Myths and realities of pharmacological treatment in ADHD

ADHD is a neurodevelopmental disorder whose symptoms are caused by a defect in brain chemicals called “Neurotransmitters”, specifically dopamine and noradrenaline.

In order to perform a certain function (to be concentrated, to organize and plan actions, to control impulses, etc.), it is essential that the brain circuits responsible for that action function properly. This is where dopamine and noradrenaline act as chemical messengers, allowing information to pass from one neuron to another, completing the circuit that allows the action to be carried out (e.g., to be concentrated or to control impulses).

Thus, when this delicate balance is disturbed (by a defect in these substances) and the message is not able to pass from one neuron to another, the result is a function performed incorrectly. It is at this level that the malfunctioning of the brain of people with ADHD lies, and where pharmacological treatment works to improve symptoms.

There are several types of medications that help children with ADHD, and which are safe and effective. These are mainly stimulants, which act mainly on the brain’s dopamine, and non-stimulant drugs, which act on noradrenaline.

At present, there are many myths not only about ADHD itself, but also about the pharmacological treatment used to treat it, which we will try to dispel below.

The pharmacological treatment of ADHD “sedates the child”, “annuls his creativity” and “reduces his faculties”.

Nothing could be further from the truth, the drugs traditionally used in the treatment of ADHD are not sedatives, they do not numb, they do not reduce the child’s faculties, nor do they reduce the child’s reflexes.

What they do is normalize the chemical imbalance that causes ADHD, allowing the child to use his or her natural abilities to focus attention, maintain concentration, think before acting, listen, attend and learn.

“Methylphenidate is an amphetamine, so it can be addictive in the long term.”

Methylphenidate belongs to the pharmacological group of “central nervous system stimulants” just like amphetamine, but they are two different drugs (in the same way that paracetamol and ibuprofen belong to the group of analgesics, but their mechanism of action and side effects are different).

On the other hand, it has been shown in countless studies that pharmacological treatment in ADHD has a preventive role against addictions in adulthood. The consumption of tobacco, alcohol and other drugs is usually lower in the population of children with ADHD treated pharmacologically than in untreated children. “Human beings use drugs to escape from reality, not to focus more on it.”

“Pharmacological treatment of ADHD slows growth and can affect the heart.”

Short-term side effects (loss of appetite, difficulty falling asleep, headaches, abdominal pain) are usually transient and with a series of simple recommendations can be minimized.

There are no known negative effects or long-term toxicity from the use of methylphenidate, and numerous studies have shown this to be the case. Neither the studies published to date, nor clinical practice, nor the epidemiological data collected to date, indicate a higher risk of cardiovascular side effects, including the risk of sudden death, than in the general population.

In relation to the growth of children treated with methylphenidate and in comparison with untreated children, many studies conclude that there is no significant impact on the height obtained at the end of growth in those treated.

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“If the child does not go to school there is no need to medicate and therefore it is recommended to rest on vacations.”

ADHD is a disorder that affects people who suffer from it 365 days a year; affecting not only their school performance and self-esteem, but also their family and social life. Therefore, treatment must be daily, without “breaks” on weekends or even when the child does not attend school. And in the same way that we do not remove the glasses in summer from a child with myopia just because he or she does not go to school, we do not suspend pharmacological treatment for ADHD just because we are on vacation and do not have to fulfill the academic obligations of the school period.

It is known that repeated treatment suspensions can not only chronify the side effects (because the child never gets to adapt to the medication), but also its long-term efficacy is ostensibly lower compared to children who receive it daily.

Is pharmacological treatment in ADHD lifelong?

Not necessarily. The treatment is usually long and must be administered as long as the child needs it. In many cases, it is maintained until adolescence or even beyond, if necessary, so each case should be reviewed periodically.

In this sense, it is of fundamental importance to carry out periodic clinical controls, which allow us not only to monitor the appearance of possible side effects or to control the evolution of the child and his weight/height and AT, but also to review the pharmacological regimen he receives and adjust it to his needs.

“There are alternative treatments that can avoid having to give medication to children with ADHD”.

Despite the infinity of scientific works that exist around ADHD as such (of high quality, with an undoubted solidity and that demonstrate that it is not an “invented” pathology), and the use of safe and effective drugs in this entity, sometimes families often receive information about the existence of alternative treatments that can avoid the use of medication in these children. In this sense, there is no scientific evidence of the usefulness of any of them, and in many cases, their efficacy is more than doubtful.

There is also no firm evidence on the usefulness of food supplements or polyvitamins, restrictive diets, homeopathy or the “Tomatis” method in the treatment of ADHD.

In short, ADHD is a disorder of neurobiological origin, the onset of which is influenced by genetics. It was first described more than 100 years ago, it exists in different countries and cultures, and parents or inadequate teaching methods are not to blame for its onset.

The difficulties suffered by children and adolescents with ADHD are not controlled by effort, just as diabetes or high blood pressure do not depend on the will of the sufferer.

ADHD causes a significant impairment in the ability to develop in the academic, family and social environment, limiting future possibilities, if not properly treated.

There are safe and effective treatments for ADHD; the risk of pharmacological treatment is much lower than the risk of not treating the child.

We believe that psychoeducation of parents and family members is essential to optimize the treatment of our children and adolescents with ADHD, so through these fact sheets we intend to reinforce the concepts worked on in the office, encouraging and helping them in their difficult role as educators.