Improve Listening Skills in ADHD Children

How To Improve Your Childs Behavior

How to Improve Your Child's Behavior The definitive program on how to teach Your Difficult Child better behavior and to help you become a more effective parent. You Will be Able to End the defiance, battles and vicious fighting in your home. Fix your relationship with your child. Bring peace and happiness to your home. Enjoy a more fulfilling relationship with your child. Have your child respect you. Regain control over your child, you life and your home. Put an to all the arguing, fighting, and talking back. Have your child obey you without complaining. Get rid of all the hostility. Gain absolute confidence as a parent and know how to handle any situation.

How To Improve Your Childs Behavior Summary

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Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is the name given to a persistent pattern of inattention, hyperactivity, and impulsivity. The problems are generally first noted in childhood, especially if there is excessive activity. These behaviors can be enormously distressing to you and those around you. In childhood, they may have impaired your learning, disrupted classrooms, alienated teachers and friends, and frustrated family members. In adulthood, they may impair your employment and intimate relationships. You may feel that there is something wrong with you or that the world is an unfriendly place, but in either case, you may find it difficult to find satisfaction in your life. There has been a great deal of controversy in recent years about the existence of ADHD and the wisdom of using medication. At one end are those who believe that ADHD is a biological disorder best treated with medication. On the other end are those who believe that these behaviors are normal. These...

Attention Deficit Disorders

Reductions in aggressive behavior after treatment with amphetamine and other psychomotor stimulants are seen in children and adolescents who have been diagnosed with hyperkinesis or attention deficit disorder. There is considerable disagreement about these diagnostic categories and about whether the violent outbursts and uncontrolled episodes of aggressive behavior are limited to the early developmental period or continue into adulthood (Mendelson et al. 1971 Minde et al. 1972).

Attention DeficitHyperactivity Disorder

Formulation Design

Attention-deficit hyperactivity disorder (ADHD) is a common neurobeha-vioral disorder that is often recognized in early childhood, and can persist into adulthood. The principal characteristics of ADHD are inattention, hyper-activity, and impulsivity. In the United States, between 3 and 6 of school-aged children meet accepted diagnostic criteria for ADHD (183). Over 60 of children with a diagnosis of ADHD continue to exhibit ADHD symptoms through their adult life (184). Methylphenidate (MPH), a psychostimulant medication, has been used for the last 50 years to treat children with ADHD, and is the most widely prescribed medication in child psychiatry (185). Immediate release formulations of MPH are short-acting and patients are typically dosed 3-4 times per day to achieve and maintain adequate ADHD symptom control. Consequently, children with ADHD require one or more doses during school hours. Beyond issues of storage and handling, adherence to a multiple dose regimen is problematic in...

ADHD in Adults

The lifetime prevalence of ADHD in adults has been estimated to be at 4 , based on data from the National Comorbidity Study. Although it had been assumed that children with ADHD outgrow their problems, prospective follow-up studies have shown that ADHD signs and symptoms continue into adult life for as many as 60 of children with ADHD. However Only a small percentage of adults impaired by residual ADHD symptoms actually meet the full DSM-IV childhood criteria for ADHD. Adults with concentration problems, impulsivity, poor anger control, job instability, and marital difficulties sometimes seek help for problems they believe to be the manifestation of ADHD in adult life. Parents may decide that they themselves are impaired by the same attentional and impulse control problems found during an evaluation of their ADHD children.

Adhd In Children

The stimulants approved for the treatment of ADHD in children are summarized in Table 6-2. New standards have been promulgated for the treatment of ADHD recommending multimodal therapy, and medication is one component of a therapeutic treatment plan. Other combinations, such as behavior modification plus medication, have been shown to be somewhat more effective than medication alone but medication plus cognitive-behavioral therapy is not more effective than medication alone. Many stimulant treatment studies for school-age children with ADHD exclude children with full-scale IQs below 70, who are considered to have mental retardation (MR). This is unfortunate, for the signs of ADHD exist in children with IQs in the MR range. Treatment with a stimulant is effective in children with ADHD who have mild or moderate MR but they may be more vulnerable to adverse effects.

Make a Complete Diagnosis

Perhaps your seven-year-old boy is hyperactive and disruptive at school and his teacher suggests that he needs evaluation for medication. After learning about attention deficit hyperactivity disorder (ADHD) from your doctor and some books from a bookstore, you decide that he does have ADHD. You know your son has always been very active, but he's worse since he began first grade. You feel that the etiology may be biological in nature, but the recent worsening in his symptoms (pathogenesis) is really due to the restrictiveness of full-time school. Keep an Open Mind As you make your diagnosis, be open to new information. Be prepared to change your mind as you gather more information and begin treatment. Maybe you'll come to believe that your depression isn't biological at all but instead is due to emotional deprivation during childhood. Maybe you'll come to believe that your son doesn't have ADHD, that he really is just rambunctious, and that the school needs education about how to...

Psychosocial Rehabilitation

Sometimes anxiety and fearfulness about starting work or doing something in the community are managed best by role-playing or even practicing the skills in the community with a case manager, therapist, or rehabilitative counselor, rather than by increasing medication or trying a medication change. For example, many children with attention deficit hyperactivity disorder (ADHD) can benefit from medication. However, many also benefit from a strong behavioral program to help them manage their impulsivity and intense feelings in appropriate ways. Adults with ADHD can often benefit from working with a therapist to develop strategies for circumventing and coping effectively with their deficits.

Psychological psychiatric

Marijuana abuse and its possible associated risks in reinforcing further use, causing dependence, and producing withdrawal symptoms among adolescents with conduct symptoms and substance use disorders has been investigated in 165 men and 64 women selected and then interviewed from a group of 255 consecutive admissions to a university-based adolescent substance abuse treatment program (77). All had DSM-IIIR substance dependence, 82 had conduct disorder, 18 had major depression, and 15 had attention-deficit hyperactivity disorder. Most (79 ) met the criteria for cannabis dependence. Two-thirds of the cannabis-dependent individuals admitted serious drug-related problems and reported associated drug withdrawal symptoms according to the Comprehensive Addiction Severity Index in adolescents (CASI). For the majority, progression from first to regular cannabis use was as rapid as tobacco progression and more rapid than that of alcohol.

