Why it might be a good idea to rethink prescribing children under the age of 13 ADHD medication

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a very common mental disorder that affects both children and adults. This condition is characterized by problems that inter with everyday tasks, such as over activity, inattention, and poor impulse control. According to the American Psychological Association, individuals affect by this disorder have trouble establishing realistic goals, often have difficulty getting organized and staying focused, and are often fidgety. These symptoms can results in behavioral problems and low academic performance.

What causes ADHD?

Individuals with ADHD show less activation in the prefrontal cortex and a significant decrease in the neurotransmitter dopamine, which is associated with learning and memory formation, than those who do not have the disorder. It is unclear what causes this and there has been many controversies on the exact causes of ADHD, as researchers are still unsure. In the past, people thought ADHD was caused by consuming too much sugar or watching TV (WebMD). Research has shown no connection between sugar and hyperactivity. Certain environmental factors, such as a mother being ill while pregnant or exposure to certain chemicals may increase an individual’s risk for developing ADHD, but there is no evidence that these are direct causes. There does appear to be a genetic component involved in ADHD, as ADHD typically runs in families.

In the research by Sinkus, et. Al (2014), they discovered that a specific gene (CHRNA7) that was linked to multiple disorders, such as schizophrenia, bipolar disorder, Alzheimer’s and ADHD. They found that in individuals with disorders like ADHD appeared to contain a duplication of exons, and resulted in a gene that no longer function properly. There also appears to be a difference in the brains of individuals with ADHD and non ADHD individuals. In the research by Onnink, et. Al (2015), individuals with ADHD have abnormalities in the gray and white matter in several brain areas, which may contribute to poor control and lead to greater impulsivity.

In research by Shaw, et. Al, they performed MRI scans of about 446 children, half what had ADHD and half that did not. They discovered that in children with ADHD the optimal cortical thickness was reached much later, at the age of ten, as opposed to the age of seven or eight as in the case of healthy children. The area that shows the most delay is the lateral prefrontal cortex, an area that is primarily associated with making decisions, creating memories, attention, and cognitive abilities. They also found that children with ADHD have a faster maturation of the motor cortex, which may contribute to hyperactivity among ADHD individuals.

ADHD Treatment

It is no wonder that the parents of children affected with this disorder seek treatment in the form of ADHD medication, which falls under the class of psychoactive drugs. ADHD medication is not a cure for the disorder, however and it only seeks to treat symptoms of the disorder to enhance a student’s attentional abilities. The problem today is there is an increasing number in the prescription of ADHD medications in children under the age of 17. ADHD is the most prescribed medication among young children. ADHD affects about 3 to 5% (about 3 million individuals) of the U.S population (Psychiatric Times, 2008), but there were about 18 million prescriptions for ADHD medication in 2010 alone (Cohen, 2013). There is concern that ADHD medication can cause unwanted side effect, be highly addictive, and researchers are still unclear about the long term effects of ADHD medication and for these reasons I think that children under the age of thirteen should not be prescribed ADHD medications.

How ADHD medications work

There are two classes of ADHD medication; stimulants (Adderall, Ritalin) and non-stimulants (Strattera). Stimulant forms of ADHD medication are derived from amphetamines a class of psychoactive drugs. They work by increasing the amount of dopamine in the brain, in order to enhance the child’s attentional ability. The stimulant drugs are effective in about 70 to 80% of individuals who take them (WebMD, 2015).

Advantages of ADHD medication

ADHD is a disorder that can adversely affect the lives of the individuals affected. Individuals with ADHD, left untreated generally have poor academic performance, are less successful in forming interpersonal relationships with their peers, are more vulnerable to hostility, depression, and anxiety, they are less likely to hold a job for long periods of time, often are more likely to get fire and be paid a lower wage (Primary Psychiatry, 2013). Adult with ADHD may engage in an increase for risky behavior and more likely to abuse drugs and develop a drug addiction later in life. Individuals with ADHD are more likely to have poor driving skills, due their impulsive nature and are at a greater risk for car accidents.

ADHD medication plays an important role in the management of ADHD. Stimulants are generally the most effective and widely known method of treating ADHD. These medications work quickly and reduce hyperactivity and impulsivity, and children show a significant improvement in the ability to pay attention and learn (NIH, 2015).

