By Dr. Audrey Griesbach, Los Angeles developmental pediatrician
On a behavioral level, what is ADHD?
When people think of ADHD, they often assume that the problem lies in the individual’s willingness to pay attention or listen. In fact, it is not a problem of ‘wanting’ to pay attention.
What we think of as ‘attention’ is actually a very complex processing function of the brain that operates continuously and allows us to engage in and demonstrate skills we refer to as attentive behavior. These skills include the ability to concentrate, seamlessly shift our focus from one thought to another, regulate alertness, maintain mental effort, organize our thinking, retrieve and access information efficiently, manage frustration, and self-regulate our emotions and actions.
Children with ADHD are often frustrated because they want to do better but they cannot show what they know. To compound the problem, they do not understand why they have difficulty and begin to doubt their abilities.
What is the biological basis of ADHD?
ADHD is caused by a biologic difference in the brain which can make it difficult for those with the problem to effectively listen, do their work, and control their behavior.
To use a computer analogy: You can have sophisticated software on your computer, but if your processor is not running efficiently, you will not be able to use the programs properly and access all the information you have.
What are the benefits of using medications to treat ADHD?
Medications can often be extremely helpful for those with ADHD. They work by increasing specific chemicals or neurotransmitters, dopamine and norepinephrine, at the connections between the neurons in the brain, increasing the ability to pay attention and process information.
When successfully treated with medication, children will be able to process information more efficiently, focus for longer periods of time, and be less distractible. They can listen better to instructions, they can start their work more quickly, and they have greater success in completing their work. They are less forgetful, less impulsive, and less likely to engage in frustrating behaviors. Research also shows that reading and math performance are enhanced. In addition, they are usually much happier. Approximately 80 to 90 percent of children treated with ADHD medications show improvement in symptoms when the medication is properly prescribed and monitored.
Describe typical stimulant medications used to treat ADHD
Often, individuals are treated with stimulant medications which fall into two categories, methylphenidates (such as Ritalin) and dextroamphetamines (such as Dexedrine). These two medications are closely related to each other. Stimulant medications are not addictive. In fact, children who have been properly treated with medication for their ADHD are less likely to abuse drugs as teens.
The methylphenidates work by blocking the re-uptake of the neurotransmitter dopamine. In simple terms, this means there is more dopamine available to support the functioning of the brain.
Newer methylphenidates such as Concerta, Metadate CD, Ritalin LA, Focalin XR as well as some others, are longer acting formulations of the medication so they are much easier to tolerate and the child usually does not have to take multiple doses of medication a day.
The dextroamphetamines work slightly differently. These drugs not only block the re-uptake of dopamine, they also increase the release of dopamine at the synapse between neurons.
The dextroamphetamines include Adderall, Adderall XR, and Vyvanse. Adderall and Vyvanse are newer, longer acting variations on Dexedrine, and similarly, have fewer side effects than the original Dexedrine.
Are there ADHD medications that are non stimulants?
Strattera is a long-acting, non-stimulant medication that also affects the same neuro-transmitter system as the stimulant medications.
What are some side effects of ADHD medications?
Typical side effects include reduced appetite, greater difficulty falling asleep, impulsivity when the medication wears off, irritability, and suppression of personality. The longer acting medications have greatly reduced the likelihood of these side effects.
It can be scary to start your child on medication; therefore, it is extremely important that you find a physician who is willing to work closely with you to find the right medication for your child. Many children will respond quite well to one medication without any side effects, while they may have side effects with another medication. Your doctor needs to be familiar with the different medications and should know how to tweak the medications and their doses depending on how your child responds.
Audrey Griesbach, MD, FAAP
11835 West Olympic Blvd., #1200 E
Los Angeles, CA 90064
Dr. Audrey E. Griesbach, MD graduated from the University of Massachusetts Medical School and subsequently did her pediatric residency and child development fellowship at Children’s Hospital of Los Angeles. Her practice is devoted to the evaluation and treatment of children with learning differences, ADHD and other behavioral issues, autism, cerebral palsy and other neurodevelopmental disorders.