TABLE 22 Various Uses of Antidepressants

Attention-deficit hyperactivity disorder Phobias Attention-deficit hyperactivity disorder Attention-deficit hyperactivity disorder (as an adjunct) Chronic enuresis Paraphilic sexual disorders Nonparaphilic sexual disorders Selective Serotonin Noradrenaline Reuptake Inhibitors Duloxetine Moderate evidence

Trends in drug use among young people what do we know

10 Arria AM, Caldeira KM, O'Grady KE, Vincent KB, Johnson EP, Wish ED. Nonmedical use of prescription stimulants among college students Associations with attention-deficit-hyperactivity disorder and polydrug use. Pharmacotherapy. 2008 28(2) 156 169. National Institute on Drug Abuse (NIDA), NIDA Community Drug Alert Bulletin Prescription Drugs, NIDA website http www.nida. PrescripAlert .

Treatment Options for Depression

Stimulants Named for the effect they produce, stimulants are most commonly used in the treatment of attention deficit disorder. They have been abused in the past by people who enjoy their ability to produce a burst of physical and mental energy. As a result, they are used infrequently for depression because so many other alternatives exist. Nevertheless, they can be effective antidepressants. Methylphenidate is the stimulant commonly employed. Although people notice improved energy right away, improvement in depression may take some weeks.

Characteristics And Patterns Of Use And Abuse

METH has been available legally in the U.S. for many years as a therapeutic drug (trade name Desoxyn) used to treat obesity and attention-deficit hyperactivity disorder (ADHD). Illegal street forms are commonly known as speed or meth, which can be self-administered via injection, smoking, nasal inhalation ( snorting ), or oral ingestion. In its highly pure smokable form it is referred to as crystal, ice, crank, or glass. When ingested, the lipophilic compound efficiently penetrates the CNS,11 increasing concentrations of monoamines (particularly dopamine, DA) through multiple mechanisms (see below).12 The intensity of the high and mood alteration

Klaus A Miczek and Jennifer W Tidey Introduction

In fact, amphetamines may be associated with extreme changes in aggressive and social interactions intense and sudden acts of aggression as well as total withdrawal from any social intercourse. These striking, seemingly opposite shifts in social and aggressive behavior under the influence of amphetamines and related substances are the product of numerous pharmacological, behavioral, and environmental, as well as genetic determinants. Another paradox about amphetamines and related psychomotor stimulants is their calming effect on excessively aggressive children and adolescents diagnosed with attention deficit disorder. The neurobiological mechanisms for the multiple effects of amphetamines on aggressive behavior have been most often related to those relevant to the motor-activating and motor-arousing effects of these drugs. Yet, mechanisms of amphetamine action specific to their effects on aggressive and social behavior have eluded a satisfactory delineation.

How to Stop Medication

Drug Holidays There are times when it makes sense to stop the medications on a regular basis for brief periods. For example, some children with ADHD take methylphenidate only on school days, not on weekends or during vacation. This minimizes the retarding effect methylphenidate can have on growth. Some people find that omitting one or two doses of their antidepressant improves the impairment the drug causes to their sexual functioning. A drug holiday needs to take the above issues into account, however, and should never be undertaken without consulting with your doctor.

Susceptibility Factors Age

Neuroleptic drugs have been prescribed for children in the treatment of psychotic disorders, Tourette's syndrome, attention deficit disorder, hyperactivity, behavioral and psychiatric complications of mental retardation, and pervasive developmental disorders, for example infantile autism (487,488).

Organs and Systems Liver

During the past two decades there have been many reports of liver failure resulting in death or transplantation in patients being treated for ADHD with pemoline. However, a descriptive meta-analysis of the existing scientific literature and drug reporting databases showed that current assumptions of the risk of acute hepatic failure posed by pemoline alone are overestimates. A 7-year-old boy with Duchenne muscular dystrophy and attention deficit hyperactivity disorder (ADHD) developed acute hepatic failure, with features of autoimmune hepatitis (2). The only medications he had taken were pemoline (56 mg day) and cyproheptadine (2 mg day). Pemoline was withdrawn after 8 months as the presumed cause of his raised transaminases. Two weeks later he developed an altered mental state, jaundice, and encephalopathy. The histological features of the liver and his autoimmune antibody panel were consistent with autoimmune hepatitis. He was treated with corticosteroids and azathioprine and...

Utilization Of Advanced Formulation Design To Optimize Therapeutic Outcomes In Cns Diseases

Formulation scientists have successfully devised new drug formulations and delivery systems to improve therapeutic outcomes for patients suffering with brain and CNS disorders (Table 3). As our understanding of the physiology of the brain continues to increase, new strategies are being investigated to enhance drug delivery to the brain. A summary of recent developments in drug therapy for specific CNS disorders is provided below. For certain diseases (e.g., ADHD, depression), the impact of novel formulations on therapeutic outcomes are discussed. For those conditions that are largely refractory to drug therapy (HIV, brain tumors), strategies that are proposed to address therapeutic shortcomings associated with these diseases.

Conclusions Perspectives And Future Directions

Pharmacotherapy of brain disorders is a formidable challenge. Only a handful of CNS diseases (ADHD, depression, pain, epilepsy) are effectively treated with drug therapy. The majority of CNS disorders including cancer, stroke, autism, neuron-HIV, and Alzheimer's disease are refractory to drug therapy. The blame for the bottleneck in CNS drug development does not fall on the brain discovery sciences, as research in molecular neuroscience has led to the identification of new therapeutic molecules to treat the brain (124). Unfortunately, research aimed at providing answers to the BBB problem is lagging behind these advances. In other words, we know what the potential CNS therapies are, but we are presently unable to deliver them.

Alternative Preparations to the Standard Stimulant Medications

Second line medications have also been studied. The most extensive controlled data exist for atomoxetine, involving over a thousand patients in controlled trials, and 3,000 in safety studies. Atomoxetine was the first agent in this class to receive approval for ADHD in both children and adults it improves ratings of core ADHD symptoms in adults. The evidence for other medications is weaker. Fewer adults studies have involved stimulants, as shown in Table 6-5. Agents used for adult ADHD have included MPH, 5 to 20 mg TABLE 6-5. Experimental Medication Therapies for Adults with Attention-Deficit Hyperactivity Disorder The evidence for the efficacy of these alternative stimulants for ADHD in adult patients is limited, so practitioners should be cautious in their use until more convincing proof is available. Of particular concern is the danger of using psychostimulants in adults with comorbid substance abuse disorder. It would be wise to use OROS MPH, because it cannot be broken down into...

