ADHD: What Really is the Best Treatment?
Ritalin Use in Children
The use of medicine has grown rapidly, as a quick, response treatment choice for many emotional or behavioral disorders amongst children. One disorder in general, Attention Deficit Hyperactive Disorder (ADHD), raises immense controversy over the health and safety issues regarding the medicine use in children. Ritalin, one of the common medications to treat ADHD, has shown positive improvements, but also carries some serious, adverse side effects. ADHD also has symptoms of wild behavior, so behavioral therapy has correlated with success in managing out-of-control behavior. So how does one choose the right treatment options? This hub will analyze the disorder, and will discuss the neurobiological aspects of Ritalin, and describe possible treatment alternatives.
Attention Deficit Hyperactive Disorder
ADHD has become a prominent disorder amongst today’s children and is rapidly reaching epidemic measures. Children with ADHD are often classified as uncontrollable, lacking attention capabilities and are very hyperactive. According to Khosh and Beneda (2003),
A child with ADHD has a wide range of symptoms including hyperactivity, short attention span, distractibility, and difficulty with organizational skills and not paying attention to details. These children are restless, forgetful and react impulsively. They may have mood swings, temper tantrums and are unable to cope with stress. [In addition] Boys seem to be two to three times more likely to be diagnosed with ADHD. (para. 4).
In addition, the symptoms must be present for a minimum of six months, and the onset needs to begin before the child reaches the age of seven, for a diagnosis of ADHD to be given (Khosh & Beneda, 2003). Although ADHD can be viewed as reaching epidemic portions, the disorder can be treated and symptoms can be alleviated. One of the most common medicines out there to treat ADHD is Ritalin.
Ritalin is a psycho-stimulant that is commonly prescribed for treating the symptoms of ADHD. As stated by Khosh and Beneda (2003), “In 1993, more than 2.5 million prescriptions were written for Ritalin” and continues to be the most prescribed (para. 6). One of the major theories behind the cause of ADHD, bases the factors of cause on the chemical imbalance of the brain’s neurotransmitters. Ritalin has shown success in providing a balance between dopamine and norepinephrine levels.
The common neurotransmitter, dopamine, is responsible for reward-seek behaviors, sexual behaviors, the control of movements, regulation of hormones, memory functions, and the control over hyperactivity (Khosh & Beneda, 2003). Dopamine is an important factor in behavior, as it serves as both an excitatory and inhibitory neurotransmitter, and any imbalance can severely affect resulting behaviors (Neurologists, Inc., 2008). In the case of ADHD patients, the levels of dopamine are decreased, thereby influencing the wild behaviors and attention deficits.
Another neurotransmitter thought to be involved in the onset of ADHD consists of, norepinephrine. Norepinephrine, another excitatory neurotransmitter, is also a possible factor, which is primarily responsible for stimulatory processes (Neurologists, Inc., 2008). Depletion of this neurotransmitter can alter attention span, cause a person to become distractible, and can impair memory (Neurologists, Inc., 2008).
The Chemical Process
In a normal person, dopamine and norepinephrine are directly related to the prefrontal cortex, and are involved the attentional systems to help control motivation and motor behaviors (Ballard et al., 1997). During normal transmission, neural impulses travel across the neuron to the synapse, where neurotransmitters are released to either stimulate or inhibit chemical interactions between neurons (Wickens, 2005). When this transmission hits the pre-synaptic nerve endings, the impulse causes the neurotransmitters to be released into the synapse to bind to other neurons, to then send the messages to the brain.
In patients diagnosed with ADHD, neuroanatomical studies have shown decreased levels of both dopamine and norepinephrine, which faults the normal inhibition of the unwanted behaviors of restlessness, decreased attention, and memory impairments (Ballard et al., 1997). These certain neurotransmissions are needed for daily functioning, and after the action potential takes place, several chemicals bind to dopamine and norepinephrine receptors to ‘recycle’ the neurotransmitters to use again, the re-uptake process (Wickens, 2005). Accordingly to Khosh and Beneda (2003), “It is thought [that] ADHD children have too many molecules that use up the dopamine before it can be used for its vital functions” thereby, causing the imbalance in the neurotransmitter (para. 7).
