Long Term Use of ADHD Medication
One of the most common questions I get in my practice, when medication is needed (particularly in a child) is: “How long will my child have to take this ADHD medication?”
The answer I give has just been confirmed by a Mayo Clinic study.
This is an important study, because it relates to a research program which studied 379 children with ADHD from diagnosis until almost 18 years of age. Most of the longer term studies do not carry on for this long.
This study looked at the stimulant medications - which include the Methylphenidate products, including: Ritalin, Concerta, Metadate CD; and the Amphetamine products, including: Adderall, Adderall XR, and Dexedrine.
In this study, they found that about 73% of these patients benefited from stimulant medication - similar to the response rates found in research studies. They also found that patients benefited from continuing the medication over time.
Regarding monitoring for long term ADHD medication use: the Mayo clinic study suggests that the patient should see their doctor (pediatrician, psychiatrist, etc) at least every 4-6 months. During these appointments, in addition to checking on the functioning with respect to ADHD, the doctor should check the: height, weight, blood pressure and heart rate.
The researcher explains that it is important to continue to take the medication, and then to have a trial without medication to see how the child will do. If they do well without it, then one can consider stopping it. If they still have many impairing symptoms of ADHD, then they need to continue to take the medication.
You can read the original story here: Mayo Clinic ADHD Research
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Written by Dr. Kenny Handelman - The ADHD Doctor
To find get a FREE special report on ADD/ADHD Medication, visit: Medication Mastery
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August 2nd, 2006 at 4:10 am
Hi,
1 re -taking meds on week ends , holidays
Some docs say , take the meds because there is a lot of informal learning taking place , others say don’t take
What’s your take
Thanks
Allan
August 2nd, 2006 at 12:26 pm
Hi,
Thanks for the comment.
Regarding using medication on weekends and holidays. I did do an audio newsletter about that some time ago, but I don’ t have it typed yet.
Here is a quick summary:
The bottom line is – the best current treatment is to treat 7 days/week 365 days per year.
The issue is that for decades, doctors said to treat with medication only on weekdays for school, and then be off the medicine for weekends and holidays. However, now we realize that people need the medicine for social and emotional development as well as academic progress. So, when there is impairment in functioning - which is generally there for the diagnosis to be made, and the impairment is worse without the medicaiton it is best to treat 7 days per week.
The only reason to take a ‘medication holiday’ is if your child is in the 2-3% who have growth slowing over the years with a stimulant medicine (i.e. Ritalin, Concerta, Adderall, Dexedrine, Metadate, etc.). He can be monitored with every 6-12 month height and weight. If this isn’t an issue –then don’t worry. The only other thing – is if any of these new cardiac issues are a concern – he probably shouldn’t be on it at all.
Anyway, best to review with your treating doctor. The analogy that you need to think about is – if this were diabetes, or hypertension – you wouldn’t take a day off the medicine just to ‘give the body a break’. There would be serious medical consequences to stopping the medicine, and research shows that this is a concern as well with ADHD.
I will get the full post of the audio newsletter up in the next few weeks on the topic of ‘medication holidays’. I will also put on my ‘to do’ list the topics of cardiac safety, and the long term consequences of not treating ADHD.
Thanks for the great comment.
Warmly,
Dr. Kenny Handelman
August 7th, 2006 at 9:19 pm
Back in the early 1980’s when I realized my son and an enormous amount of uncontrollable energy along with several other Mom’s, we developed a support group as the schools weren’t tolerant of these behaviors. In meeting with the parents, we discovered that the parents also had ADHD tendencies as well. One thing that came out over and over again was that most of the children were blond haired and blue eyed. (Ironically the parents were also of this genetic make-up as children when the ADHD was the most prevalent) As parents now, some of them said that to control their condition they smoked marijuana and it was extremely difficult to get off the drug when it was helpful for them to function in society. I have also found the correlation between the foods we eat and the ADHD behaviors. A neurologist and I agreed that food could affect the brain chemistry and each person was unique - a food sensitivity for one person wouldn’t necessarily affect another. My question then was - how can you medicate a person with the known drugs of choice without controlling every chemical that goes into the body - doesn’t this explain partially why some parents say they didn’t see a change in their child on or off the medications, and why some kids appear over medicated at times and not at others. For these reasons, I do believe our society is over medicated - we aren’t addressing all the causes of why the brain chemistry is such in an ADHD child. When they reach puberty they would just as well sell their Ritalin in a black market to make money than to take it because they don’t need it anymore (or they don’t see any improvement with or without it) Doctors see a patient once a month and medicate the child on that particular day with that particular brain chemistry. As a teacher of special needs students there are so many variables that affect behaviors that I have found protein foods seem to help balance their activity levels. I don’t know if it is scientific or not but when you are at your wits end and peanut butter crackers calm them down and the child isn’t allergic to them it is worth it to have them on hand so you can continue to educate them. I am interested in your thoughts on that. Thanks.
