What is the Role of Medication for Persons with ADHD?

Side Effects

Side effects are relatively common with psychostimulants. However, most side effects are not serious and can be dealt with without too much trouble. The most common side effects are insomnia and diminished appetite. These can usually be controlled if one is careful with respect to when the doses are administered (e.g., not too close to mealtimes or bed times). Less common side effects are abdominal pain, headaches, and irritability. There is also speculative evidence that in a very small number of cases, Ritalin may heighten one's susceptibility to have tics or increase their intensity in those already having a tic disorder, such as Tourette's syndrome.

Negative Publicity Regarding Ritalin

Ritalin has had more than its share of negative publicity in the popular media. For example, several critics of its use have appeared on high-profile TV shows, such as "Oprah," "Geraldo," and "20/20." Many of the critics have claimed that parents and teachers are too intolerant of behavioral deviations and turn to drugs to make children more docile and compliant. Many have also claimed that prescribing Ritalin for children in the early years somehow teaches them or encourages them to turn to illicit drugs, such as marijuana or cocaine, in the teenage years. Although there is a higher incidence of illicit drug use among teenagers with ADHD, there is no evidence that this is the result of using Ritalin (Barkley, 1998). In fact, there is some evidence suggesting that just the opposite is true—those who take Ritalin are less likely to abuse other drugs later (Biederman, Wilens, Mick, Spencer, & Faraone, 1999).

Research on the Effectiveness of Medication

Over the past twenty to thirty years, there have been dozens, if not hundreds, of studies on the effectiveness of psychostimulants for ADHD. The results have been overwhelmingly positive with respect to their effectiveness for improving inhibition and executive functions. For example, in one large-scale, 14-month study, funded by the National Institute of Mental Health, medication was found to be more effective than behavior management. However, what was most effective was when medication was combined with behavior management techniques (Pelham, 1981; Swanson & Sachse-Lee, 2001).

Even though psychostimulants can be highly effective for many persons with ADHD, there are some for whom the medication does not appear to be effective. Research is not conclusive, but perhaps as many as 30 percent do not respond favorably to the drug (Spencer et al., 1996).

Cautions Regarding Ritalin

Even though Ritalin is so highly effective, there are many very important cautions regarding its use:

• Ritalin should not be prescribed at the first sign of a behavioral problem. Only after careful analysis of the student's behavior and environment should Ritalin be considered .
• Although research has demonstrated the effectiveness of Ritalin on behavioral inhibition and executive functions, the results for academic outcomes have not been as dramatic. Although important academic measures, such as work completed or accuracy on assignments, have improved substantially, the impact on achievement tests has been much less (Forness et a1., 1999). Thus, teachers should not assume that Ritalin will take care of all the academic problems these students face.
• Parents, teachers, and physicians should monitor dosage levels closely so that the dose used is effective but not too strong. Proper dosage levels vary considerably (Hale et al., 1998).
• Teachers and parents should not lead children to believe that the medication serves as a substitute for self-responsibility and self-initiative.
• Teachers and parents should not view the medication as a panacea; they, too, must take responsibility and initiative in working with the child.
• Parents and teachers should keep in mind that psychostimulants are a controlled substance. There is the potential for siblings, peers, or the child himself or herself to attempt to "experiment" with it. (Hallahan & Kauffman, 2003, pp.212-213)

In addition to psychostimulants, a nonstimulant medication has come onto the market relatively recently. Strattera, which can be administered once per day, affects levels of norepinephrine. It is too early to say how Strattera will compare with the psychostimulants, such as Ritalin, with respect to effectiveness.