ADHD Medications (Ritalin) could be used with four year olds!

Scary headline, isn't it? The Vancouver Sun likes to create these headlines, which pretend to be balanced but really are designed to get you to worry ...and feel the need to read the article. The problem is, many people skim or never even look at the article itself. 


Let's go over what it says: 


The American Academy of Paediatricians released updated guidelines for treating ADHD. These guidelines expanded the ages for both the diagnosis and treatment of ADHD. The diagnosis of ADHD use to be restricted to the ages 6-12. Recently, with children attending pre-school and a careful eye on how the disorder progressing in adolescents and adults, we have expanded the ages when we think it's appropriate to diagnose ADHD. There is nothing nefarious about that.


But Sun writer Sharon Kirkey warns us that children may be misdiagnosed and may receive unnecessary medications. I suppose that's true of any medication or treatment, isn't it? But why is that the focus of this article? Here in Canada we actually have some decent diagnostic standards to determine who has and who doesn't have ADHD. I really think it would be have been helpful to tell the readers about that. Tell readers that a diagnosis should include more than a simple checklist a parent fills out, and should include some testing if necessary, and follow-up. Regretfully a major problem here in Canada is that children are seen, diagnosed, and then not seen again for a long time. Or seen by a different doctor because it's so difficult to get your own family doctor. But we do have standards of practice that are aimed at protecting us against misdiagnosis. ( see http://www.caddac.ca ) If we are really worried about misdiagnosis of ADHD maybe we should suggest that a parent ask their medical or psychological service provider what experience they have diagnosing ADHD, if they have observed children in school settings, and what guidelines they are following (see Caddac above).  That, I would suggest, is a simple step in avoiding misdiagnosis of ADHD any parent can take.


Well, the article gets worse. We further read that there will be a "further frenzy of aggressive marketing by drug companies..." Sounds scary. (I would suggest there will be a frenzy of marketing by holistic health care providers offering unproven and disproven treatments. Treatments that do nothing, and often have been proven to do nothing. Why our focus is on a treatment that has decades of research behind it and has been proven to be effective, is a puzzle to me. An online search for ADHD treatment in Vancouver shows some really unconscionable results.) This statement seems way out of line...especially if you actually read what the Academy suggests.


If your wondering if this is an anti-medication article ...well read on. The article then addresses the issue of heart problems and deaths due to medication. This is a tricky area for any parent to understand. Yes, children taking this medication have died. Did they die because they were taking these medications? Children die taking aspirin, cold medications, all sorts of medications. But bringing this issue up scares parents, and they should worry, be concerned, and deal with that concern by getting good information. A simple place to get information on this risk, an obvious place, is by asking your prescribing medical doctor. Here is what one doctor on the web says in answer to a parents concern about harmful effects of ADHD medications:


"There were 186 Ritalin related deaths in a ten-year period. In contrast there are 11 million prescriptions for Ritalin a year. If you divide the number of children who died from Ritalin by the number of annual prescriptions, that is 186/11,000,000= .000017. That means .0017% of children who take Ritalin are at risk for death. Now I realize that this is not really an exact calculation. The real way to determine the exact death rate is to divide 186 by the number of people who took Ritalin during the last decade. I couldn't find any data on this. The point is that whatever the death rate is, it is very small. It is probably more likely for a child to die from a Tylenol overdose than to die from Ritalin use. 

 

 


If your child has ADHD and Ritalin is helping, then I feel that benefits she gets from taking a drug like Ritalin far outweigh the risk of death from the drug. The bottom line is that no parent wants her child on Ritalin or some similar drug. However, if the child needs it, you as a parent should not worry that your child will be the one child in 60,000 that has a serious problem." (Anthony Kane, MD)"

Still confused? Ask your doctor. Why doesn't the Sun suggest you ask your doctor? I always wonder why they don't.

And finally, this is a comment you'll find in the middle of the article: "The authors emphasize that - for preschoolers - behavioural therapy should be tried first, such as group or individual parent training in behaviour management."  Only after that fails should medication be tried.

Actually they suggest first, foremost, and only after it fails, psychological, behavioural treatment and parent education. But this gets mentioned as an afterthought.

So I wonder, why isn't the headline of this article "American Paediatric Association Strongly Suggests Behavioural and Parent Training for Children ages 4-6 with ADHD."

I'm a psychologist. Here in Canada I can't write prescriptions for medication (although psychologists can and do in other jurisdictions). I provide behavioural therapy, parent education and teacher training to address ADHD. I offer these services all the time to schools (Burnaby, Coquitlam, Vancouver, Maple ridge), and almost always they turn ADHD specific training down, instead asking for training on ASD, Aspergers and other related disorders. ADHD, even though it's the most highly diagnosed disorder and causes the most problems in school and for the child (and teacher) is not a priority. ADHD and behaviours relating to ADHD are THE MOST RESEARCHED issues in school behaviour management we have. We know what works, we know how to change classroom environments and teach teachers skills that improve outcomes. Still, we do nothing. I wish the local papers would focus on the lack of training for etchers, and the lack of training for parents (MSP will pay for the medication, but will not pay for one single hour of parent education!)

But the American Academy of Pediatrics already suggested we do that, didn't they?

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For information on counselling and therapy services in Burnaby, Vancouver, Coquitlam and surrounding areas contact Dr. Roche at: (Office phone) 778.998.7975

About

My name is Dr. Jim Roche and I am a Registered Psychologist and a Registered Marriage and Family Therapist (RMFT) in British Columbia. In addition to my doctorate in clinical psychology, I hold a master's degree in family therapy, a certificate of advanced graduate studies (CAGS) in school and educational psychology from Norwich University, and have completed two years of post doctoral studies in neuro-psychology at The Fielding Institute in Santa Barbara, California. In addition to being a registered psychologist, I am a certified school psychologist, certified teacher of special education (New York and California), and a Clinical Member of the American Association of Marriage and Family Therapists (AAMFT). I also hold a doctoral degree in law with an emphasis in medical malpractice and education law. Beyond my academic credentials, I have completed two years of supervised clinical experience in both hospital and community based clinics and two years of post doctoral training in neuropsychology. I have served as director of behaviour programming for several school districts, as a consultant on autism for the province, and have held numerous academic positions including Clinical Instructor in Psychiatry at New York University and Bellevue Hospital in New York as well as being a faculty member at NYU, Brooklyn College, SUNY New Paltz, and Norwich University.

 

Key words

ADHD | Anxiety and Stress | Autism and Asperger's Disorder | Individual Counselling | Child Therapy | Testing and Assessments and Learning Disabilities | Couples Counselling | Depression | The Angry Child | Anger Management | Pain Management and PTSD | Forensic Services

 

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Phone: 778.998-7975