Stimulants as a means of diagnosis

[Malika]

If a child takes Ritalin or any stimulant and it "works" - ie the child is not so hyperactive or can concentrate better - does this necessarily mean the child is ADHD?
Although I have been (to my surprise) pondering about the possible beneficial effects of stimulants recently, this question doesn't actually come from me but from someone I know here. But it is a good question, I think... would seem to make sense as a crude diagnostic tool??

 

[InsaneCdn]

Classical question - and the answer is "no".
Because... the stims are used for many OTHER dxes, too.
And because stims make MOST people "perform better" - which is why the military uses stims for long-distance fighter pilots etc.

Would be nice, but... it doesn't quite work that way.
I'd be wary of any doctor who wants to take that approach, too.

 

[AnnieO]

Most Rx medications have nasty side effects. I'd avoid those if at all possible... And, what IC said.

 

[Malika]

Rx = prescription medication, right?
As we all know, the decision of whether to medicate a child or not is a really big one. On the one hand the possible nasty side effects and long-term effects and on the other the very real gains in quality of life that many people report.
I think my son's hyperactivity is a real handicap to him. I accept and love him just as he is (most of the time) - the world, of course, is not biased in his favour like me. If there were something that could control his hyperactivity, allow him to take part in social activities just like all the other children... of course part of me wants that for him!
But I don't know that stimulants would work for him. From what I read here, all medications use is based on enormous trial and error.

 

[InsaneCdn]

Rx = prescription (that is a standard pharmaceutical term).

 

[Malika]

Yes, thanks, IC, I looked it up on the net. It's standard in North America but not Europe

 

[buddy]

ok... I am NOT a doctor/nurse etc. But one thing that I have found for the stimulant class of medications that at least is one pro....you can just try one small dose a day to see how it goes. There are some who only use it on school days if their kids can manage, others like Q need it all the time to function appropriately. So I guess I am saying, at least, unlike a medication that builds up and is in them 24/7 you at least can choose to use it on a schedule that is the least amount of time you feel is necessary. NOT minimizing it is a serious medication etc. just saying it is ONE advantage.

 

[exhausted]

Stimulants work for many people who do not have ADD or ADHD. And many people with ADD/ADHD do not benefit from stimulants and have to use a different class of drugs. I don't think any doctor would think giving a drug trial as a way to diagnose an illness or disorder.

As you know Malika, my son took Ritalin for many years. We had no problems except that he was so quiet verbally when the medication was in effect. He is a huge kid so it did not stunt his growth. He ate well so his appetite did not shut down as it does for some. While I do believe we have to be careful with medications and weigh the cost+benefits, I think it is unrealistic to take a stand against anything in the blanket sense. Sometimes the side effects are worth the use of the medication. It should all be case by case. Every human is different. For my daughter, we have gained almost no good effects with drugs only adverse-but we gave it try because we are committed to relieving her suffering.

I have a very rare form of RA called Palindromic RA, which often morphs into regular joint damaging RA after years. It is incredibly painful (most painful form) and when it sets in it affects the large joints to the point that I cannot stand up or walk if it is my hip or leg. Cannot move my arm etc. I cannot function let alone sleep. The pain is so intense, I cannot relieve it with any OTC , herbal, or natural method. I tried everything, even went to a holistic doctor. In the end he told me that I would need traditional medications. Talk about scary. They use DMARDS-which can shut down your immune system and leave you open to serious infections (I work in a germ factory as a teacher so no thanks). They use anti cancers-made me violently ill. And finally I went with steroids and Tramadol. Both these medications have major bad press, yet I only take them when I feel an episode come on and they work. They let me function! I don't have to take something every day and the side effects and risk are worth it to me because I cannot take the intense pain for days at a time, nor miss work.

I have asked my boy if he resents us for medicating him. His response is that he would have not gotten through school and he thinks he is doing well today as a result. Mind you we did many other things as well-behavior mod., counseling, good parenting, lots of activities, biofeedback and even mind/body work. We have done all kinds of things for difficult child as well.

There is a pervasive fear and ignorance about "RX drugs" out there that has been pushed forward by anti-pharmaceutical factions. Yes there are problems with the drug companies and the regulating bodies. Some drugs are really scary and the side effects as bad as the benefit for some people. However, what gets me the most is people who swear by natural treatments for depression and so on....guess what? They are made from some of the same plants/chemicals that the RX stuff is made from and it is not regulated. You have no idea what you are getting in terms of active ingredient potency unless you are using them under a trained doctor. I got very sick on one brand of a natural inflammatory with bromelien (a pineapple derivative). Found out from the holistic doctor. that is was a brand that he did not use or would recommend!

