ADHD

MEDICATION

THETRUTH

History of Medication Use(for ADD/ADHD)

Stimulants first used - late 1930’s

Ritalin first marketed - 1954

Medication use first exaggerated by media - 1975

1980’s ---Early brain & genetic researchTricyclic Anti-depressants first usedScientology “bad drugs” campaign

1990’s ---Brain scans = neurotransmitter problemGene identificationNIMH 6 site study

21st Century ---Further identification of Brain/Gene anomaliesDevelopment of additional medications

Hundred’s of well done studies, to date

MEDICATION MYTHS

It’s dangerous (turn kids into “zombies”).ONLY if not used or monitored properly.

It’s addictive, or will lead to use of street drugs.No, on both counts! Proven by multiple research.

It will stigmatize the student.ONLY if mishandled; Won’t, if child & adults are educated.

The student will “depend” on it (as an excuse).Not so, especially if properly educated.

They’re “DRUGS” (meaning bad, toxic, etc.).They are no different than any other substances, whetherprescription or non. If taken based on proper diagnosisand properly monitored, they work very well.

They’re “narcotics”, “speed”.Simply inaccurate!

Over prescribedActually under-prescribed!

WHY MEDICATION ?

Yes No ADHD involves brain chemistry.

Mostly Dopamine, Norepinepherine.

ADHD seriously impairs daily life.Thinking, emotions, memory, sleep, self-esteem.

IT WORKS !!!Over 200+ studies. Over 55 years.

Reduces most symptoms, quickly.With few or no side-effects!

It IS Safe !When used properly.

No different from insulin for diabetes.“Replacement Therapy”

BUT, not as a diagnostic tool.If it works, then they have ADHD - NO! NO!

Not everyone needs it.

TYPICAL COMPLAINTS&

ANSWERS

Not eating - allow snacks; 7 week summer break & they’ll make-up for lost growth; eat by clock vs. hunger; still + on growth chart = OK

Mid-late morning problems - adjust dose timing; change to long lasting medication

After school problems - 2nd dose given?; Change to long-lasting form?

Very irritable mid-late afternoon - same as just above

After 4-6 weeks not working as well – “acclimation phenomenon”; in-crease dose

Trouble falling asleep - change dose timing &/or amount

Still can’t get up - pre-awakening dose; review sleep problems

Withdrawn, crying, angry - lower dose or change medication

Zoned-out; very tired - same as just above

Headaches; stomach pain - wait 1 week; maybe just initial reaction

Refuses to take it - more education; discuss resistance

Nothing happened in 1 month ! - increase dose !!!

What to expect??? - education

Helped some problems, not others - polypharmacy?

DOSING PATTERNS

Small changes make big differences It’s HIGHLY individual Dose-Response Method Vs. Body Weight Drug Holidays ? NO! Goal: Day-long symptom coverage Goal: Seamless symptom coverage Goal: Finding “Therapeutic Dose” Pre-awakening dosing ? Tapering doses - AM to PM Remembering to take it As Needed Use ??? (only in rare cases)

FINDING A GOOD DOCTOR

PMUST have RECENT training in ADHD/BDPAsk other parents/adults of ADHD/BD peoplePGo to a CHADD meetingPAsk other professionals you knowPSigns of a GOOD doctor --

Can tell you about recent ADHD/BD training Listens attentively Knowledge is up-to-date Knows various options Willing to learn more Realizes complexity of ADHD/BD Knows other services

PDon’t just ASK your insurance co. Ask who they refer to OFTEN

PInterview at least 3 doctorsPCheck-out the reception staff, too !PKnow what you want - insist on it !PRemember - It’s your child/your body !!!

