Let’s Talk About Attention Deficit Part 2
I commonly see Attention Deficit (AD) with or without hyperactivity in my office. The inability to posses focus will dramatically limit a child’s ability to attain and integrate new information. With a deficit in the ability to maintain attention, a child will no longer be able to make progress in many aspects of education.
Sometimes medications may be required to induce focus and concentration. Of course, prior to using medications, it is important to try the natural options first (check out part 1 where I discuss those options). If the natural options are unsatisfactory, then prescription medications may be considered.
The goal is to find medications that work to help with inattentiveness, impulsivity, and hyperactivity. In addition, when you find a medication that addresses these problems, you often also find improvement in social skills, improvements with language – both expressive and receptive, and the general ability to learn improves as well.
Medications used in treating attention deficit are designed to stimulate receptor sites in the brain. Now it can get a bit confusing here. There are different classes of attention deficit medications and each class works on different receptor sites in the brain. The question is if we “tickle” the right receptor site in the brain, do we get more focus and concentration?
Many of us have used coffee as a “drug” to stimulate focus and concentration. Actually, it is the caffeine in coffee that stimulates caffeine receptors in the brain, and for some of us, it is just what we need to stay on task. Some use cigarettes. It is actually the nicotine that stimulates the nicotinic receptor sites in the brain, and that, for some, can stimulate focus and concentration.
A general rule of thumb when prescribing these medications is to start with a low dose and quickly work up the dose until it is working, or until side effects occur. Attention deficit medications work “today” and you do not have to wait more than 2-3 days before deciding on a dose adjustment.
Classes of attention deficit medications:
Atomoxetine: Strattera
Dextroamphetamine: Adderall and Vyvanse
Guanfacine: Intuniv
Methylphenidate: Ritalin and its long acting forms, Ritalin-SR, Metadate ER, Metadate CD, Methylin ER, Concerta
Tricyclic Antidepressants: include Anafranil and Tofranil
Side effects:
Each class has its own potential side effects that must be reviewed individually as these medications can interact with other medications your child might be on, or, even conditions your child might have, such as epilepsy. As always, with everything we do in medicine, the benefits of a particular medication must outweigh the potential risks. With the children I see in my practice, when all the natural ways of inducing focus and concentration have failed to produce significant results, I do prescribe attention deficit medications.
The attention deficit medications, that I have found to have the fewest side effects in my patient population, are Strattera and Intuniv, so I usually start with one of these. Strattera can be compounded into a transdermal cream, which is great for those children unwilling to swallow capsules and have a hard time taking supplements in general. These medications dosages depend on the weight of the child. I always tend to start at a lower dose and work my way upward. It is important to be on the lookout for the side effects, I cannot stress that enough.
Several medications may have to be tried, and remember, we are stimulating different receptor sites in the brain. What works for one child may not for another child. Though I would prefer not to have to use any of these medications, some children will cease to progress academically without these medications, and for some, if not most parents I work with, that is intolerable. Benefits of learning and growing socially may then outweigh the risks of having to take some of these medications. This truly is a case by case intervention and definitely tailored to each child and their family.
And that’s my approach to Autism.