If you have a child with ADHD and have chosen to go for a non-medical route, more power to you, and if it is working well for you, that is awesome. However, I also have families that have stressed for years because of something they have heard in the media or from their friends and they and their child suffered because they didn't want to place their child on medicine for whatever reason.

Won't They Get Addicted to the Medicine?

Children on ADHD medicines are not addicted and are not more likely to have addictions later in life.

Here is the definition of addiction: "compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly  : persistent compulsive use of a substance known by the user to be harmful."

ADHD medicine do not form compulsions in children who actually need them and they are not habit forming. Just like any other medicine, parents and kids will forget from time to time and the only effect they see from missing a dose is that their child's behavior is not as good that day. There are no other side effects.

Tolerance is the effect where a person develops a bigger and bigger need for a substance in order to develop the desired effect. While there are times when I do have to increase a dose of medicine it is typically more related to the size of the child increasing and the changing stressors (increasing difficulty, etc) at school that require the increase. Changes are often necessary around puberty as well.

Finally, there are no withdrawal symptoms when a person comes off their stimulant ADHD medicines. In fact, the child “comes off” their medicine every night and can take weekends or summers off without developing symptoms (other than being more hyperactive). By definition, this means that there is no withdrawal.

So, without compulsion and habit, tolerance or withdrawal, there is no single characteristic about these medicines that make them addictive.

As for the question about children with ADHD going on to have more addictions later in life, it seems that this is more related to the ADHD than the medicine and adequate treatment may actually help prevent some of these later behaviors.

I Don't Want Them to Act Like a Zombie!

I hear this complaint or concern with just about every consult that I see. Understandably, parents don't want their children to act differently or have a change in personality because they are on medication. Guess what? Me neither. If I were to see personality changes in my patients, I would change their medicine or come up with other treatment strategies. However, this is a very uncommon complaint when families actually start medication. In my 6 years of practice, I have heard this complaint only twice and both of the parents were extremely worried about it prior to starting medicines, which makes me wonder if they weren't looking too hard for it in the first place.

It is my opinion, this was a bigger problem before with the short acting medicines (like Ritalin). Because they needed to be dosed more twice in the day, the children may have experienced the change in their blood level throughout the day which led to more drastic behavior changes.

Will This Stunt My Child's Growth?

While there have been some studies showing a slight decrease in weight and height growth over the first year of starting a medicine, these differences disappear when you recheck the children at 2 and 3 years out from starting medicine.

What are the Common Side Effects?

The most common side effects I see from the ADHD medication (primarily stimulants) are loss of appetite and difficulty going to sleep.

Loss of appetite-We usually see this problem just after starting medication and it certainly can improve over time. The child usually has the biggest problem with lunch time as that is the when the medicine is at its highest level in the blood stream. Usually, you can make up for this problem by making sure the child eats a good breakfast and dinner and eats what they can at lunch. I follow my patients’ weights closely especially when there is a concern about the child's appetite.

Difficulty with sleep-Occasionally, we will have a child who has a difficult time going to sleep. Like appetite, this is most common right after starting the medication. My first treatment for this is to make sure that are taking care of doing the right things to help themselves go to sleep: no food or drink with 1-2 hours of bed time, no screens on in the room 1 hour prior to bed time, etc. If that doesn't work we can do a trial of melatonin. Other options are available if this doesn't work.

Some more rare side effects that I want to discuss are mood instability and tics.

Some of the medicines are worse that others about this but we will sometimes have a child who is very emotional and tearful when first starting the medicines. This typically happens in the afternoon or evening as the medication is wearing off. Usually, with just a period of observation, this will improve after about 1 week on the medicine so I first have my families continue trying for a bit and monitoring closely to see what happens.

Tics are involuntary movement disorders that result in a short jerking of the head, lip smacking or some other short, quick motion. These medicines do not cause tics, but in a child who is already predisposed to them for some reason can cause them to become much more obvious and frequent. If the tics are disruptive or concerning, we will usually need to switch medicine to something else as this does not usually improve over time.

Summary

1. Children do not become addicts because of ADHD medicines.
2. Children do not become zombies because of ADHD medicines.
3. Children do not become short because of ADHD medicines.
4. Children should be watched closely for loss of appetite or difficulty sleeping when starting ADHD medicines.

For more information

Visit our Checkup newsroom resource page to learn more about ADHD. 

New research published this week in the Journal of Clinical Psychiatry may challenge that stereotype or at least require us to broaden what we think ADHD “looks like.”

The research looked at the overall rate of ADHD comparing surveys of parents completed in 2003 and 2011. It might not surprise you to learn that the overall diagnosis of ADHD increased during that time. But you may not have heard that increases were found across all racial/ethnic groups, with the largest increase in Hispanics (83 percent). Perhaps another surprise was the fact that the increase in girls was greater than the increase in boys (55 vs. 40 percent).

Symptoms of ADHD can include difficulty paying attention, hyperactivity and impulsivity. Diagnosis is based upon a conversation you can have with your pediatrician or a psychologist and usually involves a screening questionnaire to be completed by a parent and teacher. Treatment starts with behavioral and parenting strategies to help children cope with symptoms but can require medication when these are not successful.

The study showing this increasing number of children diagnosed with ADHD certainly grabbed my attention. As someone who generally does not like medication for kids, I worry that this means the number of children on medications for ADHD is also increasing. As with all medications (and more than most), treatments for ADHD do not come without risk.

