Understanding ADHD, and Why Stimulants are Its Best Treatment

 The body loses 0.5% of dopamine neurons a year from berth to death. They start and drive movement.  The amount of movement drops every year. Go to a free play playground and look at 3 year olds and 10 year olds. If you put a normal 5 year old in a 12 year old class, you will think, ADHD. That means teachers are best source of information for making the diagnosis. They have a class full of kids to compare a child. The Diagnosis of ADHD is made if the child sticks out from his same age peers. It does not respond to good classroom discipline, and will affect function. That means, the child may have to be moved out of class. The child is disrupting the learning of tohers, and consumming an unfair amount of staff attention. 

What are stimulants stimulating? They are stimulating the frontal lobes. They inhibit many parts of the brain, including the dopamine system. One old fashioned alternative was the infliction of pain, in corporal punishment. Fear helped kids control themselves in class in the past. Most parents do not want to raise their kids in fear. The other problem with corporal punishment is that it may be rewarding to a child with ADHD. They are bored. They enjoy adult attention. They are sensation seekers. Corporal punishment provide all those rewarding properties. If it worsens the child, it should be stopped. Medications should be considered. 

Stimulants are twice as effective as other medications like atomoxetine, antidepressants and blood pressure medications. They work in an hour, peak at 2 hours (both benefits and side effects), and last 4 hours (all original stimulants), 8 hours (Adderall), or allegedly 12 hours (Vyvanse, Adderall XR). They each help 70% of patients. Put the 30% of non-responders on the alternative drug, and half will improve. Try combinations on the remaining treatment resistant patients. They must be matched for strength before drawing conclusions about effectiveness. For example 10 mg of methylphenidate has the strength of 5 mg of amphetimine. Adjust the doses before comparing their effects. The dose is by the weight. An effective dose will stop working even if adjusting for weight, after several month or a year. An alternative to repeated increases in doses per weight is to stop the stimulanst for 2 weeks on a school break, and restart at the same dose. 

It’s not Ritalin That Has Gone Wrong, It is the NY Times That Has Gone Wrong

I suggest an instant increase in credibility for all left wing extremist propaganda outlets. Have a brief counterpoint box inserted into the article so people can see there two sides to the discussion. The author is a psychologist who bemoans the lack of funding for the psychological aspects of Attention Deficit-Hyperactivity Disorder (ADHD). He fails to disclose he is arguing in the economic interest of his specialty. This piece is to pressure the government to increase funding for psychological research, and self-dealing. I have no argument with self-advocacy as long as it is transparent and disclosed.

The author has no idea what ADHD is. We move around while alive. We move the most around age 2. The amount of movement steadily declines with age to 100 years old. This decline happens to parallel the loss of dopamine neurons of about 1 half percent a year.  One may therefore think of a 12 year old boy with ADHD as someone who moves like a normal ten year old. Put a six year old in a class of 12 year olds, and she will appear hyperactive, inattentive, easily distracted, and impulsive. This is despite being a normal 6 year old. At puberty, nearly all children lose the hyperactivity part of the disorder, and retain the inattention and impulsivity parts, most into adulthood. The best judge of this deviation from age based standards is the teacher observe a class of kids the same age, engaged in the same activity.

Activity level has a great deal of environmental input. Are you praying or running a foot race?  So case controls are tough in the absence of a similar environment, such as being classmates. That makes the teacher the best judge of the deviance from norms. That is not mentioned in the article.  The teacher is also the real consumer of the medication, because without it, the child cannot be controlled and no one else is able to do any learning. No mention of the deleterious impact of the untreated disorder on the entire class or family. Other children shun them, as well.

Everyone agrees insulin is a miracle drug. It controls diabetes, it does not work, “long term.”  Why hold Ritalin to a higher standard than the miracle drug insulin. It markedly changes the quality of life day to day, and that is pretty good. Parents have to choose to give it daily. The idea that an academic psychologist knows more about the interest of their families or their chid has no validity, just arrogance.

About 20% of children have a small slowing of their height growth. Stopping the drug in the summer restores these children to their pre-treatment growth line. So growth effects are temporary if unusual.

Why is a stimulant given to children who are impulsive and hyperactive? In low doses, it stimulates the parts of the brain that quiet the other parts of the brain down. That is why children do not feel much on these medications. Their own brains are quieting other parts down.

There is a tolerance to the medication, and to the side effects. One may increase doses. Then, try to stop the medication in the summer. If the child has not grown out of the disorder, restart at the lower dose.

There is a rebound hyperactivity at the end of its effect in the evening. Small doses will stop that form of drug withdrawal. However, there is no feeling sick from drug withdrawal.

All medical conditions have a response to the environment, such as stress. ADHD is no exception to the long list.

As far as habit forming. No. The opposite is true. Kids do well, have no side effects, have improved grades, are popular on medication ad the opposite off medication. They are likely to refuse to take it. If there is an opposite to addiction, kids with ADHD have it Int heir oppositionality, they refuse to take medicine and must be coerced into doing so. Why refuse if grades are high, adults are praising the work. Friends are willing to play with the patient again? Because it is a noxious feeling to not be yourself anymore, however popular and successful.

So how are motorcycle gang members getting high? They are injecting a full day’s high dose intravenously. If they ever took a prescribed dose, they would slow down, treat their old ladies better, clean up, pay the bills, and become responsible.

The data make the case for even more prescriptions to under-treated kids, and for a low quality of life off these medications.