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MD Mama

ADHD: A Matter of Drugs Now--Or Later?

I have many patients with ADHD (Attention Deficit Hyperactivity Disorder) and it seems like I have the same conversation over and over again with their parents: to medicate or not to medicate.

I completely understand the hesitation I hear from so many parents. I have to admit, I'm not entirely happy myself about prescribing a medication that has side effects and can be abused or misused, and one for which there is a black market. I also worry that too often when a child is on medication and so learning and behaving better, parents and teachers lose the incentive to help the child learn the organizational and other skills that could make all the difference later in life. Since ADHD often persists into adulthood, we have to have the long view with these kids.

But....the long view works the other way, too. Not treating ADHD with medication can lead to problems. Like drug abuse.

ADHD is really common. It affects 8 percent of children and youth--that's about 2 in every classroom of 20. Kids with ADHD can have real problems with both learning and behavior, problems that can haunt them for a lifetime (if you end up dropping out of high school because of poor grades or behavior, or end up getting arrested, it has a way of interfering with your future income and quality of life). But another thing we know is that kids with ADHD have a higher risk of drug abuse.

We don't know exactly why this is the case. Some of it is likely the impulsivity that is so common in people with ADHD; they don't always make the best decisions. It may also be that people with ADHD are more prone to addiction. Whatever it is, the risk is very real. Not only are kids with ADHD 2.5 times more likely to abuse drugs, they are more likely to start earlier, use more types of drugs, and continue into adulthood.

You know what helps? Treating ADHD with medication. In one study, using medication cut the risk of drug abuse by 85 percent. And for those parents who want to put off medication for a few years and see what else might help, here's an important piece of information: when it comes to preventing drug abuse, starting medications earlier (although not before the age of 6) is better.

None of this is simple or completely clear--that's why the American Academy of Pediatrics (AAP) issued a clinical report to help pediatricians sort it out. It stresses the importance of making the correct diagnosis (learning disabilities or depression can be mistaken for ADHD, for example). It also stresses the importance of talking to families about the proper use of medication--and of close monitoring of children who are taking them.

Along with doing all this, we really need to understand what causes ADHD in the first place. Some of it is genetics, but there is more to the story. Toxins from the environment, bumps to the head, even the kinds and amount of media small children watch may play a role; we need to figure this all out so that we can do a better job of prevention.

We also really need to find ways to help kids with ADHD from an early age. We know that they learn differently, yet too often we don't change the way we teach them--and we are often more likely to punish them for their behavior than help them learn to behave differently. The reasons for this have more to do with resources (read: money) than anything else, but it's not fair.

As it stands now, for kids with ADHD the choice really does seem to boil down to drugs now or drugs later. And while it's great that we have drugs that can help, it would be way better if there didn't have to be any drugs at all.

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