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Study on ADD and TV
The recent study published on watching television between the ages of one and
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Overview of Stimulant Medication
Stimulant medication is used to treat attention deficit hyperactivity disorder
(ADHD).
What are stimulant medications?
These are medications which affect the action of certain chemicals in the brain.
In adults they have the effect of making people more alert, active and awake.
This is why they are called stimulants. However, in children with hyperkinetic
disorder or ADHD, the effects are almost the opposite.
When is medication used?
Medication should be prescribed only after your child has been fully assessed by
a specialist. They are very rarely prescribed for children under the age of six.
Stimulants may be worth trying if there are serious difficulties:
In school (poor concentration, can't complete a task, disruptive in class).
At home (on the go all the time, can't follow instructions, unsafe crossing the
road).
With friends (difficulty taking turns or sharing, getting into fights).
It's easy to see that if these problems are not tackled early on, they can lead
to poor results in school, stressful relationships at home and difficulty with
friends. Once problems are established, they are more difficult to treat because
they are habits.
How stimulant medication works
Stimulants seem to affect parts of the brain which allow us to control how we
pay attention to what is going on around us. This makes a child more able to
learn how to control thinking and behaviour.
What are its effects?
Although you would expect stimulants to make hyperactive children more
hyperactive, they usually have the opposite effect. The child's behaviour
becomes calmer, more focused and less impulsive. Some children and parents find
that medication has transformed their lives for the better. However, medication
does not work for everyone. Even when it does, it is not a cure, and it is
important that the child has adequate help with learning in the classroom, and
with controlling behaviour.
Why does medication help?
Stimulant medication creates a 34 hour 'window of opportunity' when children can
be calmer and can concentrate better. They can therefore learn better at school
and can start to learn how to behave better. Children often say that when they
are taking the medication they can think more clearly and find it easier to
understand requests from parents and teachers. School work becomes more
interesting and enjoyable, results improve, and they have more friends.
Parents and teachers can do a lot to help a child to make these changes. Your
understanding and support (practical and emotional) are crucial. Practical and
effective ways of helping a child to improve behaviour include:
Paying particular attention to good behaviour.
Clear simple requests one at a time.
Praise for effort as well as achievement.
Rewards for good behaviour.
Removal of privileges for bad behaviour.
Brief periods of time away from other people ('time out') when their behaviour
becomes too much.
These ways of helping your child's behaviour will often work better after
medication has been started.
Which stimulant medications are used?
Stimulants are used very commonly in the USA (where they are probably
over-used), but less commonly in Britain (where they are probably under-used).
It was first shown that they worked as long ago as 1937. These drugs are only
available on prescription.
The stimulant medication most commonly used in Britain is methylphenidate
(Ritalin). When it works, the effect begins within 30-60 minutes of being
swallowed. It wears off after 3-4 hours. A child may need 2-3 doses each day in
order to get the best result. The exact amount of each dose needs to be
carefully adjusted. The 10 mg tablets may need to be halved, or even quartered.
A pill cutter (obtainable from your pharmacist) can help.
Dexamphetamine is a stimulant which is chemically very similar to
methylphenidate. It sometimes works when methylphenidate does not.
Non-stimulant medication If stimulants don't work, your specialist may suggest
one of a number of alternatives, such as imipramine, fluoxetine or clonidine.
What are the side-effects?
As with any effective treatment, there are side-effects. Side-effects are less
likely if the dose is increased gradually when the tablets are started. Most
parents are worried about addiction, but this is not a problem with the low
doses used in children.
The commonest side-effects are:
Reduced appetite.
Staying awake later.
Because of the effect on appetite, the child's height and weight should be
measured every three to six months. Giving medication after meals may help to
ensure normal weight gain and growth. If the last dose is given around midday,
the child is more likely to eat a full evening meal and get to sleep on time.
Less common side-effects include
Underactivity and excessive quietness this may be a sign that the dose is too
high and needs to be reduced.
Anxiety, nervousness, irritability or tearfulness.
Tummy pains or feeling sick.
Headache, dizziness or drowsiness.
Tics or nervous twitches.
Hallucinations (seeing, hearing or feeling things that aren't there) these are
rare.
How long should the medication continue?
If the medication is clearly helping your child, it should probably be continued
for at least a year. Regular follow-up visits are needed to make sure that your
child remains physically healthy and is making good progress at home and at
school. The treatment (including medication) may need to be adjusted by the
specialist. Physical health checks and repeat prescriptions are often provided
by the general practitioner.
Medication may need to be continued for some years. Every so often it should be
stopped so that you can see whether it is still needed. If there is no
difference between being on it and being off it, then it should be stopped for
good. Some children will be able to stop completely as teenagers, and some may
be able to stop sooner. Others may have to continue as adults. There are no
known harmful effects from using these medications for several years.
Sources of further information
The Mental Health and Growing Up series contains 36 factsheets on a range of
common mental health problems. To order the pack, contact Book Sales at the
Royal College of Psychiatrists, 17 Belgrave Square, London SW1X 8PG. Telephone
0171 235 2351, ext. 146; fax 0171 245 1231; e-mail booksales@rcpsych.ac.uk.
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Factsheets may be duplicated and distributed free of charge as long as the Royal
College of Psychiatrists is properly credited and no profit is gained from their
use. Factsheets must be reproduced in their entirety without alteration.
Second edition October 1999