Mental illness and neurological problems are diseases and disorders. I think it is medical neglect not to treat them in some way (I didn't say treat with medication as a blanket, though for some it is the only option) For some (ADHD, Bipolar, etc.), we have some very good treatment options. There are some things out there with scientific backing that are not even drugs. Try some other options for J before you go to the drug place and see what affects you get. He is young. What have you tried so far? I'm sorry I have not read all the posts so I may have missed this.

 

[addie]

Yes, if the indications are that a child MIGHT be ADHD/ADD, then Ritalin (in any of it's various forms) is, to my mind, a good idea. It is fast in and fast out. Either it works or it doesn't.
Once upon a time I thought medicating children was awful.
Many, many kids later, I think if one is working closely with a psychiatrist to monitor and report, since there are no drug trials on kids (well, very few) well, I have seen both sides of it.
I have started a ten day trial of Ritalin on someone, only to take them off it after only one day. It is that obvious that it is the wrong medication for that child. But everything I do is done with full knowledge and permission from the psychiatrist.
i have used medications that take time to act ... an anti-anxiety medication on a 6 yr old. And ... It took a few days but her encopresis gradually stopped. But we had a fair indication it was anxiety-related. But then I have had quite a bit of experience with encopresis and have always found it to be psychological, not physioligal.
if the psychiatrist feels ok about trialling Ritalin, why not? It's been around for a very long time.
i think the main thing about medications for children is that if they work, great. If not, then stop them. But everything MUST be done under the supervision of a psychiatrist. I have a great child psychiatrist.
so to ask if it is a diagnostic tool, while I would not put it quite that way ... Yes, sort of.

 

[Malika]

Thanks for your input, it's very helpful.
Well, yes, in general I do agree with exhausted that blanket positions on most things are not useful. medications... for example, I have quite severe asthma. I take a steroid (long-term effects unknown to me!) because constant asthma attacks are debilitating and this means I now hardly ever get attacks at all. I am grateful for that.
What I believe they call treatment holidays are common here in France. A child might be medicated just for school, and not weekends or in the holidays. Curiously, though, J almost calls for the other way round! But I think much will be revealed for him about what is going on for him next school year.... He may indeed reveal more serious attention problems.
Of course the problem is the fantasty.... I sometimes fantasise that a stimulant (and here, Ritalin and Concerta are the only medications licensed to treat ADHD) will just make J calm, not constantly hyperactive and constantly seeking "excitement", make him able to cope with waiting and boredom. This is really his handicap in life, as I see it, and the handicap of my life with him. Going to the doctor, the dentist, anything like that, is agonising because he just cannot sit and wait - he will be dancing around, careering, jumping off things. At every level, all the time, he cannot deal with the low stimulation of ordinary life. If I give him a jumper to put on, for example, he will - he has to, it seems - first of all throw it in the air, throw it across the room, etc.
This behaviour makes a lot of people label and avoid him. It is stressful and unsoothing to have this around you all the time. I am used to it but sometimes I find it annoying too. Which is not, of course, why I would consider medicating him, but I would like greater social acceptance for him, and for his self-image.
Am I fantasising that a stimulant might stop all that need for constant activity and excitement?

Oh - in terms of what I have tried so far (and still give every day)
Omega 3 (since he was about 1)
Iron supplement (typically, his ferritine level is below normal)
Magnesium plus B6
multivitamin plus minerals

Whether any of this helps... difficult to know! J seems generally more co-operative and easier to reason with for the last few months, which is how long I have been giving the magnesium. Coincidence?
And then, of course, I have changed my parenting style with him, deal with his fits and crises differently. I have to say nothing I have yet received from the outside seems to have helped at all - this is not for want of trying to get such help on my part and not to "blame" these professionals. But thus far I've felt like it's me alone with understanding and trying to manage J's differences.

 

[DammitJanet]

I am a firm believer in better living through pharmaceuticals. With the exception of the very new stims that have come on the market in the last couple of years, most of them have been on the market for years. Ritalin has been around for at least 40+ years and its cousins are all based on that formula so I would take ritalin's safety record into account.

People who have ADHD and ADD react completely different to stimulants than people who do not have ADHD. They do not have that speed effect. It calms them down instead of speeding them up. I think its a relatively easy and painless way to get a quick idea if a child could possibly have ADHD. If the stimulants help them then the chances are high that they have some form of ADHD at work. Could they have something else going on co-morbid? Sure but they could also possibly be simply ADHD and if they are medicated they could get with the program and live happy, healthy lives.

 

[DDD]

Are you feeling any better this morning? I hope so.

