Signs of ADHD & Treatment Options

Sep 10, 2019

By: Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

On TV, the six million dollar man, Steve Austin, was assigned to escort a Russian gymnast. When she saw Austin could easily do all the gymnastic maneuvers it took her a lifetime to master without any training, the Russian gymnast was ready to give up her sport. Because he was a hero, Austin explained it was his bionics that allowed him to do superhuman feats, and he convinced her to keep training. I am neither bionic, nor a Russian gymnast. However, I am on my bike most days from April through August trying to get ready for the MS Bike Tour. We raise money to help end MS and we ride from Dauphin to Clear Lake and back over a weekend in September. Eric spent his summer training his thumbs on X-Box and refusing to go on longer bike rides with me. Over the weekend, guess how our ride up the hills to Clear Lake went.

If a young boy (and it is usually a 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 5-9% 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 child's Ritalin prescription. Will anything bad happen if their child doesn't take Ritalin? While it is the parent's 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 child's 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 child's 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, can't organize, easily distractible and forgetful. Symptoms of hyperactivity/impulsivity include: squirming & fidgeting, can't 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 didn't 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 haven't 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.

Eric was kinda slow between Dauphin and the road to Country Fest. I was a little worried he wasn't going to make it the whole way. Then we got to the first hill. Eric took off. I never saw him again until the end. I was on my bike nearly every day this summer. Eric played Xbox. And he kicked my butt up the hills. Next year I think I need a different tactic. Maybe a lighter bike. Or maybe... "Gentlemen we can rebuild him. We have the technology. We have the capability to make the world's first bionic man. Better than he was before. Better, Stronger, Faster"

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.

The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance - www.caddra.ca

Cooper et. al study in New England Journal of Medicine: http://www.nejm.org/doi/full/10.1056/NEJMoa1110212

Six Million Dollar Man Intro - https://www.youtube.com/watch?v=HoLs0V8T5AA

 


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