Question:

I have a son who is 6 years old and was just diagnosed with ADHD. He has been having troubles in school for 2 years (paying attention, inability to sit still, impulsivity, etc) His doctor has suggested putting him on Adderall and I would like to know what kind of effect this will have on his personality. I am concerned that it will change my son and, of course, my extended family members are very much against using drug to "cure" this problem, but I am the one who has to continually hear from his teachers and see my son hurt over thinking that he is a "bad kid" because he got in trouble again in class. I know that my son is a good hearted kid, but just he is too impulsive at times. I want to do what is best for my son, but I don't know of anyone else who has had a child with ADHD. I have 4 children and he is my youngest and the only one I have this problem with so this is all new to me. I would appreciate any suggestions or comments you might have on this.

Answer:

Your question covers a lot of topics pertinent to Attention Deficit With Hyperactivity Disorder and it's treatment. You can refer to the first link immediately following this question for ideas on how to most appropriately make the diagnosis. In this answer, I will concentrate on the concerns you express about the treatment of ADHD. It is true that many children are being diagnosed with this difficulty and then treated with stimulants or other appropriate medications.

Assuming that ADHD is an appropriate diagnosis for your son, then stimulants are usually the first type of medications used to treat this "disorder". There is good evidence that conservative and appropriate use of medication can lead to marked improvement in the symptoms that you mention, inattention, impulsivity and disorganization. There are many different types of stimulants that can be used. These vary in time of effect, i.e. 3-4 hours or 8 hours or more. They also vary in effectiveness and side effects from child to child. I usually think starting "simple" is best. The simplest of medications include Ritalin or Dexedrine. Adderall is a newer, more "complex" medication that is more expensive and combines two types of Dexedrine.

Medication should be prescribed in the lowest effective dose possible and with the least side effects. Appetite suppression and difficulty getting to sleep are the two most common side effects. At higher dosages stimulants can cause "flattening of affect" which means a child will not seem to express emotions as easily. Significant sleep difficulties, affect flattening or appetite suppression if occurring with slowing of growth, constitute unacceptable side effects and should lead to decrease in dosage and then switch to an alternative stimulant if side effects persist.

There are other groups of medications that also have been found effective with ADHD symptoms. These include some of the anti-depressants and anti-anxiety medications. If a child has a significant component of anxiety then these might be a good early choice, particularly since stimulants can increase anxiety.

As I'm sure you have already discovered, there is a great deal of information available on the internet regarding ADHD. I suggest you look at the additional links for more information.

Kay-

http://www.aap.org/policy/ac0002.html American Association of Pediatrics, Statement of Policy on diagnosis and treatment of AD/HD

http://www.chadd.org/movie1.html National CHADD

"What Parents Need to Know About AD/HD and Medication: Advice from an MD" by Shashank V. Joshi, MD. , Director AD/HD Clinic, UC San Francisco. This article is available at: http://www.schwablearning.org/articles.asp?g=2&r=532