Epidemiological Data

Some authors 64 explored the use of herbs in children with attention-deficit-hyperactivity disorder or depression the prevalence of herbal therapy among 117 patients was 20 and, interestingly, the children's psychiatrists and paediatricians were not aware of such use. Ginkgo biloba, Echinacea and St John's wort were the herbs most frequently given. A survey performed in three paediatric gastroenterological centres reported that 14 of 208 children with inflammatory bowel disease used herbal medicines to treat this condition, in addition to conventional therapies 65 . In Australia, 29 of 174 asthmatic children on therapy with bronchodilators and disodium cromoglycate or inhaled steroids had used herbal preparations to ease their symptoms 66 .

Prescription Medications Containing Amphetamine or Methamphetamine

Drug Enforcement Agency listed amphetamine and methamphetamine as Schedule II controlled substances. Clinical uses include treatment of attention deficit disorder with hyperactivity, narcolepsy, and obesity. Pharmaceutical methamphetamine is d-methamphetamine. Amphetamine, however, is available as d-amphetamine as well as a mixture of d- and -isomers. Medications containing d-amphetamine (Dexedrine , Destrostat ), racemic amphetamine (Adderall ), and d-methamphetamine (Deoxsyn ) are listed in Table 2. Illicit methamphetamine and amphetamine products consist mostly of the d-isomer but, depending on the starting materials used by clandestine laboratories, significant amounts of the -enantiomer may be present. All these products will give positive amphetamines results by immunoassay as well as analytical true positive results by the standard GC-MS confirmation tests. Enantiomeric analysis can distinguish between the two enantiomers and determine their relative percentages to aid in...

Pharmacology and general adverse effects

Amfetamine is a sympathomimetic compound derived from phenylethylamine. However, the word amphetamines has become generic for the entire group of related substances, including benzfetamine, dexamfeta-mine, metamfetamine, and methylenedioxymetamfeta-mine (MDMA, ecstasy). Metamfetamine, a popular drug of abuse, is also known as speed,'' meth, chalk,'' crank,'' ice, crystal,'' or glass.'' Other amfetamine-like drugs include fenfluramine (used as an appetite suppressant) and methylphenidate (used in narcolepsy and attention deficit hyperactivity disorder (ADHD)). When it was first introduced, one of the most frequent uses of amfetamine was as an anorexi-genic agent in the treatment of obesity. A number of anorectic agents, many of them related to amfetamine, have since been manufactured. Most are stimulants of the central nervous system in descending order of approximate stimulatory potency, they are In a study of extended treatment (15 months) of ADHD, amfetamine was clearly superior to...

Amfetamines Introduction One of a

Class of sympathomimetic amines with powerful stimulant action on the central nervous system The class includes amfetamine, dexamfe-tamine, and metamfetamine. Pharmacologically related drugs include methylphenidate, phenmetrazine, and amfepramone (diethyl-propion). In street parlance, amfetamines are often referred to as speed . Symptoms and signs suggestive of intoxication with amfetamines or similarly acting sympathomimetics include tachycardia, pupillary dilatation, elevated blood pressure, hyper-reflexia, sweating, chills, anorexia, nausea or vomiting, insomnia, and abnormal behaviour such as aggression, grandiosity, hypervigi-lance, agitation, and impaired judgement. In rare cases, delirium develops within 24 hours of use. Chronic use commonly induces personality and behaviour changes such as impul-sivity, aggressivity, irritability, suspiciousness, and paranoid psychosis (see Amfetamine psychosis). Cessation of intake after prolonged or heavy use may produce a withdrawal...

Indirect Sympathomimetics

These clinical properties have been utilized as psychostimulants (an alerting effect), antidepressants (especially before the development of the real antidepressants discussed in Chapter 2), and appetite suppressants (anorexiants or anorectics), the last mentioned ideally part of weight loss regimens for short periods of two months or so. The compounds in which all these properties are most pronounced are amphetamine (No. 5) and methamphetamine (No. 6). Unfortunately, these are the two most abused and habituating compounds in this category. As the doses tend to increase, stereotypical behavior arises in patients as well as increased locomotor activity. Release of DA from central dopaminergic neurons may also be implicated. At even higher doses psychotic behavior and loss of perception becomes manifest. Because of these bizarre consequences and dependence potential, strong controls have been placed on the use of these and several related drugs.11 Their complete ban, at least as...

Concluding Remarks And Future Directions

Sickness associated with cancer chemotherapy and to counter the loss of appetite and wasting syndrome in AIDS (Iversen, 2000). There is, however, scientific evidence for the potential therapeutic use of cannabinoids for the treatment of psychomotor disorders, including spasticity, multiple sclerosis, epilepsy, disk prolapse, and attention deficit hyperactivity disorder (ADHD), and its pain relief properties are no longer a matter of speculation. It is only a matter of time before new medications for the pharmacological manipulation of the link between endocannabinoid and other neurotransmitter systems will be developed as targets for the numerous indications of marijuana and endocannabinoid ligands. In the absence of clinical data on the abuse liability of endocannabinoids, the preclinical data indicate that as with marijuana, the endocannabinoids may have minimal abuse liability in humans. The safety profile of THC, the active ingredient of cannabis, is good. It has low toxicity in...

Adolescents And Drug

The most prominent psychological characteristic predisposing to substance use is undercontrolled behavior. This is manifest broadly as conduct problems and indifference to societal norms. A temperament disposition in early childhood marked by poor self-regulation (e.g., restlessness, irritability, excitability) in severe cases commonly precedes attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) by late childhood that, in turn, leads to substance abuse in early adolescence. The same genetic factors largely underlie CD, ADHD, and substance use disorder. Moreover, drug alcohol exposure during fetal development, and having parents with poor childrearing skills, or low investment in the child, hampers the child's development of self-regulation. The dysreg-ulated adolescent domiciling in a family where there is inadequate supervision is prone to engage in risky behaviors. Specifically, the ubiquity of drugs in the social environment,...

Psychiatric Drugs Poison or Panacea

One in four people in the United States will suffer from depression at some point in their lives, one in five from anxiety. Millions more experience debilitating symptoms from schizophrenia, bipolar disorder, attention deficit disorder, and other psychiatric problems. More than thirty million people in the United States consume billions of dollars worth of psychiatric medications such as Prozac, Ritalin, Xanax, clozapine, and lithium. However, most people suffering from psychiatric problems receive no treatment.1 There is a great deal of information about psychiatric problems and drugs in the media. Pharmaceutical companies have developed many new psychiatric drugs in the last decade, which they promote at public events and in popular magazines. Celebrities like Mike Wallace, Patty Duke, William Styron, and Lawton Chiles have gone public with their problems and their experiences with medication. Many people not in the public eye have told their stories on television, in print, and on...

