Monthly Archive for April, 2006

The current issue of the Newsbriefs from the Center for Development and Learning (CDL) has a segment that will be of interest to teachers and parents of students who take medication for attention disorders or for whom medication is a possibility, as well as others who have interest in the topic. The CDL is a not-for-profit organization that promotes some worthwhile educational practices and concepts. I couldn’t find a copy of the newsbrief on the CDL Web site, so I’m taking the unusual step of posting the article in its entirety here.

Medication Issues for Children with ADHD: 3 Strategic Concerns
By Gerard A. Ballanco, M.D., FAAP
Sub-board certified in Developmental and Behavioral Pediatrics

April 13, 2006
The use of medication to treat symptoms associated with Attention-Deficit Disorders is often controversial. Parents and educators frequently express concerns that taking medications will lead to teenage alcohol and drug abuse. Many times parents may be hesitant to inform school personnel about medication use because they are afraid the label of ADD or ADHD will stigmatize their child. Additionally, they express concern about medications “controlling” their child’s behavior instead of the child developing self-control. This publication will address these concerns.

1. Does stimulant medication used to help a child with attention deficits lead to drug abuse?
Evidence is accumulating that patients with ADHD who take stimulant medication during childhood actually have a risk of drug abuse that is no higher than the general population and significantly less than untreated individuals who have ADHD. Individuals with ADHD have a higher lifetime incidence of illegal drug use, alcoholism, smoking and risk-taking behavior than do matched peers who do not have this diagnosis. This is especially true of individuals who show significant defiant or aggressive behavior. People with ADHD do not abuse the stimulant medications; they use and abuse other drugs. This observation makes sense since oral stimulant medication does not cause a “high.” It simply helps the person to focus better.

2. Does labeling a child as one who has attention difficulties and/or who is taking medication to manage his attention difficulties adversely affect how teachers treat him or her?
Labeling is an issue that generates different opinions. Should we say a child has ADHD or describe a person as inattentive, impulsive, and overactive? Should we use friendlier and more descriptive words such as: the person is inconsistent and has inconsistent mental energy to bring to task; he often fails to process information deeply enough to consider all of its important points; she fails to make transitions easily; he is too active in situations in which he is expected to remain still? How should school administration, policy and legislation deal with the myriad of possible descriptors of children with attention problems without a label to put them under? How should a parent or attorney demand that a child’s needs be addressed? How do we minimize the possibility that the label will negatively stereotype a child?
The obvious answer is to incorporate the useful elements of both labels and descriptors. We must keep insisting that descriptors accompany labels. For example, if clinicians provide a diagnostic label such as ADHD, they should also describe how the disorder affects the child’s day-to-day functioning, such as, he does not complete his classwork in a timely manner or he gets distracted when given an instruction and does not follow through. The latter suggests behaviors that need to be modified; whereas, the label of ADHD does not. Eventually, the community of individuals working directly with the child (parents, teachers, tutors, the child him/herself) will come to recognize that the descriptors are much more important and useful than the label. Some families are delighted to have a label or name for the nemesis that has plagued them; others find a label odious. Both are common reactions.
Federal law prohibits discrimination against individuals with disabilities. An individual with a significant attention deficit may be in this category. Schools, including universities, accept students with attention deficits and may have programs for students with special learning needs as well. Schools that accept federal funds may not deny admission on the basis of attention deficits or learning disorders, and they must make accommodations for the disability. In this circumstance, the diagnostic label makes an increased level of services or accommodations available to the individual.

3. Does taking medication for the treatment of ADHD deny the child the opportunity to develop a sense of responsibility?
Each person develops a sense of responsibility at his or her own pace. It comes from using and applying internalized values and the experiences that we encounter throughout life. The outcomes of this bank of experiences are compared to our internalized values, and we get a sense of self-esteem and, hopefully, confidence. We accept the responsibility of our actions and accept consequences for them, but only if we have a sense of control and think that we have a reasonable chance of success. A critical element of the development of a sense of responsibility is previewing – the ability to reflect on what we do before we do it, compare the plan to past actions in similar circumstances, and anticipate the possible outcomes before acting. People with attention deficits who are impulsive, distracted, or moving too fast may not think before they act, so they often end up with results they neither wanted nor expected.
Thus, a person with attention deficits seems to develop a sense of responsibility more slowly than his/her peers. Mistakes are inadvertently repeated, much more so than usual, as the person learns how to live with and use an inattentive brain. Spouses and secretaries are accepted supports in the adult world, but are not usually available to young students. Parents, of course, may offer to help their children who have ADHD, but their efforts may be met with resistance, especially from teenagers.
Medication appears to temporarily accelerate an individual’s sense of responsibility when it is active, but when it wears off, old ways return. Taking medication does not slow the development of the sense of responsibility, but it doesn’t speed it up too much either. It often helps the child or adult to experience a higher degree of success, which makes effort more rewarding and more likely to be repeated. It is important to explicitly state to children and adolescents that having an attention deficit does not excuse them from responsibility for doing or not doing something. The consequence or reward of a behavior should depend on the nature of the behavior rather than whether it was voluntarily or involuntarily performed.

Dr. Ballanco, MD, FAAP, serves on the CDL Community Advisory Council and formerly served as chairman of the CDL Board of Trustees. In 2004, Dr. Ballanco was listed in New Orleans City Business as one of the top 20 pediatricians in the Greater New Orleans area. He presently practices developmental pediatrics in Mandeville, Louisiana.

Link to the CDL Web site.