Rosenthal, MD and Psychiatrist in the Boulder Colorado area, is an expert on ADHD in children and adults. In an interview, he stated that many of the prison inmates with whom he worked in the past were people who should have or could have a diagnosis of ADHD. However, they had never been treated for the condition and, in his opinion, might not have become criminal if they had been diagnosed as children and received stimulant medications. He also reported that, in his work with ADHD children, there often a dramatic improvement in their behavior and academic achievement.

I would add to this my observation that, along with medication treatment, a specialized psychotherapy focused on skills development is enormously important. The important types of skills that need to be acquired by these children are such things as listening skills, impulse control or learning to delay gratification, thinking or cognitive skills, organizational techniques, taking notes in school and focusing attention, among others. There are psychologists and social workers who use particular coaching methods with ADHD children and adults.

Many of the comorbid conditions associated with ADHD result from both failure at school as well as frustration and a loss of self esteem and self confidence. It then becomes easy for children and teenagers include themselves with other children and form anti social groups who turn to drugs and alcohol by the time they get to secondary school For many of these youngsters, that then marks the start of what can become a criminal career. All to often, the criminality is the result of involvement with drugs. The same can be said for those who tend more towards depression and self hatred.

In my experience working with adults with ADHD is that there is a high incidence comorbid Major Depression. Dr. Rosenthal has stated to me that this stems from the deep sense of disappointment people with ADHD struggle with throughout their lives. It is difficult for them to feel good after they have been repeatedly told by teachers and loved ones that they are lazy, thoughtless, uncaring and unmotivated.

It is important to know that one of the symptoms that is part of ADHD is a lack of motivation. I do not believe the exact reason for this is known as yet. Also, low motivation is something that varies from one ADHD individual to the next. Suffice it to say that, by the time someone reaches adulthood without treatment, it is very natural for depression to set in.

Your comments, questions and experiences are encouraged.

Allan N. Schwartz, PhD.

 

 

 

 

 

Allan Schwartz, LCSW, Ph.D.

Readers who live in the Boulder, Colorado metro area, or in Southwest Florida may contact Dr. Schwartz for face-to-face consultation. He is also available for psychotherapy through Skype video for those who are not in Florida or Colorado. He can be reached via email at dransphd@aol.com for details.

    Reader Comments
    Discuss this issue below or in our forums.

    contradictory case - John - May 6th 2012

    I have recently been diagnosed with ADHD and after the diagnosis I was looking around the web just looking for other individuals testamonials. After doing so I had contacted my parents and had asked them if there was any possible talk of me having childhood ADHD. Really to my suprise they both said yes without hesitation. They had told me that around age 6-7 there was concern for the issue but they were divided over treatment and decided to wait atleast one year. At age 8 I was struck by a car and suffered a TBI. After that event my parents both denied any treatments as they feared any and all possible negative side effects. Now years later I am 20 years old currently serving  our country proudly in the United States Air Force as a Medic (which need I say has the most academically challenging tech schools in the entire Air Force) still with the ADHD and no medications I passed the course with \\

    ADHD/Meth = prison - A Very Sad Mom - Nov 25th 2010

    I sure wish I had put my son on meds when he was young. He was already taking lots of stimulant asthma medications and was very small. I was afraid to put him on Ritilan. This was back in the early 90s. He was diagnosed with ADHD at age 7.

    He became addicted to meth as a teen. He said it made him feel "normal." Along with the meth use came sexual problems. (Jail is for indecent exposure).

    Last week he ran away wanting to commit sucide. You know, he is not a bad person, he is very smart and loving. He is just lost.

    That's my story.

    my experience - steve - Oct 28th 2010

    Ih ave been on ADHD meds since year nine and Iam now in 4thyear university completing a bachelor of animal research degree. contrary to the mean results published and expert opinion, on the subject i would have to dissagree with the outcome of stimulent medication for treatment. I have a heavy dependence on the neuro stimulent dextroamphetamine sulfate and feel the need to take them every day. I have gone a week without them last year and I slept for 80% of the week, presented sypmtoms of extreme fatique, with a small walk (300m) putting me back to bed for another 4-5 hours of sleep. This is clearly the event of abuse which I developed within the 5th year on this medication. UnLike niave addicts I have a above average psychological mind and understanding of the lies at which one as an addict fools himself into justifying the addiction. Though on the other hand like an addict I am not pursuing help in fear that drug supply will be cut off and have to go through the withdrawel period again. My message is that this path I took led to me developing from a social but underacheivng acedemic person without the means to acheive the high expectations i once had, to a educated, developed acedemic underacheiving person, (underacheiving due to the development of my dependence issue) unsocial ( A person who has gone out with friends by modes of  intentionally  contacting friends on average twice a year. I am on antidepresents to stabolize my reuptake of seritonin due to public anxiety i had for 1 week severely which scared the crap out of me. And to reduce my innate depression disorder down to a drug withdrawn severity to its life natural level from birth. I may not be in jail or a danger to the public but I know that there is no foreseeable future benifit until I get off this drug. If I wasnt a christain I probably wouldnt have endured this long. never the less I am not lookn for help I just want to make those aware even if the majority of the peer aproved litrature and scientific experts that base the expertice on observation and statistical relationships that the outliers within the data are people and people need to at least be aware of the potential risks involved.   

    Agreement with your article - Byron Scheider LCSW - Nov 26th 2009

    I am a clinical social worker dealing with urban middle school children.  I practiced for twenty years with the VA Healthcare System before taking this position.  I knew nothing about ADHD when I started this new career path.  Ironically, I didn't know I have the condition.  As I read in an attempt to understand these children, I came face to face with my life long problems with distractibility, broken focus on so many goals, my old report cards with negative teacher comments, etc.  I spoke with an experienced psychiatrist and he diagnosed me with ADD.  He recommended stimulant based medications and I have been pleasantly surprised by how much they help me to concentrate and work diligently.  As I continue to study the topic of ADD/ADHD, I find it comforting to know that many of the problems I have experienced in life are tied to the condition.  I am heartened to be able to educate others about this often disabling condition and see new found understanding for a kinsmen or a child.

    Thanks for your good work.  I enjoy your articles and hope to publish a few myself as I grow in this new found wisdom.  Ain't it great!  A 60 year old man can still grow and find fresh hope for accomplishment.

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