ADHD has a major adverse impact on life functions for adults and children. These adverse impacts can be minimized or eliminated with medication treatment. There are only 2 stimulant medications that are effective for the treatment of ADHD. They are available in multiple forms with many durations, delivery, and dosing.
When Was Medication First Used for Treatment?
- Dr. Charles Bradley 1937- used spinal tap fluid to analyze developmental disorders
- Discovered Benzedrine (originally used to treat congestion and head colds) treated all students in home with it and it helped children to focus and follow directions
- Benzedrine is solely made of amphetamine
- Leandro Panizzon- 1944
- Studied amphetamine molecule
- Produced methylphenidate- eventually called Ritalin (after his wife)
- All ADHD meds are derived from this
- ADHD Medication
- Stimulants: Methylphenidate, Amphetamine
- Non-stimulants: Clonidine, Guanfacine, Atomoxetine, Bupropion, Viloxazine
Why Are There So Many Medications to Treat ADHD?
- 46 meds approved by FDA for ADHD treatment
- Methylphenidate & amphetamine are short-acting (wear off after 4 hours)
- Need to have a minimum amount of the drug to have a therapeutic effect, but don’t want to go too high, because that’s when you get the side effects of the drug
- This cycle happens 3-4 times a day for the child (psychological state changes)
- Drug companies finally came up with some long-acting drugs (10-12 hours)
- All are using the same basic methylphenidate or amphetamine, just using different ways to deliver/create long-lasting effect
- Chewable tablets, orally disintegrating tablets (ODT), liquid, skin patch
How to Start ADHD Medication Treatment?
- Start with a long-acting methylphenidate
- Start with low dose and adjust to optimum benefit with minimal side effects
- Consider a short-acting medication as dose wears off
- Consider liquid or skin patch to fine tune dose
- If methylphenidate is ineffective or significant side effects, consider amphetamine
- If significant side effects continue, consider non-stimulant or combine the two types
Does ADHD Medication Work?
Research studies on core symptoms of ADHD (short attention, distractibility, organizational issues, memory problems, etc.)
- Look at the effect size from studies
- Methylphenidate and amphetamine have highest effective rate
- Atomoxetine is moderately effective
- Clonidine and guanfacine is mild to moderately effective
- Meta analysis
- One study found that all types of meds were effective
- Methylphenidate meds had less side effects & better tolerated
- Long-term outcome of ADHD
- Education: Typically receive lower grades, more likely to be retained, expelled, less likely to finish high school/college (less risk if medicated)
- Job Performance: 3x more likely to be unemployed, frequent job changes, lower salary
- Finances: More financially dependent, difficulty paying bills, higher credit card debt
- Social Relations: Fewer friends, difficult relationships with loved ones, move more frequently, more likely to be separated or divorced
- Sexual behavior:
- More children outside of marriage
- Sexual adjustment difficulty
- 4x more likely to have an STD
- Illegal Activities:
- 2x as likely to have been arrested & 15x more likely to have been incarcerated
- 3-5x more likely to be convicted of a crime
- Driving
- Traffic violations/suspended license
- 2-6x more likely to be in car accident (with greater damage)
- Substance abuse:
- Children: more likely to smoke and use alcohol
- Adults: more likely to abuse drugs
All of these risks are greatly reduced when taking ADHD medication.
- Brain scans in adults & children
- ADHD brains have smaller prefrontal cortex (planning/organizing), fronto-striato-cerebellar projections (attention, focus, ignoring distractions), and caudate nucleus (learning and memory)
- Adults with ADHD continue to have the same smaller area of the brain EXCEPT if they were treated with medication as children
Conclusion: Medication Works!
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Presented by: Dr. Walt Karniski, Developmental Pediatrician
Write up by: Nicole Frischknecht