ADHD medications also have benefits that go beyond treating individuals with ADHD. There is evidence that psychostimulants can also improve symptoms in those with treatment resistant depression and can help reduce the negative symptoms in individuals with schizophrenia. It is also shown that ADHD can reduce binge eating in those with bulimia nervosa, since the drugs cause a decrease in appetite (Sinita, 2014).

Disadvantages of ADHD medication

About 84% of children who tried amphetamine based drugs experience side effect. These side effects can include decreased appetite, sleep problems, weight loss, irritability or anger, headaches, and mood and emotional problems (Tobaiqy, M, 2011). Amphetamines have been shown to affect the cardiovascular system and may be unsafe for children who have an underlying heart condition and some children may show signs of withdrawal symptoms when the dose wears off. There are some stimulant medicine that are approved for children over the age of three (WebMD, 2015). These side effects can be very unhealthy in young children and 35% of parents whose children no longer take ADHD medication say it is because of the side effects of the drug and 44% of parents wish there was another method of treating their children besides medication (WebMD, 2015).

For parents that are worried about the side effects of stimulants, non-stimulants are also an option. They are not as effective for everyone as stimulant medicines and can take longer to show improvements. Strattera is not a controlled substance, so there are fewer restrictions place on them, which make some parents think that they are safer. This drug also can have a pretty negative side effect as some studies show that children and teenagers who take atomoxetines (Strattera) are more likely to have suicidal thoughts, than those on amphetamines (NIH, 2015).

High abuse potential

There is also concern that ADHD medications, such as Adderall and Ritalin, have a high abuse potential among non-ADHD individuals (Cohen, 2013). Individuals who do not have ADHD often take drugs like Adderall in order to improve their academic performance and help with studying. It is relatively easy to obtain ADHD medications, most often individuals get them from their friends or family members who have a prescription. It is also possible to obtain a prescription for ADHD medication, without having the disorder. This is called an off-labeled prescription and when this happens the medication can be used for anything from weight loss, or as a study drug. This can be very dangerous as scientists are not sure what the long term effects of the drug are or how it will affect the developing brains of young children.

Other solutions

Many parents turn to medication as the first and only treatment option for children with ADHD. However, there are also many non-psychostimulant treatments for ADHD that may be just as effective and more appropriate for younger children, such as exercise, behavioral therapy, parent training, and school accommodations.

Exercise is probably one of the easiest ways to treat ADHD. Exercise works in the same way as the psychostimulant drugs, it allows a way for more dopamine to enter into the brain and works very effectively in reducing ADHD symptoms and has no side effects. It might be a good idea to have a child with ADHD participate in a sport or get at least thirty minutes of exercise every day. There are some studies that show that children with ADHD may also have nutritional deficiencies, so making sure that the child gets a well balance diet full with zinc, omega-3s, iron, and magnesium is also a relatively easy and effective way in reducing symptoms (Helpguide.org, 2015).

Behavioral therapy is also another option and works to help children to change their behavior. This will help to child to develop social, organizational, and emotional skills, and has been shown to reduce aggressive behavior and help children do better in school (NIH, 2015).

If after all other options have failed, there is also non-stimulant drugs such as SNRIs (selective norepinephrine reuptake inhibitors). These drugs block the reuptake of norepinephrine in the brain, allowing more of it to remain. This increases the activity in the prefrontal cortex, an area which is underdeveloped in children with ADHD and increases attention, and reduces the symptoms of ADHD, and does not have a risk for abuse potential.

Final thoughts

With any prescription medication, there comes risks and benefits and it important that the benefits outweighs the risk. ADHD medications are very helpful in treating individuals with moderate to severe ADHD and can help those who suffer from the disorder to improve their attention and do better in school. It is also important that parents should consider the side effects of medicating young children, not every child is going to respond to the same treatment in the same way and it is essential that parents choose an option that is right for them. There are many options besides stimulant medications that will also help minimize the symptoms of ADHD and these include behavioral therapy, regular exercise, and non-stimulant medication. I believe that we need to reevaluate how readily doctors are writing prescriptions for ADHD stimulant medications in young children. There is still a lot we do not know about these medications and we should be very cautious with prescriptions and who has access to these drugs. Nobody without moderate to severe ADHD should be allowed to take these drugs.

References

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