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Facts for Families: Children with Oppositional Defiant Disorder (published by the American Academy of Child & Adolescent Psychiatry)§ion=Facts+for+Families
Methylphenidate facts (Published by PubMed Health)

ADHD medication no substitute for effective parenting

As I was preparing for a lecture on ADHD, one sentence in a 2009 UNESCO report caught my eye:

“A single ‘good’ quality study of methylphenidate (MPH) with 114 preschool children provided low SOE for improving child behavior. ….Adverse effects were present for preschool children treated with MPH; adverse effects were not mentioned for PBT.”

We in academia are so fond of acronyms. Luckily, we are required to decode them: SOE means strength of evidence, and PBT means parent behavior training.

This quote is from a research report on treatments for children who are at risk for ADHD (attention deficit hyperactivity disorder). At risk means they are highly likely to be diagnosed with the disorder when they are older.

Methylphenidate is a prescription drug sold as Concerta, Metadate, Methylin and Ritalin – a drug as popular and as widely consumed as popcorn.

The researchers compared the effect of two treatment methods on children’s behavior: 1.) Prescribing methylphenidate to children and 2.) Training parents to manage their children’s behavior without medication.

Children with ADHD have problems paying attention, are impulsive and hyperactive. A diagnosis usually occurs at or after 7 years of age. Children who are younger than 7 years, at risk for ADHD, may be diagnosed with oppositional defiant disorder.

According to the Centers for Disease Control, “Parents report that approximately 9.5 percent or 5.4 million children 4-17 years of age have ever been diagnosed with ADHD, as of 2007.” And the number is increasing.

Having grown up in a world without ADHD, I struggle with the idea that many young children are increasingly being considered at risk for ADHD. I also struggle with the fact that medication is a part of the treatment package for many preschool children.

Like all drugs, methylphenidate has many side effects. According to PubMed, “Methylphenidate may cause side effects … nervousness, difficulty falling asleep or staying asleep, dizziness, nausea, vomiting, loss of appetite, stomach pain, diarrhea, heartburn, dry mouth, headache, muscle tightness, uncontrollable movement of a part of the body, restlessness, numbness, burning, or tingling in the hands or feet…”

While I am grateful that drug manufacturers are required by law to publish the side effects of all drugs in the market, one thing bothers me. How does one expect a preschooler to even begin to comprehend what symptoms she is experiencing, let alone communicate them to parents?

And as if these side effects are not serious enough, they warn you about serious side effects, including “…irregular heartbeat, difficulty swallowing, fainting, seizures, hallucinations and tics.”

Two statements at the end of the PubMed webpage were foreboding: “Methylphenidate may cause sudden death in children … (and) may slow children’s growth or weight gain.”

Naturally, the UNESCO study found that medication had adverse effects and hardly improved children’s behavior, whereas parent training programs improved children’s behavior and, most importantly, had no harmful effects.

Now what does that tell us about parenting? It is in our hands to prevent our children from being diagnosed with ADHD and protect them from harmful side effects of medication, unless extremely necessary.

As parents, we want the best for our children. However, their best will not evolve if we don’t do our best to raise them. And doing our best includes learning about the harmful effects of drugs before we force them on our children.

If your doctor has told you that your child has ODD, learn everything about the condition and treatment options before you agree to medicate him.

Learning how to manage your child’s behavior without medication is the most effective first option of treatment and causes no harm to your child. Ask your health care provider to give you information about parent behavior training program in your area. If there is none, get together with other parents who are concerned about their preschoolers’ behavior and demand that such a program be initiated in your community.

Let us make a concerted effort and learn to manage children’s behavior without resorting to Concerta.

Rama Cousik is an assistant professor of special education at IPFW. She wrote this for The Journal Gazette.