So is it safe to give children under 13 medications for ADHD? If so what are the risks/benefits? Shouldn’t there be other forms of treatment? All these questions usually over bear a child’s parent, doctor or even teacher when it comes to a child with ADHD. That being said medication could actually be beneficial for ADHD in an academic setting, and the improvement of core symptoms such as self-esteem and interactions within a social environment in their future. But before going in depth about the right treatment for ADHD one must understand what exactly children with ADHD go through in their everyday lives. Imagine you were a child under 13 going to school but act differently from other students around you. You are not able to pay attention in class, you can not sit still in your seat, you interrupt your classmates as they speak, you are not able to be quiet and so you continue to talk excessively and you are not able to finish any tasks given to you. All of these uncontrollable symptoms can be frustrating for a child at a young age. There is really no way of diagnosing ADHD other than a long process of gathering information from the child, the child’s school and the caregivers (parents, babysitters, etc.).
To treat ADHD there are 3 different types of clinical treatments: behavioral management, medication management as well as a combination of both. For medication management doctors prescribe 2 types of drugs pshycostimulants such as Adderall, vynase, concerta, focalin, daytrana, Ritalin and quilivant XRm and non-stimulant drugs including intuniv, kapvay and Strattera. The big question for most parents is which clinical treatment is more effective within ADHD children. According to researcher Peter S. Jensen most children with ADHD showed significant improvement when taking medication or having the combined treatment rather than just doing behavioral management. They found that medication management was better in comparison to behavioral management for aggressive behaviors, controlling internal symptoms such as fidgeting and impatience, peer interactions, parent-child relations and reading. However children with ADHD who do take medication reduce their negative view of social interaction, but their social behavior was seen to not significantly change. It was concluded that if medication is used as a first line of treatment for ADHD in early childhood, then later on in their life they would require less intensive behavioral intervention by caregivers at school and at home.
During the day and most of their life, children spend most of their time within a school environment. Many studies have suggested that clinical treatments for a child with ADHD can affect their academic performances. Without treatment ADHD children show slow achievement in their education and generally face problems in school. Their levels in the IQ system compared to the controls (meaning those without ADHD) are below or average. Usually children with ADHD face limitations from participating in class, more often they use academic services such as tutoring and counseling, and most are placed in special ED classes. In the long run without clinical intervention students run the risk of facing huge problems with suspension, repetition of grade levels and not meeting graduation requirements. At the start of a child’s life ADHD begins at the age of 3-6 years old and consequently more then likely from the beginning of preschool children with ADHD are behind in their academic skills. Scientists, Irene M. Loe and Heidi M. Feldman did a study of the effect of clinical treatments on the academic performances of children with ADHD. Since ADHD can affect 2 domains in academic success: 1. Learning and applying what they learn including reading and writing and 2. General tasks and demands including handling ones own behavior and managing stress/frustration. They found that children who were not clinically treated, showed within their adolescent stage failing grades, lower ratings in school subjects, and lower ranking percentage in their class. In their teen years some ADHD children failed to complete high school, college attendance was low, and less seem to graduate from their college. So what can medicine do to change this? Well psychopharmacological treatments reduce the core of ADHD symptoms. They have been shown to improve the child’s ability to handle tasks given to them at school such as completion in homework and projects, their quality of note talking has improved and scores on worksheets and quizzes increased. Behavioral treatment can also reduce the core symptoms of ADHD but not as dramatically as medication treatments. Behavior treatment is however seen to improve a child’s functioning and social interaction. In terms of the combined treatment there were no significant differences in behavioral change.
So what happens if children stop taking ADHD medication? Many parents believe it is a hassle for the child and themselves to be on a routine schedule for ADHD drugs. A lot of parents watch their child face the side effects of the drugs and that’s why many go in favor of having them stopped. If medication treatment is stopped or never taken on, the child might be loosing the benefits of the drug. Some parents believe that social skills aren’t that important when it comes to risking them using the medication. However, often what would happen is that kids who are not treated eventually have a low self-esteem; they start to feel bad for themselves because of who they are and how different they are to the rest of their peers. This can turn to a one-way street of negative consequences, poor academic performances, drug abuse, alcohol abuse, driving disability and change in eating habits later on in their life. The reason for that is because without treatment kids don’t learn the ability to control emotion and social skills.
Researchers, Hechtman, Weiss and Perlman did a study on 75 hyperactive children between the ages of 6-12 who were treated with the stimulant methylphenidate for 3 years. After the 3 years the behavioral outcomes of their young adult years (mean age 21) were then compared to children who were not hyperactive and groups who were considered hyperactive but did not receive any stimulant treatments. What they found was that children who were treated with methylphenidate showed improvement in behavior in their young adult years. They showed to have less car accidents, more positive views of their childhood, better social skills, and high self-esteem, less delinquencies and less problems with aggression. I think the most important finding was that the stimulants helped decrease the need for them seeking psychiatric treatment later on in their life. This is important because many believe that since ADHD is a neurobehavioral disorder, which starts in the beginning of ones childhood, the prevalence, persistence and impairments are a long lasting effect in ones life. But when taking certain stimulants such as methylphenidate there is a possibility of decrease in treatment in the future depending on the subtype of the ADHD condition.
One may argue however, that stimulant dosage can lead to sever side effects in children, which can be another reason in which they shouldn’t be used. Well that has a yes and no answer. In reality it is important for the medical doctors to really evaluate the right amount of dosage for the child based on the symptoms they are expressing. The reason for that is, is because ADHD is a disorder with a ton of variation amongst individuals and their behavioral symptoms. Usually stimulants prescribed are titrated to the optimal level so that there is a reduction of ADHD symptoms as well as a significant decrease in side effects. Researchers Mark A, Stein and his colleagues did a study specifically on the dosage of methylphenidate and the effects of the stimulant based on dosage. Since methylphenidate is the most common medical treatment for ADHD it is considered the most effective drug for clinical use. The most common side effects of the stimulants is sleep and decreased appetite. But according to Stein et al, stimulant side effects are correlated to dosage intake; higher doses yield to a more severe side effect. In their experiment they had 47 subjects with 3 dose conditions of methylphenidate, ranging from 18-45mg. they found that a lower dosage of the medication revealed the most improvement in cognitive task.
In general I feel that the outlook of medication treatment is misunderstood because of the fear of children facing the side effects of the stimulant drugs. However, with the proper diagnoses and the right over seer a doctor can manage the dosage levels of the medication based on their side effects and reaction to the medication. In the end medication can really improve a child facing ADHD in their academic performance, and social skills within their younger years. Many of the studies mentioned, revealed that in the long run the need for intervention and psychiatric help is based on the treatment given at childhood. The medicine management treatment is the optimum route to improve the reduction of ADHD symptoms in a child and their future self.
Work Cited:
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Evans S. W., Pelham W.E., Smith B.H.,Bukstein O., Gnagy, E. M., Greiner A. R., Altenderfer, L. and Baron-Myak Carrie. Dose–response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. Experimental and Clinical Psychopharmacology 2001; 9(2): 163-175
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Loe M. Irene and Heidi M. Fledman. Academic and Educational Outcomes of Children with ADHD. Journal of Pediatric Psychology 2007;32(6): 643-654
Mark A. Stein, Christopher S. Sarampote, Irwin D. Waldman, Adelaide S. Robb, Charles Conlon, Phillip L. Pearl, David O. Black, Karen E. Seymour, and Jeffrey H. A Dose-Response Study of OROS Methylphenidate in Children With Attention-Deficit/Hyperactivity Disorder. Newcorn Pediatrics 2003; 112(5): 04-413
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