ADHD and Head Injuries

A concerned mom recently received a diagnosis of ADHD for her son, and wondered whether a head injury he had suffered a year or so earlier could have caused his ADHD.

Almost anything that affects the brain can cause symptoms similar to ADHD, including head trauma, lead poisoning, hypothyroidism, birth trauma, prematurity, exposure to drugs, alcohol, or nicotine in utero, meningitis or encephalitis, etc.

It is probably more common for someone with ADHD to experience head trauma from a bicycle accident than for someone without ADHD to develop symptoms of ADHD following such an accident, given the extremely high rate of accidental injury in children with ADHD.

Bright children with ADHD often do well in the early grades because they don't have to pay too much attention to do well. However, with each new school year comes an increase in the amount and difficulty of work, the amount of homework (detailed and often boring busywork), and long-term assignments (the nemesis of everyone with ADHD).

Fifth grade is often when ADHD is first apparent for bright students. The next hurdle is middle school, when suddenly there are multiple teachers, multiple assignments that are more difficult requiring more work, and more long-term assignments. The same increase in demands that require planning, organization, time management, study skills, and follow-through, issues related to ADHD, occurs with the transition to high school, and again with the transition into college.

Related Topics: ADHD: Diagnosing a Disorder, Diagnosing ADHD

Tags: diagnosis, ADHD, WebMD

Strattera and ED

The FDA approval of Strattera, a non-stimulant medication for ADHD, was an exciting breakthrough in treatment. Nevertheless, some patients experience sexual side effects when they begin to take Strattera for their ADHD.

Often, sexual side effects to Strattera are transient, and improve after a few weeks. However, if it continues on a long-term basis improvement isn't expected. Medications that increase norepinephrine can cause sexual side effects (although less frequently than antidepressants that increase serotonin). Strattera primarily increases norepinephrine, while methylphenidate (Ritalin, Concerta, Metadate CD) and Adderall primarily increase dopamine and only to a small degree increase norepinephrine. When people experience sexual side effects to methylphenidate or Adderall, I give them a trial of Dexedrine, as it's the only stimulant that only increases dopamine.

Stimulants treat symptoms of ADHD in a greater percentage of people than Strattera, and often treat inattention and distractibility more robustly than Strattera. Strattera isn't safer than a stimulant, and if effective a stimulant alone would be a far better choice than adding a medication such as Viagra.

Related Topics: Change Meds to Reverse Sagging Sex Life, Dealing with Erectile Dysfunction (ED)

ADHD Book Recommendation

The author of the excellent book, ""The Link Between A.D.D. & Addiction,"" Wendy Richardson, MA, has just released an updated version, "When Too Much Isn't Enough: Ending The Destructive Cycle of AD/HD and Addictive Behavior"

It covers the gamut of addictions: alcohol, marijuana, gambling, internet, food, sex, shopping. I highly recommend this book to anyone who struggles with ADHD and addictive behavior or anyone with a friend or loved one with these problems.

Related Topics: Instant Gratification, Gamblers and Substance Abusers Share Traits

Drug Holidays

Around this time of year I start to see lots of questions about whether or not parents should give their children a "drug holiday" over the school break. The usual reasoning is that because their children are not in school, they shouldn't take their ADHD medications.

ADHD often affects many aspects of life, including academic performance, relationships with peers, family life, and participation in sports and other activities. It is a "life" disorder, not a school disorder. Medications should be used as one would for any other medical disorder. One wouldn't stop using an asthma inhaler at 3:00 when school gets out, on weekends, or on holidays. On the other hand, if one weren't wheezing, there would be no need to use an inhaler, no matter what day it was. What I'm getting at is that ADHD is a neurologically based disorder, and when to use medications has more to do with how well someone is functioning than the day on the calendar.

ADHD symptoms may be more obvious during the holiday season, as parents' and children's schedules become more hectic and daily routines are disrupted.

There are many kids who primarily have problems with inattention, are not hyperactive, impulsive, or disruptive, and do not have difficulties with peers or within the family, who may do well over the holiday off medications. For other kids, life may be a constant struggle, and they may benefit from being on medications whenever they are awake, seven days a week.

Occasionally there is a child who has a decreased appetite with significant weight loss and a decrease in the rate of growth when on stimulant medications. When other measures fail, such as eating before they take their medications and after medications have worn off, or using supplements such as Ensure, drug holidays may need to be implemented.

An excellent resource on medications is, "Straight Talk about Psychiatric Medications for Kids," by Timothy E. Wilens, M.D.

Related Topics: Docs Overlook After-School Treatment of ADHD, Tips to Reduce the Side Effects of ADHD Medications

Stimulants for Life?

Many visitors to my ADHD Message Board are concerned about starting their children on stimulant medications, because they have heard that stimulants lead to addiction, and are also concerned that they will never stop taking medications.

About 60 - 70% of children with ADHD continue to have symptoms in adulthood, and the majority would continue to benefit from medications. However, "forever" is a long time, and as rapidly as our knowledge of the brain, genetics, and science is changing, I don't have any idea how ADHD will be treated 10 years from now, let alone a "lifetime" from now.

Dependence on amphetamines develops when large doses are used in a manner that causes a rapid increase of the drug in the brain, which is primarily obtained by snorting or injecting the drug. Although abuse of amphetamines is a problem in the United States, it's extremely rare for someone with AD/HD to abuse their medications. I'm more concerned about a teenager selling or giving their medications to friends than I am to them abusing it.In 25 years of practice I've never had a child come into my office and say, "Give me more of that medication doc, it's good stuff." Instead, most children don't want to take medications and parents find pills that have been spit out and hidden behind the couch.

Several excellent studies have found that children who have been treated for ADHD with medications such as Adderall, have a much lower incidence of drug use in adolescence and young adulthood than those with untreated AD/HD. The better a child does in school and in life the less chance they will hang out with the "losers" or "dopers," in school, and the greater chance their friends will be involved with sports or other activities. If you're concerned about the potential for drug use, continue treatment rather than stop it.

Related Topics: Choosing the Right ADHD Medication for Your Child, ADHD Drugs Don't Lead to Drug Abuse


WebMD Abstracts: A CDC report shows how common ADHD has become in the U.S. and how many children are receiving treatment for ADHD. The CDC research confirms ADHD is more common in boys than girls and more than half are taking medication for ADHD. New research on ADHD published by the American Medical Association's Archives of Pediatric and Adolescent Medicine is exploring potential causes, treatment and quality of life issues for ADHD children and their families.