Stimulants Relaxants Weight Control and Pain

Nervous Synapse

Used to treat attention-deficit hyperactivity disorder (ADHD) Used to treat attention-deficit hyperactivity disorder (ADHD) Used to treat attention-deficit hyperactivity disorder (ADHD) Used to treat attention-deficit hyperactivity disorder (ADHD) competition because of their amphetamine use. As a result, amphetamine is banned by the IOC and is illegal without a written doctor's prescription in most countries. Amphetamine is used legally to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy, and to control weight. Methylphenidate, or Ritalin , as it is more commonly known, is an amphetamine-like prescription given to children with attention-deficit hyperactivity disorder (ADHD). Interestingly, although methylphenidate acts just like other stimulants in adults, stimulating the central nervous system, it appears to have the opposite effect on children. Ritalin is prescribed for children who are hyperactive, and acts as a calming medication. Doctors are not exactly sure...

Pharmacotherapy for Specific Psychiatric Disorders

Follow-up of children with attention deficit-hyperactivity disorder (ADHD) and conduct disorder has revealed high rates of substance abuse, and ADHD may be over-represented in substance abuse treatment settings. It is possible that patients with ADHD may seek stimulants for self-medication. The diagnosis of ADHD requires evidence of illness during childhood, preferably with verification from another person. These patients have benefited from methylphenidate, according to some reports. Desipramine and bupropion have been used successfully in treating children with ADHD and both have been advocated in patients with comorbid substance abuse.

Ritalin and the Human Brain

How Ritalin Works

ATTENTION-DEFICIT HYPERACTIVITY DISORDER SYMPTOMS IN SEARCH OF A CAUSE The symptoms of inattention, distractibility and or hyperactivity that define attention-deficit hyperactivity disorder (ADHD) improve when treated with the stimulant drug Ritalin. For long-term success, however, the behaviors associated with these symptoms can also addressed with different techniques, some of which have been described in Chapter 2. These two different types of treatments point to two different causes for ADHD. The improvement observed when taking a chemical substance seems to indicate that ADHD has a biological cause. However, improvement by behavioral modification techniques suggests that ADHD may have an environmental cause. ADHD A BIOLOGICAL CAUSE The prevalent theory among both health professionals and the general public today is that the symptoms of ADHD have a biological cause. The most generally cited causes are birth defects, an infant trauma, and the brain's inability to produce enough of...

Most Parents Dont Know If Their Teen Is Depressed

Obesidad Sobrepeso Quotes

The use of new antipsychotic medications, such as Risperdal, has grown nearly 300 percent. The only prescription drugs not exhibiting huge rises in use are stimulants (typically for treatment of ADHD). For children under 18 years old, the number of prescriptions written for Ritalin-like drugs is up 23 percent. This smaller increase is mostly due to the fact that attention-deficit hyperactivity disorder is not as stigmatized as teenage depression. During the past ten years, it was much easier to get treated for ADHD than depression. This study illustrates that treatment of mood disorders was much more prevalent, most likely from increasing public knowledge about the subject. The difficulty in resolving these opposing arguments is that there are very few clinical studies which track the safety and efficacy of many new antidepressants currently prescribed for teenagers. In fact, many of these antidepressants are not officially mandated for use in adolescents. What's more, several...

Wonder Drugs Hold The Seed For Addiction

These symptoms may also occur in children who are using Ritalin for the treatment of ADHD. Because some of these symptoms may be the reason the child was put on medication in the first place, parents may not recognize them as a withdrawal reaction. Instead, they may think the child needs another dose of medication or an increase in dosage to treat the underlying symptoms. If cocaine is a dangerous and addictive drug, and Ritalin is pharmacologically similar to cocaine, then, theoretically, millions of ADHD children and adults taking Ritalin could be at risk of becoming addicted to the drug. Although no one knows whether this possibility is certain, according to the DEA, a number of recent studies, drug abuse cases, and trends among adolescents from various sources, indicate that methylphenidate use may be a risk factor for substance abuse. 28 In fact, some studies show that stimulants sensitize the brain to other stimulants, which means that if an individual has been previously...

Clinical Experience With Mdmaassisted Psychotherapy

GG I'm a psychiatrist in private practice. I have a small outpatient psychotherapy practice, and I also work half-time in a residential treatment center for post-traumatic stress disorder (PTSD), mosdy with patients who have experienced sexual or physical abuse in childhood. They also generally have depression and other mood disorders, eating disorders, attention-deficit hyperactivity disorder (ADHD), and addictions. It's a very intense patient population. They come to our program from all around the country after being in hospitals for about a month. It's a residential program designed for afterhospital care. I'm the psychiatrist there, and I evaluate patients and prescribe medications. GG Exactly. If you think of it as a continuum of attention deficit disorder, where dopamine releasers or stimulants enhance the focusing of attention, MDMA definitely has a similar effect. Getting back to the palliative care issue, I did receive phone calls from AIDS treatment centers. They told me...

Question Of Cannot Versus Will

Increase Ritalin Usage

When, after years of struggling with their child's behavior, parents ask a doctor whether their child has ADHD, what they are really asking is whether there is a physiological reason for their child to behave the way he or she does. What they are asking is whether the child cannot behave or whether he or she will not behave. In the first case, taking a pill is readily justified. In the second, there is no easy cure. This accounts for the allure of a biological cause for ADHD. has ADHD and should be taking Ritalin. Many ask directly whether the doctor will perform ADHD tests. If the doctor tells them that an ADHD test does not exist, they will take their child to another doctor. If this particular doctor does not give their child a prescription for Ritalin, they will take the child elsewhere until they find a doctor who does. It is not surprising, then, that the number of children diagnosed with ADHD and taking Ritalin has increased. Between 2 and 3.5 of children in the United States...

Federal Schedule Listing Schedule Iv Dea no 1680 USA Availability Prescription Pregnancy Category C

Modafinil is used against obstructive sleep apnea, in which people have temporary breathing stoppages while asleep and which can make them sleepy the next day. Experiments find that although modafinil helps people stay awake, it does not interfere with the quality of their sleep, as dextroamphet-amine does. Modafinil has helped patients respond better to antidepressant therapy while also reducing their feelings of weariness. Favorable results have been seen in experiments using the drug against attention deficit hyperactivity disorder (ADHD) and against organic brain problems caused by alcoholism. An animal study indicates the substance may have potential for treating Parkinson's disease. Some authorities speculate that the compound may reduce brain problems caused by aging. Modafinil makes animals more active. Aviation, Space, and Environmental Medicine 62 (1991) 432-35. Modafinil for Narcolepsy. Medical Letter on Drugs and Therapeutics 41 (1999) 30-31. Rugino, T.A., and T.C. Copley....