Ritalin’s Chemical Function
Since the discovery of the neurotransmitter imbalance, psychopharmacology research has formulated the group of psycho-stimulants to assist in controlling the levels, and furthermore, alleviate the unwarranted behaviors. These drugs produce an increase in the arousal of the central nervous system and structurally mimic the effects of certain neurotransmitters (Ballard et al., 1997).
Ritalin, one of the most common prescribed drugs for ADHD, is used as a stimulant to treat patients with ADHD. As referred to by Khosh and Beneda (2003), Ritalin interferes with the re-uptake process, and works to increase the levels of dopamine and norepinephrine by binding to their receptors and allowing increased levels to reach the brain to allow for normal functioning. Once the levels have been increased, symptoms begin to cease and behaviors can improve amongst the children. However, even though Ritalin has shown positive results, major adverse side effects have been noted and have raised the controversy over the best treatment methods.
Which is the Best Treatment?
Ritalin has some serious side effects that need to be considered before parents choose medicine as the only treatment. As stated by Khosh and Beneda (2003),
Children can develop appetite suppression, weight loss, retarded growth, emotional blunting and detachment, and many parents complain that the child acts like a "zombie. Children on higher doses and chronic use may develop paranoid symptoms -- withdrawal, anger, restlessness, suspicious behavior, [and] it has been shown that adults who abuse amphetamines regularly develop psychotic states with paranoid features (para. 8).
Suicide has also been linked to Ritalin, thereby, increasing the severity behind the side effects of choosing Ritalin as the primary treatment.
Alternative behavioral interventions have been associated to positive results in ADHD treatments. Behavior modification therapy sessions are available, and parental involvement becomes critical. Children with ADHD tend to need more ‘parent time’ than normal, and need positive reinforcements such as: rewards, physical affection, consistency, and a sense of confidence and security (Ballard et al., 1997).
The best behavior management plan, in regard to a child’s health and safety, would be a combinational treatment method. Children can be prescribed a low-dose of medicine, in supplement to, a therapy program with parental participation. This way, the child can be gradually weaned off the medicine to avoid the possible long-term adverse side effects, but can continue with the consistency within the therapy to produce the desired, positive behavioral outcome.
ADHD is a serious behavioral disorder, common to children, and can directly affect their daily functioning, as well as the lives of others. Psychopharmacology efforts have discovered the use of psycho-stimulants to help alleviate some of the common symptoms through the bio-chemical processes of increasing neurotransmitter levels. Through research processes, certain neurotransmitters have been noted a possible factor in the cause of the associated symptoms. The imbalance of dopamine and norepinephrine has been shown to influence the onset of the unwanted behaviors and impaired attentional processes. Since the discovery of the chemical imbalance, Ritalin has been used as a primary psycho-stimulant to increase levels of dopamine and norepinephrine in the brain to allow them to control their vital functions. However, the known adverse side effects bring up controversies over the right treatment for their child. Behavioral interventions have also shown positive results, to end with a recommended combinational treatment arrangement, as the best behavioral management plan.
Ballard, S., Bolan, M., Burton, M., Snyder, S., Pasterczyk-Seabolt, C., & Martin, D. (1997). The neurological basis of attention deficit hyperactivity disorder. Adolescence, 32, n128. p.855(8). Retrieved June 04, 2009, from General OneFile via Gale.
Khosh, F., & Beneda, D. (2003). Attention deficit / Hyperactivity Disorder. Townsend Letter for Doctors and Patients, p.68(4). Retrieved June 04, 2009, from General OneFile via Gale.
Neurologists, Inc. (2008). What are Neurotransmitters. Retrieved June 4th, 2009 from, http://www.neurogistics.com/TheScience/WhatareNeurotransmi09CE.asp.
Wickens, A. (2005). Foundations of Biopsychology. (2nd ed.). Prentice Hall. Pearson Education Ltd.
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