ADHD, Stimulants, and Catholic Parenting

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I have heard Catholic parenting “experts” discourage the diagnosis of attention deficit hyperactivity disorder (ADHD) and attention defecit disorder (ADD).  Such so-called “experts” especially discourage the use of medications to treat this diagnosis.  Instead, many Catholic parenting advocates encourage behaviorial modification and alternative parenting techniques.  As a Catholic pediatrician, I find that the best approach to ADD and ADHD is a combination of behavior interventions and medication.

Many parents are strongly averse to giving their child a stimulant medication, such as thosen often used to treat ADHD and ADD.   Most parents wouldn’t give a child with attention deficit hyperactivity disorder (ADHD) a caffeinated drink, for fear that their hyperactivity would only worsen.  So why do doctors give stimulants to kids with ADHD?  It seems so counter-intuitive.

A quick internet search will give you the medical explanation that ADHD stimulant medications increase dopamine and norepinepherine neurotransmitters in the brain and also increase blood flow to the brain.  While this is true, this explanation still leaves many parents confused as to why stimulants work.  As a pediatrician and a parent, I would like to offer another way of thinking about this paradox.

Kids with ADHD are constantly self-stimulating.  They wiggle, they talk out of turn, and their mind doesn’t seem to turn off.  Their thought processes are non-linear.  They talk while brushing their teeth and wiggling their foot at the same time.  They seem to do everything except follow directions.  Whey you give a stimulant to such a child, they no longer have such an urgent need to self-stimulate.  Non-medication stimulants also work, although for limited amounts of time.  If you give an ADHD child a lollypop, which provides oral stimulation, they are more likely to listen and follow directions.  ADHD kids usually have no problem paying attention to video games, which provide constant visual, auditory, and tactile stimulation.  Reading books and following directions, however, are not stimulating activities.  ADHD kids will try to get through these experiences by self-stimulating through wiggling, talking, etc.  If you give them a stimulant medication, they no longer have the need to self-stimulate.

According to a recent survey by the Center for Disease Control, nearly 1 in 10 U.S. children have been diagnosed with ADHD by a health care professional, about 5.4 million kids.  About two thirds of these children take a medication.

Many parents are hesitant to give their children a stimulant medication.  In part because of this parental resistance to stimulant medications, drug companies are now marketing new non-stimulant drugs for ADHD, including Straterra and Intuniv.  These drugs are heavily marketed with a stress on the fact that they are non-stimulants.  There are situations where such drugs are necessary, such as the 10-30% of patients who do not respond or do not tolerate stimulant medications.  They are also appropriate for patients with certain types of heart disease that cannot take stimulant medications.  Yet, there is a reason why they vast majority of ADHD medications are stimulants—they work.

As a pediatrician, I do not feel that non-stimulant medications for ADHD have been in use long enough to really show their long-term efficacy.  Many of these drugs are mild sedatives.  It is my best medial opinion that sedating medications may meet the needs of teachers and parents more than the needs of the child.   These medications may keep kids from having hyperactivity in the home and classroom, but do they really help kids learn?  We do not yet have sufficient scientific data to suggest that sedating ADHD medications improve childhood learning and cognitive performance, especially in the long term.

Stimulants, however, are a tried and true treatment for ADHD.  Ritalin has been used to treat ADHD since the 1960’s and is still in use.  Many of the brand-name ADHD medications such as Concerta are just long-acting/slow release formulations of Ritalin.  There is an enormous amount of quality medical research on stimulants, especially Ritalin, that was not funded by drug companies.  Stimulants increase both fine and gross motor control as well as cognitive performance and executive function.  In other words, stimulants can improve handwriting and sports performance as well as behavior and attention.

ADHD diagnoses continue to increase in the United States.  Many attribute this increase in diagnoses to improved screening and greater awareness of the diagnosis.  As diagnoses increase, drug companies are going to continue to advertise designer drugs that curb the fears of parents.  I encourage parents to thoroughly research treatment options before declining stimulant medications.

Although research shows that medication is better than behavioral interventions alone, all ADHD treatment plans should include behavioral interventions.  What interventions?  Stay tuned for my column next month…

Copyright 2011 Kathleen Berchelmann, MD 

 

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About Author

Kathleen M. Berchelmann, M.D., is a pediatrician at St. Louis Children’s Hospital and Assistant Professor of Pediatrics at Washington University School of Medicine. Kathleen is the director of ChildrensMD, a blog written by five dynamic mom-pediatricians who share their true confessions of trying to apply science and medicine to motherhood. Kathleen and her husband are raising five children. Connect with her at KathleenBerchelmannMD.com.

3 Comments

  1. I have a few questions. I have a cousin who is an adult now who was diagnosed with ADHD as a child. When he was a teenager, his pedi was trying to encourage him to take more control of his behavior and get off his medication (since he was almost an adult).

    My question is this…is ADHD diagnosis with children something a child outgrows? Are there adults out there who have ADHD still on medication?

    I understand that young children need medication to help overcome the ADHD, but at what point do you control your own behavior?

    I’ve recently read that a number of children with ADHD are also being diagnosed as bipolar and are given a cocktail of medications. So this messing with a young developing brain makes me nervous. Children’s psychiatry is still waging wars with drug companies for more studies with children. I’m not sure I want my children on any mood altering, stimulants, or psychotropic drugs until there’s more research.

  2. Dear DeltaFlute,

    ADHD is a lifetime condition, but as ADHD children mature, they gain greater control over their own behavior. It is generally easier for adults to cognitively manage their own ADHD through coping mechanisms and good habits. Some adults do still require medications. I agree that pediatric studies of many psychiatric drugs are lacking. Ritalin, however, is one of the most heavily studied pediatric drugs, and it has been around a long time. It’s safety profile in children is well understood.

  3. Dear doc ,

    I’m saddened by your response The research does not show that as adults that Add/ ADHD indiviual due better or have an easier time but rather still struggle with the same problems they had in school but it can be worse because because of the myth that we we out grow it. Its impoartant that they get treatment and I believe God would want me to do see a Doctor for what ever illness I had.

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