Carbolith Cibalith Duralith Eskalith Lithane Lithizine Lithobid

The incidence of this type of depression is not nearly as high as unipolar depression. About seven percent of the United States population has typical depression, only one percent has bipolar disorder (Figure 5.1). There is a much higher risk of suicide with bipolar disorder than with unipolar depression (6-15 percent as compared to 2 percent). Bipolar disorder is even more uncommon in adolescents. In fact, some clinicians do not believe it is possible for children under twelve to have the disorder, while others are convinced that children as young as preschool age can experience symptoms of bipolar disorder. However, the rate of diagnosis of bipolar disorder in teenagers is growing every year. One reason for this increase is that clinicians are learning to differentiate bipolar disorder from attention-deficit hyper-activity disorder (ADHD). Bipolar disorder and ADHD are similar in that both are characterized by high energy states but are actually quite different illnesses. Like the...

Long Term Effects Drug abuse

Methylphenidate shares the pharmacological properties and the abuse potential of the amphetamines. When given intravenously, it activates psychotic symptoms in schizophrenic patients if administered during the active phase of their illness, but not after remission. It failed to produce a psychotic reaction in most manic or depressed patients or in healthy subjects (27). Adults with childhood-onset ADHD had an earlier onset of psychoactive substance use disorders, independent of any psychiatric co-morbidity (33). However, bipolar disorders conferred a significantly increased risk for early onset psychoactive substance use disorders independent of ADHD. The question arises as to the contribution of stimulant treatment to psychoactive substance use disorders. There were no differences in medicated versus unmedicated adolescents with ADHD in a review of eight outcome studies comprising 580 adolescents briefly treated with stimulants for six months to five years (34).

Trends in Ritalin

The trend in Ritalin use has changed dramatically during the last decade. The number of people diagnosed as having attention-deficit hyperactivity disorder (ADHD) has increased from 900,000 in 1990 to about 5 million in 2000. At the same time, the number of prescriptions for Ritalin has increased from 3 million in 1991 to 11 million in 1998. In addition, the age and the type of individuals diagnosed as having ADHD has also changed. As late as the 1980s, ADHD was considered a childhood problem. The majority of children diagnosed with the disorder had very severe symptoms, of which hyperactivity was obligatory. According to Diller in his book Running on Ritalin, the typical profile of an ADHD sufferer in the 1980s consisted of boys from six to 12 years old, extremely hyperactive and impulsive, functioning poorly (if at all) in a normal school situation. Many were quite out of control, and Ritalin was often needed to give other treatments a chance to work. 17 Parents were confused about...

Methylamine Methamphetamine Mail

Dextroamphetamine should be used with caution and only upon medicinal indication in treating narcolepsy, consequences of encephalitis, and other illnesses accompanied by apathy, drowsiness, asthenia, for temporary increase of physical and mental capacity, in treating attention deficit disorder in children, and in treating obesity.Synonyms of this drug are d-amphetamine, dexamphetamine, dexalone, tempodex, zenidex, and many others.

Additional Reading

MTA Cooperative Group (1999) 14 month randomized clinical trial of treatment strategies for children with attention deficit hyperactivity disorder. Archives of General Psychiatry 56 1073-1086. 4. MTA Cooperative Group (2004) National Institute of Mental Health multimodal treatment study of ADHD follow-up 24-month outcomes of treatment strategies for attention-deficit hyperactivity disorder. Pediatrics 113(4) 754-761. 6. Greenhill L. (2002) Childhood attention deficit hyperactivity disorder pharmacological treatments. In Treatments that Work, 2nd edition (Eds Nathan PE, Gorman J), Saunders, Philadelphia, 25-55.

Effects of Treatment on Symptoms

Stimulants ameliorate disruptive ADHD behaviors cross-situationally (classroom, lunchroom, playground, and home) when repeatedly administered throughout the day Although psychostimulants produce moderate to marked short-term improvement in motor restlessness, on-task behavior, compliance, and classroom academic performance, these effects have been demonstrated convincingly in studies where the medications are given under protocol conditions. For example, academic improvement on tests of academic skills were maintained over 14 months of the MTA protocol. When examined over greater intervals, however, stimulant treatment plans in the community have generally failed to maintain academic improvement or to improve the social problem-solving deficits that accompany ADHD.

Maintenance Treatment

The predicted duration of treatment is an important step in the generation of a treatment plan for a child with ADHD. Although there is no clear-cut recommendation for the length of psychostimulant treatment, many parents have a reasonable expectation that it will not be open-ended.

TABLE 68 Side Effects Associated with Atomoxetine

The incidence of atomoxetine side effects in school age children appears to be low but comparative trials with other treatments for ADHD are lacking (Table 6-8). Atomoxetine has recently been found to cause rare cases of jaundice. Treatment with atomoxetine should be discontinued if hepatotoxicity is suspected.

Medications for Cocaine Dependence

Psychomotor stimulants have been suggested as an agonist maintenance treatment strategy. Although early clinical reports suggested stimulants might exacerbate cocaine dependence, more recent placebo-controlled trials suggest oral dexedrine may have promise. Patients with attention deficit disorder, which commonly co-occurs with cocaine dependence,

Diagnoses in Psychiatric Disorders

Attention Deficit Hyperactivity Disorder It has been known for many years that some children, primarily boys, have pronounced difficulties with inattentiveness, impulsivity, and hyperactivity. Many such children cause difficulty for their families and schools to the point that they are brought to their doctors to investigate whether something is wrong with them. These children have been categorized in the scientific literature as abnormal and given a diagnostic label, even though much of their behavior falls within the normal range. The first term applied was hyperkinetic behavior syndrome.2 This label was replaced by hyperactivity, and then minimal brain disease. The current term for the syndrome is attention deficit hyperactivity disorder (ADHD). Parents and professionals disagree on whether the syndrome of ADHD even exists, and, in fact, there are no reliable diagnostic tests or procedures that definitively determine the presence or absence of ADHD. The label is generally applied...