More Helpful Tips on Medication Never take stimulants with citrus juices - The citric acid will negate their effectiveness. Solution:Wait 2 hours, and then have your OJ. Legally doctors cannot prescribe more than a month’s-worth of stimulants. So, don’t get upsetwith the doctor. Prescriptions for stimulants in CA must be hand-delivered to the pharmacy within 7 days of thedoctor writing it. Many medications have what are called “acclimation” effects. They are like “side-effects”, but onlyoccur during the first 1-4 days. Typical “acclimation” effects are mild GI distress (upper &/or lower),mild headache, mild light-headedness, mild edginess. If you feel you “must” read the list of potential “Adverse” effects listed for the medication(s) you aretaking, go ahead. But, PLEASE BE AWARE, those lists consists of every adverse effect that has ev-er happened with that medication. Many of the listed “adverse” effects happened to only one in sev-eral thousand people. Just for a fair comparison, also look-up the list of potential “adverse” effectsof Aspirin or Tylenol. Never take stimulant medications after 11 a.m. They will keep you from falling asleep! Most long-lasting medications, in pill or tablet form, CAN be broken WITHOUT damaging theirlong-lasting properties. Examples are, Concerta and Wellbutrin XL. Many doctors and pharmacistsare not aware of this, and will tell you not to. Never let a pharmacist tell you that Ritalin SR, Methylphenidate SR, Concerta, Ritalin LA, Focalin,Metadate, and Methylin are all the same. Ritalin SR and Methylphenidate SR are old “long-lasting”formulations that are very ineffective. Concerta, Ritalin LA, Focalin, Metadate and Methylin are allnew long-lasting preparations. However, each manufacturer uses a different slow-release technolo-gy. Therefore, each of the new versions of Ritalin (methylphenidate) ARE really different in terms ofhow people respond. Give stimulant medication to a preschooler??!! Yes! But, use caution and only if their ADHDsymptoms seriously impair their functioning (e.g., unable to attend preschool due to behavior prob-lems). The National Institute of Mental Health and Johns Hopkins University have both done recentstudies indicating that this is safe and appropriate. Anti-depressants dangerous for teenagers? Not really. Don’t blame the medication. The REALproblem is doctors and other clinicians who don’t do a proper evaluation and who prescribe medica-tion too quickly. Here’s the TRUTH – anti-depressants are dangerous for teenagers who have Bipo-lar Disorder. Anti-depressants can worsen their Bipolar symptoms! If you have any doubt that your child is actually taking and/swallowing their pills, hand the pill(s) tothem and watch carefully. Concerta is designed to last 10-12 hours and Adderall XR 8-10 hours. These are averages.There are people for whom these medications last shorter times. Many of these people need eithera second dose taken about 2-3 hours before the 1st dose wears-off; or, they need a second dose ofthe short-acting form. Adderall XR capsules can be opened and sprinkled over food, for children who have trouble swal-lowing pills. If your doctor says they prefer starting out by giving you or your child Strattera because stimulantmedications are “risky”, go see another doctor. All available scientific evidence indicates this ap-proach is incorrect. Free or Low-Cost meds. are usually available through “Patient Assistance Programs.” Go to themanufacturer’s website. Look for “Patient Assistance Program.”

KEYs to successful medication trials -(whether for ADHD or any other condition)

1. Thorough diagnostic evaluation, according to current standards.2. Selection of medication based upon matching symptom profile with current knowledge about which medication best targets which symptoms.3. The patient and family must educated about how the medication works, what symptoms it is expected to target, what benefits to look for, what side-effects to look-out for.4. Usually start at the minimum dose.5. Psychotropic medications should initially be monitored by the physician/therapist weekly. This can be done via phone call.6. Close monitoring can determine degree of benefit and whether side-effects, if any, are sig-nificant.7. Close monitoring can also determine when/whether to increase or decrease dose. Most medication doses can be increased after 1-2 weeks as long as no significant side effects occur. A common mistake by primary physicians is to give a prescription andhave the patient schedule a follow-up appointment in 2-4 weeks. Waiting 2-4 weeks to checkon medication response is inadequate and can result in a “failed-trial” due to poor or negativeresponses that the patient/family does not understand.8. Close monitoring means frequent (at least once per week) and systematic questioning re-garding potential benefits, side effects, and the degree of each.9. Most psychotropic medications need considerable adjustment, initially, in order tooptimize benefits and minimize side effects. It is a highly individual process.10. It is usually best to try one medication at a time, making adjustments until optimum bene-fits are reached. Then, if additional medication is necessary, further trials can more easily de-termine effects of the second medication, because the exact effects of the first one are known.

--------------Beware Bogus Treatments

There are many, many sources who claim to successfully “treat” ADD/ADHD. They even claim thattheir product is “clinically proven”, “scientifically proven”, “natural”, “no harmful side effects”, andbacked by glowing testimonials from very sincere-sounding, convincing people “just like you”.

Be a wise consumer. Investigate.

In my 35 years of practice, I have yet to come across a non-prescription product that significantly re-duces the symptoms of ADHD and has solid, well-done, consistently duplicated research supportingits effectiveness. I have had many clients who have tried many non-prescription remedies, of all sortand types. Not one has consistently, over-time reported significant benefits. In fact, all have either re-ported either no benefit at all or some initial “mild” changes that disappeared over time. Remember“placebo effect” is roughly 35-45%, i.e., 35-45% of people who try a particular remedy or “treatment”report at least “some” improvement, even if the “remedy” or “treatment” has absolutely no active in-gredient (“sugar pill”).

This does not mean that prescription medications are totally wonderful. Some of them aren’t very ef-fective either. Some have very problematic side effects no matter how careful one is in using them.However, there are two factors in their favor: (1) Most of them do have solid, well-done, replicated re-

search demonstrating their effectiveness, and, (2) Many of them do reduce ADHD symptoms to ahigh degree, 60-90%.

Here are some good resources for a REALITY CHECK on various “treatments” and “remedies” -

http://www.quackwatch.org/

http://www.acsh.org/ (American Council on Science & Health)

http://www.healthwatcher.net/index.html

http://www.ncahf.org/ (National Council Against Health Fraud)

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DISCLAIMERI am not a physician. I cannot “recommend” any prescriptionmedications. I can pass-on to you information which I havegathered from reliable sources from around the country. Theforegoing information represents a synthesis of current datafrom several highly respected national resources.

Also, the information I am presenting should not be used tomake decisions about the medication needs of a specific indi-vidual. Medication decisions can only be made as a result ofan appropriate assessment process conducted by a trained, li-censed professional.

Michael G. Gingerich, MSSW, PhD (Ret.)2020

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