A recent review by Reeve and Garfinkel29 demonstrates that “most researchers have shown no effect on expected weight or height in long term follow-up studies. Initial growth suppression appears to be corrected by rebound growth at a later date.” In addition, the same studies have shown that drug holidays produced no detectable increases in height and only mild effect upon weight gain. In contrast, the disruption to children with ADHD and their families which these medication interruptions caused is tremendous.30
The psycho-stimulants can be used safely in spite of co-existing conditions. The only absolute contraindication to the use of stimulant medication is glaucoma. Otherwise minor accommodations can make stimulants the drugs of choice in virtually every patient.
SEIZURES: Amphetamine was once used as an anti-seizure medication. Stimulants only lower the seizure threshold at very high doses.
TIC DISORDER/TOURETTE’S: Recent research31 32has found that properly adjusted stimulant medication usually does not worsen the familial tic disorders and many patients with Tourette’s get better on stimulant class medications.
PREGNANCY: No problems have been reported with methylphenidate. Several cases of biliary atresia and heart valve malformation have been reported with amphetamine33 but these were not in excess of the number expected in the general population.
SECOND LINE MEDICATIONS:
In summary, ADHD is a serious, neurobiological disorder which has far reaching implications for those who have it. It affects every area of that person’s life. There is no reason in this day and age for anyone to suffer with this disorder for it is easily treatable with the safest and most effective medications.
28 Biederman J, Wilens T, Mick E, Spencer T, Faraone SV, Pharmacotherapy of Attention Deficit Hyperactivity Disorder reduces rick for substance abuse disorder. Pediatrics 104(2): 1999.
29 Reeve E, Garfinkel B, Neuroendocrine and Growth Regulation: The Role of Sympathomimetic Medication, in Ritalin: Theory and Patient Management, Greenhill LL and Osman BB, eds. Mary Ann Liebert, Inc.: 289-300, 1991.
30 Barkley R, et al., Driving-related risks and outcomes of ADHD in Adolescents and Young Adults. Pediatrics 92(2) 212-218, August 1993.
31 Gadow KD, et al., Long-term methylphenidate therapy in children with comorbid Attention Deficit Hyperactivity Disorder and chronic multiple tic disorder. Arch Gen Psychiatry, 56(4): 330-336, 1999.
32 Law SF, Schachar RJ, Do typical clinical doses of methylphenidate cause tics in children treated for Attention Deficit Hyperactivity Disorder? J Am Acad Child and Adolescent Psychiatry. 38(8) 944-995, 1999.
33 Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation, 4th Edition: Williams and Wilkens, Baltimore, MD; 28a-33a.
Dr. Victoria Martin, M.D. is a graduate of the University of Texas Health Science Center at San Antonio. She completed her residency at the VA Hospital in San Antonio, and her fellowship at Timberlawn in Dallas. Dr. Martin is board certified in Child, Adolescent and Adult Psychiatry by the American Board of Psychiatry and Neurology. She has been in private practice in Dallas for over 20 years.