I realize you're trying to think thru all aspects of future stimulant use but somewhere in the thread it was noted that some parents only give it on school days. I've been trying to understand that choice for forty years. Decades ago a Mother was chatting in the Pediatricians waiting room with another Mom. Both their children were climbing on furniture, tossing magazines etc. The two Moms agreed "we never use Ritalin except for school days". I'm sitting there buried in a book and thinking "look out world", lol. I've also heard alot of parents say "come here X and take your pill so you can be good". WTH? Keeps life interesting, lol. DDD

 

[InsaneCdn]

Some kids only need the boost, when under the stress of school. We had a neighbor boy like that... he couldn't do heavy-duty essays and such, without his Ritalin... but it wasn't to take the edge off his behavior.

Others... need to catch up on their eating, and use the weekend for that... that seems to be older thinking, but is still done.

And the "other" kids, obviously, need it all the time!

 

[DDD]

Accurate and thoughtful response, Insane. I used to wide a brush in my response. DDD

 

[BusynMember]

I'm on a work break and didn't get to read the responses, but my answer is no. College students use stimulants to focus on long work days and studying, even if they have no ADHD symptoms. Stims help a lot of people focus. They also make many people flip out. Depends on the person. There is no "gotcha" way to make a diagnosis of ADHD. I don't like using medications to diagnosse anyway. To me that's kind of like experimenting on a kid. A lot of kids with ADHD do not do well on stimulants...it's such a crapshoot.

JMO

 

[Malika]

Because J has much more marked hyperactivity than deficit attention, my own question was really whether the stims "work" in terms of calming down constant agitation and movement. But, just to clarify, no-one that I have heard of is talking about doctors using it as a diagnostic tool - it was just a parents' query.

 

[InsaneCdn]

Malika - with respect to stims affecting activity level? favorite story from the BIC (behavior intervention class) teacher ... worst student she EVER had, for weeks was having HER pull out her hair (this lady didn't get ruffled by NOTHING). And then, one Monday morning he walks in (like usual) and sits down at his desk, and it's "yes, Ma'am" and "no, Ma'am" and "could I refill my water bottle please"... and she's wondering if this kid has a twin that traded places for a day just to really confuse her, and... then this kid pulls out this FULL BOTTLE of Ritalin, to read the instructions and figure out when to take his next dose. (this is elementary school... kids don't GET to carry their own medications!) But, he had started on medications on the weekend, and... he was transferred back out of BIC by the end of the week.

Yes, this is a true story.

 

[buddy]

Are you feeling any better this morning? I hope so.

I realize you're trying to think thru all aspects of future stimulant use but somewhere in the thread it was noted that some parents only give it on school days. I've been trying to understand that choice for forty years. Decades ago a Mother was chatting in the Pediatricians waiting room with another Mom. Both their children were climbing on furniture, tossing magazines etc. The two Moms agreed "we never use Ritalin except for school days". I'm sitting there buried in a book and thinking "look out world", lol. I've also heard alot of parents say "come here X and take your pill so you can be good". WTH? Keeps life interesting, lol. DDD

I have thought that too, I know a boy who really struggled out of school and ultimately took drugs on his own and then killed himself. but over the years I have found that kids with less of the hyperactive symptoms, I see the point. My nephew really does not have issues when he does not have to focus on school work/homework. If he is just playing outside or playing sports, he is absolutely fine. Doesn't need it for watching TV or going shopping. Now, in my house, that would NEVER work. SO, he has Concerta for the school days, and Ritalin short acting for homework times. It really works well.

 

[BusynMember]

Without attention deficit, hyperactivity can be due to a lot of things, such as anxiety. If it's, say, anxiety, then stimulants can make a child even more anxious. I'd get a firm diagnosis first. I think you're being smart to go slow. There is honestly no drug on earth that will make a child behave. He can outgrow the hyper too. My son was so hyper, I swear he hung from the chandeleirs when he was younger. Now, at eighteen, he is a couch potato. If it's not about attention, I'm not sure I'd be looking at ADHD medication at all.

Again, JMO

 

[Malika]

Thanks, MWM. Yes, to be honest I am thinking this, too - that it is wise to be taking things slowly.
About the deficient attention - it's hard to pinpoint this exactly. On the one hand, J concentrates well when given a specific task to do in certain conditions, for example at school. There is obviously some social pressure on him to do this but the fact is he can do it, unlike presumably a lot of ADD-type children who simply cannot, try as they might.
And then, in "normal" life, his attention is frequently dispersed because he's hopping from one thing to another - eating a bite of food, then getting up to get a toy or constantly picking things up to touch, throw, manipulate, then putting them down and picking up something else, etc. Obviously this is linked to hyperactivity and I've no clue to what degree it shows deficit attention. He can sustain a conversation on the same subject for a long time, although he talks a lot, generally, and fast....
So I have to be sure to point all this out to the new psychiatrist we are going to see in April - not let it all get brushed under the carpet of unquestionable ADHD. Or maybe he is just typical for a hyperactive/impulsive type of ADHD. I don't know.