Drug Administration Drug formulations

A modified-release, once-daily formulation has been evaluated in 282 children with ADHD in a double-blind, placebo-controlled trial for 28 days (37). For core ADHD symptoms, both once-daily modified-release and thrice-daily immediate-release methylphenidate were superior to placebo and not different from each other. A similar percentage of patients reported at least one adverse event with both formulations. The most commonly reported adverse events were headache and upper respiratory infections, followed by abdominal pain, cough, pharyngitis, vomiting, and otitis media. Of these, only headache and abdominal pain were considered to be related to the study medication. One patient withdrew because of depression with modified-release methylphenidate and one because of tics with placebo. Headache occurred in 14 , 5.8 , and 10 of patients taking modified-release methylphenidate, immediate-release methylphenidate, or placebo respectively, and abdominal pain in 6.7 , 5.8 , and 1.0 . Other...

Hypothalamic releasing hormones

Ludwig 2001, Elefant 1995, Wilshire 1993). Nevertheless, concern about its potential side effects on the CNS persists. In a controlled study, 6 pregnancies exposed to GnRH agonist and 20 unexposed controls were followed to a mean age of 8 years. Four of the ante-natally exposed children showed neurological developmental disorders, including attention deficit hyperactivity disorder (three children), motor difficulties (three children), speech disturbances (one child) and epilepsy (one child). The authors suggested a possible toxic effect of GnRH analogs on development (Lahat 1999). More recently, another case of one 7-year-old child with attention deficit hyperactivity disorder exposed to GnRH agonist during pregnancy has been reported (Papanikolau 2005).


The syndrome of ADHD consists of a variety of behaviors that demonstrate hyperactivity, inattentiveness, and impulsivity. Manifestations of hyperactivity include difficulty staying seated, feeling as if there was an engine inside of you that won't slow down, being constantly on the go, and having difficulty relaxing during leisure activities. Inattention is demonstrated by being easily distracted, making frequent mistakes in work, daydreaming, difficulty starting and finishing tasks, difficulty listening in conversations, losing things necessary for tasks, and being forgetful in daily activities. Impulsivity can be seen by saying things without thinking of their consequences, interrupting people, being impatient while waiting, buying impulsively, and switching from task to task in a haphazard fashion. Some people with ADHD are irritable and find themselves in frequent arguments. Many people with ADHD abuse alcohol, caffeine, and other drugs to alter their mood and thinking. We all...


Amphetamines are used to manage attention deficit hyperactivity disorder (ADHD) in children. Children with this disorder exhibit a short attention span, hyper-activity, impulsiveness, and emotional lability. The condition is more prevalent in boys than in girls and poses a problem with school and learning, although these children are usually of normal or above average intelligence. How amphetamines, which are CNS stimulants, calm the hyperactive child is unknown. These drugs reduce motor restlessness, increase mental alertness, provide mood elevation, produce a mild sense of euphoria, and reduce the sense of fatigue. In addition to taking a CNS stimulant, the child with ADHD may also need psy-chotherapeutic counseling.

Pregnancy Category D

Clonazepam is considered one of the more powerful benzodiazepine class drugs. Primary medical uses are against some kinds of convulsions, particularly in certain kinds of epilepsy, and against panic attacks. For persons suffering from panic attacks, measurements indicate the drug improves both quality of life and work productivity. The drug is also used as an antidepres-sant and to treat anxiety, catatonia, obsessive-compulsive disorder, the manic phase of manic-depressive behavior, and social phobia in general. A two-year follow-up study of persons receiving brief clonazepam treatment for social phobia found their improvement to be sustained after dosage stopped, and at the two-year mark they were doing better than a control group that had received a placebo. Clonazepam is sometimes preferred over alprazolam in treating anxiety because that condition seems less likely to reappear between doses of clonazepam than between doses of alprazolam. Clonazepam can be substituted for...


The substance stimulates the central and sympathetic nervous systems and is comparable to methamphetamine. Dextroamphetamine is typically used to treat narcolepsy, to treat attention deficit hyperactivity disorder (ADHD) in adults and children, and to help reduce a person's weight in rhesus monkey experiments it is one of the most effective appetite suppressants. Some use has been made to help epileptics. The drug can be given in combination with scopolamine as an anti-motion sickness medicine astronauts have used this combination during missions in outer space and consider it effective. Biphetamine, like other dextroamphetamines, is medically used to treat obesity, narcolepsy, and ADHD. Biphetamine is used recreationally to boost mental quickness and physical activity and to create euphoria. The compound can facilitate hallucinations, raise blood pressure, and prevent sleep. Dexedrine's oral capsule is designed to deliver some of the drug immediately, followed by gradual...


In sum, performance on tasks designed to measure attention processes can be enhanced by stimulation of nicotinic receptors. Specifically, the a4 and P2 subunits appear to contribute to this enhancing effect. Notably, researchers have begun to examine the feasibility of using nAChR compounds as potential therapeutic agents for attention deficit hyperactivity disorder (ADHD). Nicotine delivered by a transdermal patch to adults with ADHD showed some effect in aiding attentional processes 58 however, further research in this area is required.

W Health

Another implication of this analogy is that perhaps Nick Diaz is special in the way he responds to cannabis because of his ADHD. This would definitely appear to be a possibility when one considers the case report of the young German man with ADHD who in the process of reap-plying for his driver's license was tested under the influence of rather high serum levels of cannabinoids and was found to be better than averagely fit to drive on several of the measures of performance taken and at least passing on all the others. It was suggested that cannabi-noids were producing a beneficial effect on this individual's ADHD symptoms and may actually be improving his performance over baseline (which was not taken because the subject was clearly in no state to drive) (16). If we apply this to our driving sports analogy, we see that it is possible the same could be happening for Nick Diaz, even though it has been demonstrated he can win just fine while testing negative for cannabinoids. If this...

Birds vs bees

Most differential disease patterns are a total mystery because the factors that cause them are so complex. Mental disorders are particularly vexing, because in addition to environmental exposure and genetic factors there are cultural factors that can play an important role. Men tend to have higher rates of schizophrenia, autism, attention deficit hyperactivity disorder and drug addiction, while women tend to suffer from anorexia, clinical depression and anxiety disorders more often. Teasing out whether these differences are biological or based on social and cultural pressures is extremely difficult, and thus we know less about mental disorders than we do about just about every other disease category. Since many of these disorders show significant heritability from one generation to another and are present in all cultures, it is likely that innate genetic susceptibility plays a far greater role than was previously expected. Many researchers feel that the differences are caused or...

