ADHD treatment Flashcards
What is the most common drug therapy for ADHD?
- stimulant medication
- amphetamine called methylphenidate
- RITALIN
How does ritalin work?
- increases the level of dopamine in the brain
- addressing a possible dopamine imbalance?
- affecting the chemicals in the brain and nerves that contribute to hyperactivity and impulse control
Problems with medicating ADHD?
Does appear to yield significant results….
- BUT there are some objections to using medication to modify children’s behaviour!
- also - lack of evidence for the long-term effectiveness of medication
- what about the possible long-term physical and neurological effects of medication?
Ritalin - abuse?
- is a “Schedule II Substance” - means that it has a “high potential for abuse”
- “may lead to severe psychological or physical dependence”
- SO the FDA sets limits on the amount that may be manufactured each year
- (despite pouring millions of dollars into advertising for it)
FDA warnings:
- related to amphetamines - similar in chemical structure, metabolism and clinical effects
Common side effects of Ritalin
- addiction
- nervousness including agitation, anxiety and irritability
- trouble sleeping (insomnia)
- decreased appetite
- headache
- stomach ache
- nausea
- dizziness
- heart palpitations
Ritalin - other serious side effects
- slowing of growth (height and weight) in children
- seizures - mainly in P’s with a history of seizures
- eyesight changes or blurred vision
Ritalin - effects on academic achievement of children diagnosed with ADHD
- Weber et al (1992)
- 22 children diagnosed with ADHD receiving Ritalin vs 22 control
- compared achievement between groups (Ritalin vs control) and within groups (before and after use of Ritalin)
- ADHD children - found to be poorer readers both before and after placement on Ritalin
- experienced a drop in achievement the year before they were placed on R but stabilised after R treatment
Over-prescription of ADHD?
- effect of labelling and media pressures to the disorder
- now college students taking to to boost their academic performance
- over-prescription - ethical issues!
Ritalin - Treister et al (2012)
- Alterations in pain response by methylphenidate (Ritalin) in adults with ADHD
Psychophysically assessing sensitivity to pain in ADHD P’s as compared to controls
- examining the effects on R on pain response in ADHD P’s
- ADHD P’s without R in comparison to controls –> significantly shorter cold thresholds
- no differences in pain intensities between groups found
- following MP/R treatment - both cold threshold and tolerance in ADHD P’s increased significantly compared to those with no treatment
- suggest that adults with ADHD are more sensitive to pain compared with controls
- MP/R - may exert antinociceptive properties in these P’s
Further research needed but interesting results!
Effects of MP/Ritalin correcting / improving pain responses
- interesting side effect
- lot of co-morbid conditions associated with ADHD
- maybe a good thing then if the treatment for ADHD helps other health conditions
- or is it a bad thing?
Treating ADHD
- Jensen et al (2001)
Compared efficacy of medication management, psycho-socail intervention (parent training, teacher support), combined intervention (combination of previous two) and community care
- medical treatment - significantly more effective for the core symptoms of ADHD
- psycho-social intervention - did not significantly improve outcomes when combined with medical treatment
- consequence - medication is recommended as the best intervention!
Treatments - Psycho-social interventions
- used for many years and have been found to be very effective
- many ideas and techniques taught in behavioural parents are common sense parenting techniques
- many parents do need careful teaching and support to learn skills and use them consistently
- can be difficult to earn behaviour modification and implement an effective program just from books or website
- -> help from professionals is often necessary!
Parenting training sessions - typical topics covered
- establishing house rules, structure and consistent routines
- learning to praise appropriate behaviours and ignoring mild inappropriate behaviours
- using appropriate commands
- using ‘when…then’ contingencies –> withdrawing rewards or privileges in response to inappropriate behaviour
- planning ahead and working with children in public places
- time out from positive reinforcement - using time outs as a consequence for inappropriate behaviour
- daily charts and point/token systems with rewards and consequences
- school-home note system for rewarding behaviour at school and tracking homework
Parenting Training Sessions - Examples
- New Forest Parenting Programme
- for parents with child between 3-11 with moderate to severe symptoms of ADHD
- takes place in the family’s home through 8 weekly visits
- during these visits, parents learn strategies for managing their children’s behaviour and difficulties with attention
Parenting Training Sessions - Examples
- Triple P Positive Parenting Programme
- one of the most effective evidence-based parenting programs in the world
- backed up by more than 30 years of ongoing research
- gives parents simple and practical strategies to help them build strong, healthy relationships, confidently manage their children’s behaviour and prevent problems developing
