Expert: Christine D. DeLoatch, MA CCC-SLP - 2/24/2005

Question
I have some questions about two of my kids that are on ritilin.

First, has it been found in studies that if ADD children were place in a loving, structured envirnoment, either in school and/or home, that there was marked improvement?  For example, if one could arrange it, perhaps in the second half of the day (instead of being in a class) give private tutoring to a child in which he not only learns the normal subjects, but the tutor will help the child become more aware of his deficit and teach him ways to deal with it as well as give him a loving, yet disciplined direction.

Also, since there is more than one kind of medicine for ADD and since there appears to be some strong evidence of short term and long term negative symptoms, why not just alternative with different types of medication?

Thanks
David

Answer
Dear David,

Thanks for asking me your question.  

The answer to your first question is both yes and no.  

All children with AD/HD as well as other disabilities do better in highly structured settings.  One-on-one teaching is easier because there are fewer distractions.  Does that mean that their processing is better? Yes, but only because of the artificial environment.  When placed again in the traditional environment of the typical classroom distractions prevail and the same challenges exist.  

If your family has the finances & community resources to do this, it can be helpful, but ultimately - training the child to deal with the distractions (like using ear phones, asking for what he needs in the classroom, etc.) would also be of value long-term.  

In the 1990's the estimate of children receiving special education was 12%.  Thirteen percent of the U.S.'s population is African-American.  If you train a black child to be able to only deal with other African-Americans, that is a dis-service.  They need to learn to not only survive - but thrive in the mainstream.  The same is true for individuals with disabilites.  

Society expects things and unless they find themselves in a position where they have little contact with others - they need to learn all skills & suplimentary skills for all settings.  

Now with reguard to your question about medication, I'm not sure you have accurate information, So I will discuss the pros & cons of all medications used for AD/HD alone.

Stimulants- this includes Ritalin, Dexidrine, Cylert, Adderall, Concerta and a few others.  

Ritalin has been used for more than 40 years (also to treat narcolepsy).  Most common side effect is appetite loss.  Usually appetite loss means that the dose is not too low to impact AD/HD symptoms. Long term side effects are none.

There is no risk of addiction when the medication is taken by someone diagnosed with AD/HD and when the medication is taken orally as prescribed.  

Other medications that sometimes work are SSRI's (Selective Seretonin Re-uptake Inhibitors) like Welbutrin, Zoloft, Celexa, etc). The new medication Straterra is more like these.  There is a longer time for this type of medication to reach it's full potential, about 4 weeks.  

It is not unusual for there to be medication changes as the result of hormone fluctuations due to puberty, secondary symptoms (depressions), or just growth.  Since these cannot be anticpated, it is not a good idea to change medications because you anticipate some side effect that may or may not happen.  All people are individuals and different people experience different side effects.  I suggest the philosphy : If it isn't broke don't fix it.

Just a point of information. Side effect warnings are based upon what symptoms the patients reported at the time of clinical trials and then during prescription usage.  If someone caught a cold during the clinical trial, because they can't rule out the medication being the cause - they have to list it as a possible side effect.  There is no way of knowing whether or not that person would have caught a cold anyway.  They have to be more cautious so that they don't miss anything and get sued.  It doesn't mean that everyone will get a cold.  I hope that helps you understand a little better about the stating of side effects.  It was never supposed to be something that causes undue alarm -but was supposed to help give infomation so that with your MD you can way the cost verses the benefits.  

I hope that I have answered your questions.

Blessings to you and your family.

Christine