Mental Health

Anxiety disorder, attention deficit disorder, alcohol addiction. I've been through the works, and no one was able to give me a firm answer about what I might be suffering from. I have done most of the research myself, and although I could not say I am one hundred percent, I feel so much better by just being aware of myself, aware of my thoughts, my feelings and my actions. All I can say to you is if you feel anything out of the ordinary (that is what you term to be ordinary, not someone else) please, please speak to someone. Look on the internet, test yourself on one of many psychological quizzes. Just do something. Don't let yourself be a prisoner of your own mind. Reach out, and ask for help.


For parents who want their children to be quiet they seem to be going about it the wrong way. Rather than leading by example and not over stimulating their own brains, they are constantly talking and discussing and arguing all above the noise of the satellite tv or the music system. Then they over stimulate their children by keeping them on the go all the time (it's no wonder that adhd seems to be becoming more and more prevalent). Go, go, go, go, go, go, that's all it ever is. Achieve, achieve, achieve, achieve. Learn, learn, learn, learn. Behave, behave, behave, behave. It's a wonder that everyone's brains don't just explode with all of this stimulation


In contrast to alcohol and cocaine, heroin and other opiates do not appear to have any teratogenic potential. In contrast to those children who are damaged by alcohol, problems with neurological development (including cognitive abilities) in the children whose mothers who have abused drugs seems to be more a consequence of the deprived social environment in the first years of life. In such instances, intact family relationships as a result of prompt adoption after birth appear to permit broadly normal development (Ornoy 2001, Coles 1993). Only attention deficits and hyperactivity (ADHD) were noted more often in adopted children than in the unexposed control group. However, there were significant differences between adopted children (37 ) and those children who remained in a drug-taking environment (67 ). This was the result of a follow-up study of 6- to 11-year-old children exposed prenatally (Ornoy 2001).


Methylphenidate's prime medical use is for managing attention deficit hyperactivity disorder (ADHD), a condition in which people are so excitable that they have severe problems with social interactions. The affliction is more common in children than adults, and methylphenidate seems more effective against ADHD in children, though one study finds the drug to have little influence on long-term outcome. Limited success is seen in experimental usage of the drug to help autistic children. A case report says a regimen of that drug and the antidepressant sertraline (Zoloft) cured a young kleptomaniac. Among adults methylphenidate is typically prescribed for narcolepsy and has also been used successfully against apathy and depression. Despite the drug's occasional tendency to increase blood pressure, studies find the substance promising for rehabilitation of persons recovering from stroke and other brain injuries, not only improving mood but also helping ability to move. as 6 . In the...

Further Reading

Attention Deficit Disorder A Handbook for Diagnosis and Treatment. New York The Guilford Press, 1990. -. Taking Charge of ADHD. New York The Guilford Press, 1995. Beal, Eileen. Everything You Need to Know About ADD ADHD. New York Rosen Publishing, 1998. Gordon, Michael. ADHD Hyperactivity A Consumer's Guide. New York GSI Publications, 1991. Haber, Julian S. ADHD The Great Misdiagnosis. Dallas FAAP Taylor Trade Publishing, 2000. Hallowell, Edward M., and John J. Ratey. Driven to Distraction Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood. New York Pantheon Books, 1994. Levinson, Harold N. Total Concentration How to Understand Attention Deficit Disorders. New York M. Evans and Company, 1990. Morrison, Jaydene. Coping with ADD ADHD. New York Rosen Publishing, 2000. Silver, Larry. Dr. Larry Silver's Advice to Parents on ADHD, 2nd ed. New York Random House Times Books, 1999. Williams, Julie. Attention Deficit Hyperactivity...


And ADHD, 27-30, 32, 57-58 Diller, Lawrence H., 26, 46, 80, 89 Inattention Dopamine, 11, 48-51 Driven to Distraction Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood (Hallowell and Ratey), 17, 56-58 Drug Enforcement Administration (DEA), 64,71-72,81-85 and drug scheduling, Hallowell, Edward Driven to Distraction Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood, 17, 56-58 Harmann, Thom Attention Deficit Disorder A Different Perception, 57 Harrison Narcotic Act and ADHD, 17-18, ADHD (Barkley),


In the United States pemoline became available for medical purposes during the 1970s. It is used to treat depression, weariness, and attention deficit hyperactivity disorder (ADHD). The drug's stimulant effects are described as greater than caffeine but less than amphetamine. Unlike many scheduled stimulants, pemoline is unrelated to amphetamine. Studies find pemoline about as effective as either dextroamphetamine or methylphenidate in helping children with ADHD. Pemoline has been used successfully against ADHD in teenagers and adults as well. Growth rates are below normal in some youngsters with ADHD, and pemoline itself can temporarily hold back such development but without long-term harm youngsters develop normal adult weight and height. Those deficient growth rates may be treated with growth hormone. One study found, however, that pemo-line seems to make the hormone treatment less effective in some patients. As the age of ADHD patients grows, so can unwanted effects that...

Human Research

Another recent study of chronic heavy marijuana users diagnosed with attention deficit hyperactivity disorder reported prefrontal cortical and temporal lobe hypo-perfusion from clinical judgements of single photon emission computed tomography (SPECT) images (Amen and Waugh, 1998). Some of these changes were evident in users who had been abstinent for more than 6 months. However, this finding was not supported as being associated with heavy marijuana use according to Block et al.'s (2000b) high resolution measurements. In reviewing the combined literature on neuroimaging and animal receptor and neurochemical models, Loeber and Yurgelun-Todd (1999) concluded that the metabolism of component regions of the frontopontocerebellar network are altered by both acute and chronic exposure to marijuana through modulation of the cannabinoid and dopamine systems. They propose that chronic use results in changes at the receptor level that lead to an alteration in the dopamine system which then...


Methamphetamine is used to treat narcolepsy, attention deficit hyperactivity disorder (ADHD), and adult obesity. Typically the drug is not recommended for juvenile obesity. Although patients lose more weight than if they use a placebo, the difference is only a few ounces per week. Researchers do not know how the drug promotes weight loss. Scientists are even unsure if the drug is responsible or if diet, coaching, attitude, and other factors explain the difference. In general, the longer patients take the drug, the lower their rate of weight loss. Standard practice is to stop the drug when weight benefits decline, rather than increase dosage.


As there is no objective measure to prove or disprove the presence or absence of any psychiatric disorder, this can be a difficult assessment. For example, if your child's teacher thinks your child has attention deficit disorder and may need medication, it is important to get a complete picture of the child's experience in the classroom. You need to decide whether your child is behaving in a manner that is out of the normal range or whether the school has an especially low tolerance for children who are active and energetic with a tendency to be rambunctious. Even if it turns out that he does have attention deficit disorder, some school programs are able to manage a child with attention deficit disorder without the use of medication through implementation of a strong behavioral plan. If your school does not have this capability, you must ask yourself whether you are medicating your child for the child's symptoms or the limitations of the school. Your child deserves a complete...