August 8th, 2006 at 1:13 am
Nancy,
Thank you for your comments and for sharing your experience.
Obviously there are many variables to a persons ‘chemistry’. The leading research has been on brain chemistry and how medications improve that. There is also a lot of research into the genetics of ADHD, and the genetics of medication responses.
Are there alternative approaches which can be helpful?
Yes.
Research shows that about 60% of people who go to a doctor about ADHD have sought alternatives.
Although I am not an expert in these, I will seek out other experts in the coming months to explore the use of alternatives in treating ADHD. Keep watching for that content
With respect to food - a protein snack can be helpful. I am sure that you are aware of how refined sugar (i.e. from a chocolate bar, candy or soda) can cause a spike in the blood sugar level, and then cause a subsequent drop in the blood sugar about 90-120 minutes later. This is a ‘relative hypoglycemia’, meaning that the blood sugar is relatively lower than it generally is. This may lead to behavioural outbursts. If a child or adult is having behavioral changes due to refined sugars - the best way to overcome this is to cut out refined sugars (sugar snacks) as well as refined grains (white bread, white rice, etc.) and eat whole grains, as well as protein snacks. While this may be helpful for some individuals with ADHD, research has shown that only about 5% of individuals have a good response to diet modification for their core ADHD symptoms.
August 10th, 2006 at 5:24 am
My 14 year old son was prescribed Adderall xr 20 mg at the suggestion of the
school. They said he was ADDHD. He was 14 about to begin highschool. The
highschool did not let him in and he had to go to a smaller charter school. On the 29th day of his medication mt husband forund him dead in the bathroom
45 minutes after I gave him the medication. He had an underlying heart problem
never diagnosed and he had several complete physicals. It is very scary. I have another son who is 19 and was on all meds for 10 years. He is off everything now.
He wants to learn how to feel without meds. We had him checked. He is fine.
I understand that many DR.s in the area are getting their patients hearts checked.
I think that is so good . If my Dr would have known that they were having problems in Canada. I think he would have checked him. PLEASE if you are on these drugs get your hearts checked for damage. I t might save yoour life. Matthew was a prescious son. He did not deserve to die like that.
Ann Hohmann
August 11th, 2006 at 9:31 am
Ann,
Thank you for sharing your story with us. It is very sad to hear what happened to your son.
As I am sure you know, warnings have come up in the recent past about cardiac issues with the ADHD medications, and I will do a post addressing these issues in the near future.
Kenny Handelman
April 22nd, 2008 at 11:17 pm
Hi my daugher is currently taking Concerta 90 mg and she is about 48kg her family doctor has refused to reorder this dose that her child psychologist increased her to from the 74mg before this. He says that it is an unsafe dose, when she was taking that dose she had no side effects and was well controlled in her ADHD. On the 74 mg we were noticing that she was getting hyper and unable to focus or control herself after school during school she was okay but it was not lasting long enough. The psychologist increased the dose and said it was fine.
Now I am left fighting between doctors and wondering if this dose is unsafe even though reading says that teens and adults can go as high as 108mg is this true. If it is would you have any websites I could find info about that to give to her doctor so she could be treated correctly. I would love to change physicans but we live in small town in Ontarion and doctor shortages prevent me from changing. Any help would be great Thank you.
April 23rd, 2008 at 8:48 am
Hi,
Please review this article on Concerta Dosage:
http://www.addadhdblog.com/concerta-getting-the-right-dose/
That may help.
You can also look at the CADDRA (Canadian ADHD Resource Alliance) Practice Guidelines:
For kids (see page 10 here):
http://caddra.ca/english/2007-08_guidelines_pdfs/2007-08_Caddra_Guidelines_Chapter_1.pdf
or for Teens (see page 3 here):
http://caddra.ca/english/2007-08_guidelines_pdfs/2007-08_Caddra_Guidelines_Chapter_3.pdf
The only other thing I can suggest is to see if a child psychiatrist can put in writing that this is a safe dose for your daughter, and then your family doctor may consider staying with it.
All the best,
Dr. Kenny