The principal medications sometimes used today in the treatment of ADHD are methylphenidate (trademark Ritalin), dextroamphetamine (trademark Dexedrine), and pemoline (trademark Cylert). These have been used successfully to treat students in the public schools for several decades. Negative criticism has centered on (1) using medications to "drug" children into passive behavior, (2) the possibility that children exposed to these drugs might develop dependence on these and, later, other drugs, and (3) the possibility that these drugs may be abused by the patients or others, Research indicates that there has not been good evidence of significant chemical dependence or abuse in those for whom the medications are prescribed. There has also been little or no diversion of these materials by family members of the patients. It is difficult to argue that these persons should be deprived of useful medications because of the possibility of theft and abuse of the medication by others outside the family.
It was once argued strenuously that the problems of ADHD ended ,"lith adolescence. Perhaps that belief was influenced by the fact that the focus on ADHD at that time related mostly to motor hyperactivity or restlessness. Today significant numbers of post-adolescent patients with ADHD use psychostimulant medications during study and examination time. Some other individuals with ADHD use these medications only during times, when they require their highest levels of concentration and performance.
Alternative Treatments for ADHD
Behavioral techniques and medication will ordinarily be tried with most individuals who haw ADHD. Behavioral techniques may not achieve the desired results. Medication may not give acceptable results, or medication may be rejected because of the public conflict over its use.
Alternative treatments may be employed. In many cases these have little or no accepted scientific basis. Their success is also debatable. Often they are expensive and time-consuming.
These alternative treatments may be largely divided into physiological and chemical areas. The physiological category includes patterning, biofeedback, and treatment of "vestibular dysfunction." Patterning has been proposed for a variety of conditions, including mental retardation and learning disabilities. It requires a great deal of time taking the individual through successive developmental levels and its usefulness is not, well accepted among professionals.
Biofeedback uses an electroencephalogram (EEG) to monitor brain waves. An attempt is made to train the individual to change the brain waves to a pattern that is believed to be inconsistent ADHD.
The chemical category of therapies includes megavitamins, trace elements. avoidance of refined sugars and food additives, and use of herbs. Megavitamins are comparatively large doses of water soluble vitamins (vitamin C and various B vitamins).
Trace element therapy is based on a belief that the low-concentration chemical elements found in the body may not be at the optimal concentrations. Their concentrations are measured in hair or nails, and an attempt is made to correct the balance by element intake or by chelation therapy. The elements may be determined with high levels of accuracy, but it is not clear what treatment of hair or nails should be used to remove contamination. In addition, it is unclear what area of the head should be used as the source of the hairs and what segment of each hair should be used.
Food additive avoidance therapy arises from the observation that large numbers of additives (mostly flavor and color) are introduced into our foods. Adherents to this theory alter the diet to try to alleviate symptoms. For ADHD in particular they try to avoid foods containing certain additives or salicylates. Some medications (prescription and over the counter) are prepared to meet this market. An objective panel, having reviewed the literature, agrees that a small percentage (probably 1% or less) of individuals affected by ADHD may show improvement with this approach.
Refined sugar avoidance therapy relies on an observation by some parents that their children become hyperactive when eating refined sugar. This observation has not held up well in controlled studies. If refined sugar did pose a problem, it is unclear whether this theory blames an impurity introduced or important nutrients removed during the refining process.
Herbal therapy relies on the idea that certain herbs contain materials that alleviate ADHD. The medications offered contain such materials as pycnogenol, ginko biloba, colloidal minerals, multivitamins, amino acids, enzymes, dried plant extracts, or a combination of more than one of these. Some of these are not subjected to a high level of analysis, and the components may be present at variable concentrations.
Allergy therapy has also been suggested by some for treatment of ADHD. Although this initially sounds like what we have discussed with food additives, allergy therapy can also focus on nondietary allergens. The major nondietary allergies involved here are respiratory. Therapy can include removal of respiratory allergens as well as symptomatic treatment- e.g., with antihistamines.
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