Attention Deficit Hyperactivity Disorder (cont.)
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What Are the Risks of the Use of Stimulant Medication and Other Treatments in Children?
Stimulant medications have been successfully used to treat patients with ADHD for more than 50 years. This class of medication, when used under proper medical supervision, has an excellent safety record in patients with ADHD. In general, the side effects of the stimulant class of medications are mild, often transient over time, and reversible with adjustment in dosage amount or interval of administration. The incidence of side effects is highest when administered to preschool-aged children. Common side effects include appetite suppression, sleep disturbances, and weight loss. Less common side effects include an increase in heart rate/blood pressure, headache, and emotional changes (social withdrawal, nervousness, and moodiness). Patients treated with the methylphenidate patch (Daytrana) may develop a skin sensitization at the site of application. Approximately 15%-30% of children treated with stimulant medications develop minor motor tics (involuntary rapid twitching of facial and/or neck and shoulder muscles). These are almost always short lived and resolve without stopping the use of medication.
A recent investigation studied the possibility of stimulant medication used to treat ADHD and cardiovascular side effects. Concern focused on a possible association with heart attack, heart rate and rhythm disturbances, and stroke. At this time, there is no certainty in a proposed relationship to these events (including sudden death) when medication is used in a pediatric population screened for prior cardiovascular symptoms or structural pathology of the heart. A positive family history for certain conditions (for example, unusual heart rhythm patterns) may be considered a risk factor. The current position of the American Academy of Pediatrics is that a screening EKG is not indicated before the initiation of stimulant medication in a patient without risk factors.
"Diversion" is the transfer of medication from the patient for whom it was prescribed to another individual. Several large studies have indicated that 5%-9% of grade and high school students and 5%-35% of college-aged individuals reported use of non-prescribed stimulant medication, and 16%-29% of students for whom stimulant medications were prescribed reported being approached to give, trade, or sell their medication. Misuse was more frequently seen in whites, members of fraternities and sororities, and students with a lower GPA. Diversion was more likely with the short-acting preparations. The most common reasons cited for use of non-prescribed stimulants were "helped with studying," improved alertness, drug experimentation, and "getting high."
ADHD is a controversial diagnosis for several reasons. Many well-meaning individuals have spoken out against making children behave according to a norm or taking medications for the sake of improving grades. These individuals have expressed concern about addiction or drugging children. This kind of concern is valid; however, the following must also be considered.
The use of psychostimulants in children should be scrutinized carefully. Fortunately, methylphenidate (Ritalin [and its long active formulation, Concerta], historically the most widely prescribed medication for ADHD) has been available for many years. This long period of clinical experience has shown that this is one of the safest medications used in children.
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