ADHD – To Drug or not to Drug?

A couple of reports came out this week regarding ADHD. One was an interview posted at Sharp Brains with Dr. Arthur Lavin, a pediatrician at Case Western Medical School and an expert in ADHD. The other was a report in the Journal of Neuroscience on the effects of Ritalin, a popular ADHD drug, on the brain.

ADHD, or Attention Deficit Hyperactivity Disorder is characterized by a lack of attention or focus, increased ‘fidgeting’ and acting out and increased impulsivity. The National Institute of Mental Health estimates that approximately 2 million kids in the US have ADHD. This translates to about one child in every classroom of 25-30 kids.

ADHD diagnosis is increasing in prevalence in our kids. Some attribute increases to better diagnosis of a condition that was already there, others attribute it to unnecessary over diagnosis by zealous school counselors and psychologists and heavily marketed drugs. Still others believe that the rise is real and something is going on to increase prevalence of this disorder.

Wherever you stand on the debate, if your child is diagnosed with ADHD you need to make the decision what to do about that diagnosis. Many professionals are quick to jump to drug therapies, using primarily Ritalin.

It may surprise you, with the high use of Ritalin, that there is a lot that we don’t know about how this drug works. A multi-university study just published in the Journal of Neuroscience looked at what Ritalin does to the brains of mice. They gave mice therapeutic doses of Ritalin when they became adolescents (in mouse time) and discontinued treatment when the mice became young adults.

They found striking changes in many brain systems that control mood and anxiety. Unfortunately, we don’t really have much idea what that means long term. The same study did find that by time the mice reached older adulthood many of these changes had gone away. However, the authors admit that there could be long-term effects that are not detected.

As a brain researcher myself, I know that any studies like this only looks at a very small piece of the puzzle. It’s impossible to completely analyze all the possible changes that Ritalin might cause. All you can do is look at the stuff you think is important and see what you find. In my mind, this study raised the need for concern because of the dramatic changes that appear to be going on in the adolescent brain on Ritalin.

As I’ve written in the past – when it comes to playing with mother nature, we’re just not that smart. We usually don’t know what the long term consequences are and when we see this degree of short term changes, it makes me uncomfortable.

The interview with Dr. Levin, mentioned at the top of this article highlights a different potential approach. He uses a program called Cogmed, which is a software based training program to help ADHD kids develop better abilities to focus their attention. The program claims 80% effectiveness over about 5 weeks.

Presumably, programs like Cogmed are also changing the brain. How else could they possibly improve attention? So, what’s the difference whether you change your child’s brain with drugs or with a program as long as they both work to help their ADHD.

In my opinion, the difference is actually quite large. In the case of drug therapy you are forcing the brain to alter it’s chemistry and that has the effect of changing brain circuits that control the symptoms of ADHD. In effect, improvements in ADHD are a side effect of the therapy. And usually, there are other side effects that are not so desirable.

In the case of programs like Cogmed, you are asking the brain to adapt to deal with challenges you are giving it. You are directing the brain to make changes that alleviate the symptoms of ADHD through specific tasks. Effectively, you are allowing nature to figure out how to do the best job instead of forcing her to do it your way.

This is really the difference between any lifestyle-based approaches versus drug-based approaches for any disease or disorder. Now, this is not to say that drugs have no place. Sometimes brain chemistry is so out-of-whack that gently directing nature to fix herself is not powerful enough, and drug intervention is required in order to give your system a boost.

However, I strongly believe that drug therapy should rarely be the first line of attack, unless conditions are life threatening. It would be great to see more physicians take the time to try alternative, and admittedly more difficult, approaches, as Dr. Levin has done with treating ADHD.

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This entry was posted on Wednesday, July 11th, 2007 at 1:22 pm and is filed under brain fitness. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

2 Responses to “ADHD – To Drug or not to Drug?”

Joe Says:
July 11th, 2007 at 6:43 pm
If you takes kids off of sugar, they improve. Also, zinc has been shown to be effect with ADD & ADHD. With industrial farming, there are very few minerals left in the soil.
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ADHD – To Drug or not to Drug?

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