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Each of the children received one of four possible treatments over a fourteen-month period - behavioral treatment, medication management, combination of the two, or usual community care. The results of this study showed that children who were treated with medication alone, which was carefully managed and individually tailored, and children who received both medication management and behavioral treatment had the best outcomes with respect to improvement of ADHD symptoms. The best results in terms of the proportion of children showing excellent response regarding were provided by ADHD combination treatment and oppositional symptoms, and in other areas of functioning. Overall, those who received closely monitored medical management had greater improvement in their ADHD symptoms than children who received either intensive behavioral treatment without medication or community care with less carefully monitored medication.
Treatment for ADHD is not without controversy. For most children with the disorder, medication is an integral part of treatment. The primary medications used to treat ADHD are mostly stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. It has been charged that these medications are used to control behavior. While adult patients may sometimes choose to self-medicate with caffeine or nicotine, this is not usually an option with children. Indications that an individual is self-medicating would be the observation that his or her focus improves with the stimulant, and that he or she cannot function as well without the stimulant.
Stimulant medication, which can only be prescribed by certain medical professionals, should be used to improve the symptoms of ADHD so that the individual can function more effectively. Some research has shown that children and adults who take medication for symptoms of ADHD usually attribute their successes to themselves, not to the medication. One stimulant that is sometimes used is kratom, which is a plant that produces a stimulant-type effect in lower doses. Little research has been done on the relation between ADHD and kratom, but it has been used for centuries in Thailand to help motivate laborers. In low doses, it increases awareness, and concentration, allowing someone to sustain work habits, making long tasks more enjoyable, suggesting that kratom may be an effective method to help treat ADHD. Some users have indicated remarkable success using this substance. It is not recommended for children however, and as the dose increases, it can cause euphoria.
The traditional stimulants are grouped into several classes. There are Methylphenidates, Amphetamines and Atomoxetines. Some of the Methylphenidates (and doses) used to treat ADHD are: Ritalin, Metadate, or Methylin (4-6 hours per dose). It is a regular formulation, usually taken in the morning, at lunchtime, and in some cases, in the afternoon. Longer-acting formulations are those such as Ritalin SR and Metadate ER (8 hours per dose), usually taken twice daily. There are also some all-day formulations such as Ritalin LA, Metadate CD and Concerta (10-12 hours per dose), usually taken once a day.
Amphetamines are Dextroamphetamine (4-6 hours per dose) available as a regular formulation and sold as Dexedrine. It is usually taken two to three times daily. A more longer-acting formulation is Dexedrine Spansules (8-12 hours per dose) taken once a day. There is also Adderall, a trade name for a mixture of dextroamphetamine and laevoamphetamine salts. It is available in a regular formulation, Adderall. (4-6 hours a dose), taken twice a day and the longer-acting formulation, Adderall XR (12 hours a dose), taken once a day. Also part of this class is Methamphetamine, available in a regular formulation, and sold as Desoxyn by Ovation Pharmaceutical Company. It is usually taken twice daily.
Atomoxetines are a Selective Norepinephrine Reuptake Inhibitor (SNRI), introduced in 2002. It is the newest class of drug used to treat ADHD, and the first non-stimulant medication to be used as a first-line treatment for ADHD. Available in a once daily formulation, sold by Eli Lilly and Company as Strattera (24 hours per dose), and taken once a day.
Second-line medications include benzphetamine, a less powerful stimulant, and Provigil/Alertec/modafinil. Research on the effectiveness of these drugs has not been completed. Cylert/Pemoline is a stimulant that was used with great success until the late 1980s, when it was discovered that it could cause liver damage. Although some physicians do continue to prescribe Cylert, it can no longer be considered a first-line medicine, and in March 2005 the makers of Cylert announced that it would discontinue the medication's production.
Because most of the medications used to treat ADHD are included in Schedule II of the U.S. DEA schedule system, and are considered powerful stimulants with a potential for abuse, there is a great deal of controversy surrounding prescribing these drugs for children and adolescents. Despite these concerns, researchers studying ADHD sufferers who either receive treatment with stimulants, or go untreated, have shown that those treated with stimulants are much less likely to abuse any substance than are ADHD sufferers who were not treated with stimulants.
In 1996 the World Health Organization warned that Ritalin over-use has reached dangerous proportions. Because of a lack of research, use of these drugs on a long-term basis is questionable. Safety of such long-term use is simply unknown, and increasingly many dangerous side effects have been observed. Ritalin, for instance, may cause seizures and suppress growth, or it may lead to angina, blood pressure changes, depression or any number of a long list of serious side effects. Dr. Robert Mendelsohn has noted: "No one has ever been able to demonstrate that drugs such as Cylert and Ritalin® improve the academic performance of the children who take them.... The pupil is drugged to make life easier for his teacher, not to make it better and more productive for the child." relatively uncommon side effect of medication is the development of latent tics, which are involuntary vocalizations such as throat clearing, sniffing, or coughing beyond what is normal eye blinking, shrugging and clearing of the throat or motor movements such as blinking, facial grimacing, shrugging, or head-turning. The emergence of a tic disorder in susceptible individuals can be facilitated by certain Psychostimulant medications. Sometimes the tic will disappear when the medication is stopped, and for many children with ADHD, vocal tics or motor tics will occur as a time-limited phenomenon. Medications may bring them to parents notice earlier, or make them more visible than they would be without medication. They sometimes eventually go away, even while the child is still on medication.
Studies have indicated that seven percent of children with ADHD have tics or Tourette's syndrome, which is often mild, but can have a negative social impact in the rare, severe form of the disorder. It is also estimated that 60% of children with Tourette's have ADHD. Tourette's syndrome is a chronic tic disorder that involves vocal and motor tics. Some research indicates that the development of Tourette's syndrome in children with ADHD is not related to psychostimulant medication, however, where there is a family history of tics or Tourette's syndrome, a cautious approach to treatment is recommended. Certain children will experience worsening of their tics with stimulant medication. There is also a correlation with other disorders. "Nearly half of all children with ADHD (especially boys) tend to also have oppositional defiant disorder, characterized by negative, hostile, and defiant behavior. Conduct disorder (marked by aggression towards people and animals, destruction of property, deceitfulness or theft, and serious rule-breaking) is found to co-occur in an estimated 40% of children with ADHD. Approximately one-fourth of children with ADHD (mostly younger children and boys) also experience anxiety and depression. And, at least 25% of children with ADHD suffer from some type of communication/learning disability." In these cases, treatment with nonstimulant medications should be considered as an alternative.
In conclusion, while these drugs have been shown to have some success, the lack of definitive research into the long-term effects makes them a dangerous gamble. The short-term statistics suggest that there is more success in cases where medication is used, however these statistics cannot be extrapolated into the long-term. These strong stimulants must be studied further before they are prescribed for children.
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