Abnormal Neurochemical Transmissions

Stimulant Medication and Attention Span

Attention span does increase for the majority of children who take stimulants, as evidenced by physiological and behavioral measures such as greater brain wave height and frequency, greater cerebral blood flow, heightened reflectivity, reduced impulsivity, and faster reaction time and "hit rate" when required to spot things (such as number 9's flashed on a computer screen). One researcher, noting improvements in impulse control, concentration, and planning, commented that with medication hyperactive children are better able to "stop, look, and listen." Intelligence test scores have been shown to increase by about 15 percentile points in children taking these drugs because, once their attention is channeled, they can make better use of their problem-solving capabilities and past knowledge.

Stimulant Medication and Activity Level

Children taking stimulants are better able to sit still in structured situations that demand paying attention; their in-seat wiggling and foot wagging also decrease. By contrast, when they are not required to focus in a sustained manner on a task, such as on the playground or in the lunchroom, these children's activity level is only sometimes reduced.

Stimulant Medication and Motor Performance

Children show a remarkable improvement in fine- and gross-motor coordination when they take stimulant medication, including reaction time, speed and quality of copying, performing mazes, and balancing. It appears that the drug has a direct effect on the metabolic and neural mechanisms that control and speed up motor responses after the brain has evaluated information, searched its memory, and decided on a course of action.

Stimulant Medication and Academic Achievement

On average across studies, children taking stimulant medication show about a 15 percentile point gain on standardized reading and spelling tests, though not in mathematics. In the classroom, as much as 25 to 40 percent improvement in accuracy, quantity, and speed of completing daily assignments are common, as are improvements in quiz grades. Moreover, persistence is better on frustrating tasks and on memory tasks (such as memorizing word pairs). The improvements in daily productivity and proficiency certainly are notable, though gains on standardized tests remain only modest.

Stimulant Medication, Behavior, and Long-Term Adjustment

Over time, hyperactive children do calm down. They no longer run away from their mothers in the grocery store, rip boxes off the shelf, or break grandma's best china, but their minds continue to wander. Said one adolescent, "My mind is like a television set on which someone is always changing the channels." Fidgetiness (e.g., pencil tapping), restlessness (e.g., leg wagging), impulsivity, speaking out of turn, and doing something reckless without thinking first are common.

A number of studies have shown that stimulants can suppress demanding, antisocial, aggressive, disruptive, and noncompliant behaviors, so that home and school become more manageable, less negative, and less demanding of adult supervision, guidance, admonition, and commands. Peer acceptance also improves. Despite improvements in restlessness, crying, temper outbursts, distractibility, excitability, frustration and pouting, sadly the hyperactive child's reputation for chaos sticks with him or her. Even after a few years on medication, the hyperactivity and inattention continue to set the child apart from his or her peers. These children tend to have few friends, engage in more antisocial behavior, lack ambition, are rebellious and aggressive, fail in school, have poor self-concepts, and are sad. Many are hard to discipline and end up in trouble with the law. Perhaps all those years of being told to "sit down and mind your own business" take their toll. Their reputation makes it difficult to turn around others' negative expectations, especially that of peers. It is no wonder that these youngsters continue to have difficulty negotiating their social worlds, especially when it comes to friendship and intimacy.

The behavioral patterns of the hyperactive-impulsive ADHD child are particularly difficult to modify. Medication alone has more powerful effects on behavior than any other intervention. Nevertheless, no studies have shown peer relations or emotional adjustment to be any better for youngsters who have been on medication several years than for those who have never taken stimulants. It seems that stimulant medication may create greater readiness to adapt socially because adverse behaviors have diminished, yet more than medication is needed to generate long-lasting change in behavior and friendships. Studies have found that a combination of medication and behavior modification, and sometimes cognitive self-control strategy training, social skills training, or attribution training (learning to assume responsibility for the consequences of one's actions) is the most effective intervention. One example of a behavior modification intervention is for the teacher to use a remote control to add points to a monitor on the child's desk when the child is on task. The teacher and student mutually set a goal and the reward for meeting that goal. These types of interventions are not nearly as effective when used alone as when used in combination with stimulant medication. The child needs to be in a more ready state to learn, and the environment needs to be appropriately structured to encourage positive change by systematically teaching these youngsters alternatives Tor coping with problematic situations.

Overactive Inhibitory Mechanisms and Hypoactivity

In contrast to the child with ADHD, hypoactive youngsters seem to suffer from overactive central nervous system inhibitory mechanisms. Therefore, stimuli that would usually grab a child's attention get screened out. These children's sluggishness shows improvement with sedatives, which quiet the overactive inhibitory mechanisms and allow more stimuli to come to their attention.