“Dust mite allergy,” the allergist told John and Tamara, consulting with them about their constantly scratching 10 year old who now had constant red marks on his arms and the backs of his hands, “You’ll have to wash everything, buy hypoallergenic covers, it’ll take a lot of housecleaning.” This sounded like a perfectly reasonable explanation to the couple, and so they cleaned. “I actually clogged my dryer vent with lint because of the number of loads of bed linens I washed.”
But there was another culprit that the couple had never thought of; a medication side effect.
Up until now, the prescribing of medication for children with attention deficit hyperactivity is often tedious for the physician and the family. Children who do not respond to the first stimulant prescribed may respond to the next one tried or the one after that.
There are two types of stimulants found to be effective for treating ADHD: amphetamine and methamphetamine. A study involving 89 children between the ages of 7 and 11 conducted at Cincinnati Children’s Hospital found that subjects with at least one copy of the 7-repeat DRD4 gene had a positive response to methylphenidate (a methamphetamine) while children without this gene related to dopamine did not. Methylphenidate is the active drug in Ritalin and Concerta along with several other ADHD medications.
This is good news for physicians and parents. This may prove to become part of the prescribing process that could lead to finding the best medication on the first try. According to the lead researcher in Cincinnati, Dr. Froehlich, “with more information about genes that may be involved in ADHD medication response, we might be able to predict treatment course, tailor our approach to each child, and improve symptom response while decreasing health care costs.”
I fully understand the concerns of parents regarding medication for ADHD. My wife and I struggled with this when my son was 5. He had a great response to stimulant medication and remained on medication until he was 14. He suffered no observable side effects. He is a 6’4” guy who completed college with honors and has been employed for 5 years in the film industry and currently is an editor for a top rated cable network show. We were at our wits end and what we called “the small vitamin” was a miracle drug. At home we also used psychosocial interventions from time to time during his formative years.
During my years as a child psychologist, I have been able to help many children with mild to moderate symptoms of ADHD do well at home and school without medication using psychological interventions. However, children with more severe symptoms benefit greatly from medication. Current guidelines now state that behavioral interventions should be tried first for mild to moderate symptoms and also should be used for more severe manifestations along with medications which may reduce the dose needed to control symptoms and may reduce the length of time required to remain on medication.
In a commentary in The Boston Globe, pediatrician Claudia Meininger Gold wrote, “medication can’t fix a broken childhood.” She goes on to say, “with our over-reliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff’s investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.”
Also, US News & World Report also provides in-depth coverage of this topic, starting first by citing the recent recommendation of the National Institute for Health and Clinical Excellence of the UK. They recommend the trial of behavioral intervention prior to medication for the treatment of children diagnosed with ADHD.