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LISA CLARK: Welcome. And thank you for joining us for this Webcast. I'm Lisa Clark. If your child is diagnosed with Attention Deficit Hyperactivity Disorder, the last thing you should do is feel alone. An estimated 3-5% of school-age children are dealing with some form of ADHD. Although the disease can be frustrating to parent and child alike, the good news is that treatment is available.
For the next few minutes, we'll talk about the various medical options your doctor might recommend to treat ADHD. Joining us for this discussion, Dr. Patricia Quinn. She's a Developmental Pediatrician who is in private practice in Washington, D.C. And Dr. Peter Jensen, Professor of Child Psychiatry at Columbia University here in New York. Thanks and welcome.
We need to talk about various forms of therapy, just briefly, that might be used in approaching ADHD. What sorts of things might doctors suggest—before we get to the medical treatments themselves?
PETER JENSEN, MD: Well the most proven form of therapy that we use is what's called behavior therapy. It's basically teaching parents or teaching teachers how to give small rewards, or consequences, to the child for behaviors that are carefully selected to encourage or discourage. And so basically it's a little reward system, if you will, easily taught, and which takes a lot of persistence. But they are quite effective. And parents need to use them, not just for ADHD, but for children without those problems as well.
LISA CLARK: But hand in hand, there are a lot of medications which might be prescribed. Could you lay out some of the classes, or some of the typical medications that a parent might be giving their child who has ADHD.
PATRICIA QUINN, MD: ADHD is a neurobiochemical disorder resulting in problems in the dopamine system in the brain. And we know that there's a class of medications called stimulants that actually work in this area of the brain to improve the release of these chemicals, to prevent them from being reabsorbed and used up. So that we actually use stimulants to turn on areas of the brain that are not working in children with ADHD. The two stimulant classes are methylphenidate and amphetamines.
LISA CLARK: That might not seem logical to a parent to think here is a child who is very active, hyperactive, why would you treat this person with stimulants?
DR. PATRICIA QUINN: What we're doing is trying to turn on the brakes, or turn on the inhibitory systems. These are areas that aren't working. And by using a stimulant, we can turn on the brakes, or turn on these inhibitory systems.
LISA CLARK: Dr. Jensen, what kind of side effects do these various drugs cause for the children?
DR. PETER JENSEN: Well by and large, we think of them as nuisance side effects, in the sense that they're a little irritation. They're a nuisance but they're usually not dangerous or of any great significance, other than in dose adjustments or careful selecting of another medication from time to time. They include problems with appetite, where the child may not be very hungry at lunch or dinner time. And difficulties with sleep. Sometimes tummy ache, that's another common one. Maybe headache. Those would be your most common symptoms you'd have with these medications.
By and large children get over these various side effects, if you will. Or we can make them go away simply by either picking another medicine or lowering the dose.
LISA CLARK: Dr. Quinn, some parents might be concerned that treating young children with these kinds of drugs, with stimulants, might cause addiction problems down the road. But you say that's not true.
DR. PATRICIA QUINN: That's one of the myths, and a very common myth. And I'm glad you brought it up, Lisa. Because what we find is untreated children are the most likely ones to get into substance abuse and alcohol abuse to kind of self-medicate as they get older. What we find is that if you have a child with the diagnosis of ADHD, and he's appropriately treated with stimulant medication, you can reduce the incidence of substance abuse eightfold in these kids. So you actually get less substance abuse and alcohol abuse in children with ADHD if they are properly treated with medication for their ADHD.
LISA CLARK: Because then they're not tempted to try and self-medicate.
DR. PATRICIA QUINN: Absolutely.
LISA CLARK: Now most young children, and many older children, hate the notion of being different. Some of these drugs require treatment at school, during the day. How do you help your young patients cope with being given pills in the classroom situation?
DR. PETER JENSEN: Well it's a very important problem, particularly as the child gets older. And it can be a real source of embarrassment or stigma. And so if that becomes an issue, there are really now some very exciting new medications that have become available that allow one to very precisely and accurately dose a child throughout the day with a single dose. And so some of these medications—and there are often new ways of delivering the common medicine, like Ritalin—for example, one called Concerta—you can actually use this medicine just in the morning, and it basically moves throughout the day and then turns off around 8:00 at night. So it's a new technology, the same medicine. It's the way the pill's designed basically.
LISA CLARK: I understand. Now some doctors like to give their patients a drug holiday, say during a school vacation or during summer time when there's not as much need for them to be able to focus and participate in a classroom setting. What do you think about that?
DR. PATRICIA QUINN: I really feel, and from working with children all these years, this is a 24 hour a day, seven day a week, 365 day a year disorder. And if a child is having trouble with relationship with their peers or with their grandmother, or with their coach or the other children on the playground, I really do feel that the child needs to be medicated during those times. It is not just a disorder that is from eight in the morning until three in the afternoon while the child is at school.
And when you get to the adolescents and teens, I don't know about you, Lisa, but if I have someone in the car next to me who has trouble paying attention and is distracted by other things, I'd rather have them on their medication during those times when they need it. So for teens, for driving particularly, I think they need to be on their medication.
LISA CLARK: Yes. Dr. Jensen, why would some doctors think that they don't need to have medication all the time?
DR. PETER JENSEN: Well it really turns on whether the child is doing really well or not. And so at times a parent or a youth may say, “You know, I really want to do it by myself. I want to be off the medicine.” Sometimes a child might notice subtle changes in personality or spontaneity. And these can be issues that the child may notice, that others may not. And so a doctor, or a parent, or even a youth may feel, you know, this kid's doing very well under these conditions.
And so by and large, I agree with Dr. Quinn. It's 24 hour a day, seven days a week. But there's certainly children I treat, from time to time I'll say, “I understand where you're coming from. Then let's not use it on the weekend because you're doing really so well. But if you're not, hey all bets are off.”—I'd urge that child to continue on the medication.
LISA CLARK: How many years do most patients stay on their medications?
DR. PATRICIA QUINN: Studies show that it's about three years, from the time you start until you come off. However, we now know that the symptoms of the disorder continue into young adulthood and to adulthood. So that for most individuals who start in elementary school, probably about 70-80% of them will continue into their college years and use it for college. And about 50% of adults need medication to treat the disorder.
LISA CLARK: What advice do you have for parents and children who are coping with ADHD and have questions about the medical treatments?
DR. PETER JENSEN: Well I think one of the things that parents should do first is educate themselves. And often turning to other parents, in addition to finding a doctor you can trust and teachers you can really work with and are working with you for the child. Often other parents have been around the block, and they've seen what it's like. And they can often be really great sources of wisdom if they've been there and understand what it's like and have actually worked through the ropes of the problems themselves and can show you how to do it.
LISA CLARK: Good advice. Dr. Quinn, any final thoughts?
DR. PATRICIA QUINN: I think that, again, for a parent, if they are feeling that there is something wrong with their child, they really should go and get help. Because this is a very treatable disorder.
LISA CLARK: That's a very key word: treatable. Thank you both so much for being here with us. And thanks to you in our Web audience for joining us. I'm Lisa Clark.
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