Amphetamine Class

Amphetamine stimulants are pharmaceutical products created in laboratories, not harvested or refined from natural products. When amphetamines debuted under the brand name Benzedrine during the Great Depression of the 1930s, they were an ingredient used for inhalers that people would sniff to relieve stopped-up noses. Another effect was a burst of energy and alertness, sometimes accompanied by a brightening of mood into euphoria, and people began using the nonprescription inhalers for recreational purposes. Such drugs were called Cartwheel, Euphodine, and Halloo-wach. Amphetamines became accepted therapeutically as a treatment for depression and worked best if a person simply had difficulty coping with stress during part of a day, as a dose wears off quickly and can leave a person feeling lower if nothing has changed in the situation causing the stress. For example, a dose might deal effectively with occasional aggravation in the workplace but not work so well for a person who stayed...


Although stimulants make people more awake and alert, and increase their energy, stimulants do not act to simply increase action potentials. Their actions are not simply the opposite of the actions of depressants, which act to decrease the number of action potentials. Stimulants excite the nervous system by activating the neural systems that normally create and maintain arousal and attention. This class of drugs includes cocaine, the amphetamines (most prominently, methamphetamine, known as meth, ice, or crystal) and a few other drugs, such as methylphenidate (Ritalin), which is now commonly used to treat attention deficit disorder.

Ritalin And Insulin

Although many pediatricians believe that depriving a hyperactive child of Ritalin is similar to, say, depriving a diabetic of insulin, others find this metaphor faulty. Diabetes, they argue, is a physiological disease, whereas ADHD is a collection of behaviors without a known biological cause. Although diabetes is caused in part by the lack of insulin, the brains of children with ADHD cannot suffer from a lack of Ritalin. Unlike insulin, a hormone that naturally is produced in the body, Ritalin is an artificial drug. only set of rules for making an ADHD diagnosis. Most were more influenced by other behaviors, such as acting out or learning problems. GATHERING INFORMATION TO DIAGNOSE ADHD In their book Beyond Ritalin, Garber and colleagues suggest several steps in the gathering of information toward an ADHD diagnosis. A modified version of their approach is as follows Step 1 Rule out medical problems as the cause of the observed symptoms. A physical examination of the child must be...

Ritalin Abuse

Ritalin abuse and addiction were reported during the 1960s and 1970s in the United States and Japan. Ritalin was marketed as a weight-loss product in Sweden in the 1960s, but its abuse as a street drug created an epidemic of such magnitude that the Swedish government was forced to ban its use in 1968. In the United States in the 1970s, the FDA and the National Academy of Sciences warned that Ritalin was developing a black-market value as a recreational stimulant. Yet the warning did not prevent the boom in Ritalin that was legally prescribed for children with ADHD over the following decades.


ADD ADHD Statement of Drug Enforcement Administration. Gene R. Haislip, Deputy Assistant Administrator. Office of Diversion Control, Drug Enforcement Administration. United States Department of Justice, Washington, D.C. At the conclusion of the conference on Stimulant Use in the Treatment of ADHD. Available online at http www.add-adhd .org ritalin.html. NIH Consensus Statement on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. Available online at http


There are three treatment options you can pursue if you decide that you have ADHD after educating yourself about the disorder, obtaining neuropsychological testing, and consulting with a psychiatrist. Shape the Environment Search for a good fit with the environment. Children with ADHD will probably not do as well in a large class in which the teacher expects everyone to remain seated throughout the day. A small class that allows a lot of physical movement led by a teacher who values exuberance and creativity can make a world of difference to your child's academic growth and emotional well-being. Helpful modifications in school can include taking untimed tests, sitting next to the teacher, receiving individualized homework assignments, and receiving permission to leave the classroom when overstimulated. Adults with ADHD tend to perform better in an environment with a clear structure although it can feel restrictive. New challenges can bring out the best in both children and adults....

Synthetic drugs

Amphetamine, another widely used synthetic drug, was first synthesized in Germany in 1887. However, it was not used until the late 1920s, when it was investigated as a cure for a variety of illnesses, including epilepsy, schizophrenia, alcoholism, opiate addiction, migraine, head injuries, and radiation sickness. In 1932, amphetamine was marketed as an over-the-counter inhaler to treat nasal congestion. Five years later it was found to have a positive effect on some children with attention deficit hyperactivity disorder (ADHD). In 1919, scientists in Japan discovered methamphetamine, which was more potent and easier to make than amphetamine.


GENERAL Preparations Generic and brand names Aventyl and Pamelor in pills and liquid form. Class Tricyclic antidepressant. Used in ADHD, bulimia, depression, panic disorder, other anxiety disorders. Mechanism of action Blocks the reuptake of norepinephrine and serotonin into presynaptic neurons.

Childhood Disorders

TCAs, especially imipramine, are indicated for the treatment of enuresis. Anxiety and phobias in children (such as separation anxiety or school phobia and ADHD) are responsive to TCAs. Uses for SSRIs in children include repetitive-type abnormalities associated with autism and mental retardation, ADHD (as an adjunct to methylphenidate), and chronic enuresis. Bupropion has been used successfully in the treatment of ADHD in both children and adults. It may, however, exacerbate tics in attention-deficit patients with concomitant Tourette's syndrome.

Treatment Resistance

Many apparent nonresponders to stimulants may simply have been treated with too low a dose or not treated with a second stimulant when the first one fails. Both MPH and DEX should be tried before moving to nonstimulant treatments for pedi-atric ADHD but specialist advice should be sought before venturing beyond a total dose of 60mg day of MPH and 40 mg day of DEX. Approximately 25 of children with ADHD are not helped by the first psychostimulant given or experience side effects so bothersome that meaningful dose adjustments cannot be made. It is estimated that between 10 and 30 of children with ADHD do not improve with stimulants or improve but experience unmanageable side effects.


Once-daily modafinil for an average of 4.6 weeks has been evaluated in an open-label trial in 11 children aged 5-15 years with ADHD (38c). This pilot study, with non-blinded ratings, a small number of subjects, and a short duration of treatment, showed significant improvement. Adverse events were responsible for drug withdrawal in one child. The most common adverse event was delayed onset of sleep or sleep disruption, which, in two of three