I do have some theories as to why the number of children diagnosed is increasing:

Theory No. 1 - Parents and teachers are more aware of the signs of ADHD.

Many hyperactive and impulsive children were previously labeled as trouble-makers and ended up spending lots of time in detention and in school suspension. Many inattentive children slowly started to have more trouble as classes got harder and parents and teachers eventually gave up on them as someone who just “wasn’t made for school.” Now we are realizing that those hyperactive/impulsive kids can’t simply “just sit still” and that those kids who were previously doing well shouldn’t be failing just because they can’t listen to lectures or get their paperwork turned in on time.

This particularly accounts for the increased rates of diagnosis in children of Hispanic and African-American descent. Previously, the stigma associated with all mental health conditions (including ADHD) prevented parents from seeking help. Also, because many girls are inattentive, rather than hyperactive and always in trouble, they could also go undiagnosed.

Theory No. 2 - Physicians are increasingly giving in to parent demand to “fix” their child.

This is by far my least favorite, but I just believe it is something we should at least consider. In a world where the expectation is that a pill can cure just about anything right now, parents increasingly want something today that will resolve their child’s behavior problems. Long term treatment plans that involve behavioral techniques and maybe even counseling aren’t as popular for all parents. However, we should fight against this as the diagnosis of ADHD and decision to start treatment should not be based on demand from a parent.

Theory No. 3 – The expectations and demands on children are changing.

Children are learning to read and do more intense math earlier and earlier. Homework was virtually non-existent when I was growing up until second or third grade. This is not necessarily the schools or teachers fault so don’t call up and gripe at your child’s teacher. Many of the requirements for what they teach and when they teach it come from above them. The simple fact is that, in trying to keep up with the success of other countries, we have decided to accelerate curriculum and to challenge students. It’s not always a bad thing, but it can be if you have a hard time sitting still for long periods or can’t keep yourself organized.

Theory No. 4 - New medications with less side effects have made parents more likely to seek treatment.

No one wants to see their child “turn into a zombie.” It’s still the number one concern I hear when starting treatment for ADHD. Fortunately, with newer medications, the side effects are much less severe and much less common. Loss of appetite and difficulty falling asleep are now the most common side effects I see, even those are not that frequent.

Keep in mind, each of these things are theories based on my experience. We will need to continue investigating why we are seeing this increase in the rate of ADHD. We all need to be observing our children for signs and symptoms, particularly if they are struggling with school but parents and teachers need to be careful not to attribute all school struggles to ADHD.

For more information, read: 

ADHD stands for attention deficit hyperactivity disorder.

There are three core symptoms of ADHD:

1. Inattention

2. Impulsivity

3. Hyperactivity

Inattention

Inattention can present itself in many ways. Some of the most common complaints that I hear about are daydreaming, forgetting assignments and inability to complete a short list of chores at home.

Often children who mostly have inattention do not become recognized until they are older because they are not the ones causing all kinds of problems in the kindergarten classroom. They will skirt by making OK grades and not getting in trouble until they get a little older and the requirements to sit still and complete assignments on their own increase.

Impulsivity

Do you know that split second where you think about telling someone off but you stop yourself? Or you think about driving 100 mph because you’re running late but don’t because you realize it will be dangerous? That split second is another thing that children with ADHD are lacking. They push right through that pause and act before thinking about the consequences of their action.

The best summary for this problem is that they lack the ability to determine if the upcoming action is: safe or appropriate for time and place.

Hyperactivity

The hyperactive symptoms are the ones that most people (even strangers) will notice about children with ADHD. They are not even necessarily bad kids, it’s simply that they have a significant struggle with staying seated, staying still when seated and not talking out of turn. These symptoms are usually noticed by 4 years of age and progressively worsen until about 7 years.

Learn more about hyperactivity and ADHD here.

ADHD subtypes

There are three major types of ADHD and they are characterized by which of the core symptoms your child demonstrates: mostly inattentive, mostly hyperactive-impulsive and combined.

Diagnosis

The diagnosis of ADHD can be made by multiple practitioners: pediatricians, psychologist, psychiatrists and some counselors are trained to diagnose ADHD. I prefer to make my own diagnosis in my clinic unless the case is particularly challenging or there is something complex about the presentation.

There are many different modalities that can be used to diagnose ADHD but it is mostly made by parental history, teacher’s reports and screening scales. I prefer to use the Vanderbilt scale but there are many other scales out there that can be used.

Diagnostic criteria

Diagnostic criteria for ADHD start at age 4 so younger children are generally not diagnosed with ADHD. This is due in part to the complexity of trying to decide what is normal and what is hyperactive or inattentive for a child younger than 3.

The following criteria are used:

1. Be present in more than one environment (home and school) - this is important because children who have issues only at home or only at school are usually having more of a problem with the structure at one place than actually having a tendency towards ADHD

2.  Be present for more than 6 months

3. Be present before age 7 - this is becoming more of a problem as adolescents and adults are becoming more aware of the problem but demonstrating that there were symptoms prior to age 7 can be difficult

4. The symptoms must impair function-see below

5.  Be excessive for the developmental level of the child - An active 2 year old is not hyperactive but normal.

Does it impair function?

My main point when I am discussing a child’s ADHD with the family is focused upon this aspect of the diagnosis and treatment. For most children, impairment of function means that they are not progressing through school appropriately, are in trouble at school regularly for hyperactive or impulsive behaviors or have difficulty performing regular function at the house because of their ADHD.