Oct 15, 2013
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
Okay, listen. When the TV is on, stop talking. Talk all you want during the commercials. But nothing is more annoying than sitting next to someone who is quiet during the commercials and then starts talking when my show comes back on. I get distracted, and miss both the show and the conversation. Then I get frustrated and annoyed and say inappropriate things. I love The Daily Show with Jon Stewart. However, it has become a battleground in my marriage. My wife thinks it is boring and stupid. Thus she is quiet during the commercials, but has the innate ability to talk during every punch line. I get distracted and frustrated. Soon poor decisions are made, the fight is on and Im in trouble again.
If a young boy is always making poor decisions, and always getting into trouble, it could actually be a medical condition. ADHD or attention deficit-hyperactivity disorder is one of the most common psychiatric diagnoses in children and adolescents. It affects 8-10% of children < 18 years old. It can stay with patients into adulthood. If a child has a diagnosis of ADHD, there is an 80% chance he will have symptoms as a teenager and 60% chance he will have symptoms as an adult. In fact about 4% of all adults have ADHD. ADHD is most often treated with stimulant medications like methylphenidate or Ritalin. We are often asked by parents if we think they should fill their childs Ritalin prescription. Will anything bad happen if their child doesnt take Ritalin? While it is the parents choice to fill the prescription, research shows patients with untreated ADHD are 3 times more likely to repeat a grade, 4 times more likely to be arrested, nine times more likely to have a teenage pregnancy and 11 times more likely to be put in jail than non-ADHD people. So whether or not to treat a child with ADHD is an important decision that should be discussed carefully with the child, the family and the childs doctor.
What does it mean when we say a child has ADHD? ADHD has three main symptoms doctors look for. They look for: inattention, hyperactivity and impulsivity. Every child or adult has problems with these once in a while. To be diagnosed with ADHD, these symptoms must cause significant problems in the childs life. Other things the doctor will be looking for is if the symptoms have lasted more than 6 months, if the child has these symptoms in different settings such as problems in school, at home and when playing hockey, and if the symptoms are caused by other problems. Symptoms of inattention include: careless mistakes, difficulty sustaining attention, no follow-through, cant organize, easily distractible and forgetful. Symptoms of hyperactivity/impulsivity include: squirming & fidgeting, cant wait their turn, on the go all the time, seems driven by a motor and blurting out answers. The exact type of symptoms will determine the diagnosis. The symptoms can also change over time. The child can have hyperactivity when they are young and as they age they can become impulsive and as they become an adult they can become inattentive.
Treating ADHD is important and the most common treatments are the stimulant medications like Ritalin. Although these stimulant medications can work very well to help the child concentrate, there have always been concerns about how these medications affect the heart. Stimulant medications can make the heart beat faster and raise blood pressure. The worry was if a child had an undiagnosed heart problem and you gave them a stimulant drug, the heart problem would get worse and cause the child harm or even death.
There was a large study published in a November 2011 edition of the New England Journal of Medicine by Cooper et al. The study says these stimulant drugs may not be as dangerous as we thought. Although this was not a double blind placebo controlled trial, the researchers looked at a large group. They examined the medical records of 1,200,438 children and young adults between the ages of 2 and 24 years and including 373,667 person-years of current use of ADHD drugs. They looked for heart problems including heart attacks and strokes. They didnt find any more heart problems in the children taking ADHD medications than in those that did not take them. That was reassuring news for me as a pharmacist and should be reassuring for parents who have children taking ADHD medications.
Will stimulants like methylphenidate help my child with ADHD? The short answer is yes. Stimulants medications have definitely been shown to improve behavior, attention and self-control. However if a parent asks if their child with ADHD will get better grades on stimulants, the answer is no. Stimulants havent been shown to increase academic performance. Interestingly, stimulants have been shown to improve driving. So, as the ADHD teenager reaches driving age, care should be taken to have stimulant coverage during the hours the teenager is driving.
Technology has alleviated my TV distraction issues that seem to get me into meaningless fights. While I still see no reason for someone to be silent during commercials and talk during my show, DVRs now exist. I can now pause and rewind live TV with my DVR. So I can put Jon Stewart on hold. Then I can listen to my wife tell me why one of my children got some one on one time with their teacher. I get less distracted and frustrated and so I get in less trouble. Thats what we hope ADHD medications will do for children with the condition as well.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca
The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance - http://www.caddra.ca
Cooper et. al study in New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1110212