Male1: Do you really know why they work?
Male2: Well, we do not know. The most commonly used medication for ADHD are stimulants, there are other medications that work differently and stimulants affect certain chemicals in the brain. I do not think we really know why they work. All we know is that when you take a stimulant, it does two things. In terms of clinical, it allows a child to pay attention better, so they test better on medication. There is no evidence that this medication makes a difference long term, just at the time when he is on it.
The other thing we know, there had been some functional imaging studies and they really are just research approach, it is not done clinically and functional imaging basically looks at the brain’s function and to make it very simple, there are delays in certain parts of the brain and specifically the frontal part of the brain in ADHD children, there is an immaturity of the way the frontal part of the brain activates. On medication in a few patients studied, this immaturity improves, so it does seem to affect functioning both from a test taking perspective on medication and also in terms of functional imaging and functional MRI.
Male1: The most important thing is that you should be careful using the medicine. It should not be just used because you walked in the front door. You should have some good test material before and after to know that it is helping the child or the adult when we see it and we should always along the way, if there are certain medicines that can affect the liver, you should have some tests run on it to make sure that it is not causing, as we call, some of the side effects. It can affect liver function and you always should consult your doctor first and I think we have said here because every kid is unique, is that true?
Male2: I think that is right and I think if you do start medicine, you have to do two things. One, you have to have an endpoint to see if it works, and secondly, you want to make sure there are no side effects either behavioral or any other things. Most of these medicines are relatively safe that we use for ADHD, in fact, there are about as safe as anything around, but there are medications and I think the point is, everything can do everything. And everybody is very unique and you could always be the one in ten million if something happens, so one has to use it knowingly and one has to use it in a rational way and not just put someone on and let it go and not worry about it.
Male1: There is a little abuse with Ritalin lately. I have been hearing some people are trying to get it to lose weight, but they think if you take it, you would lose weight and they would lie to some doctors and telling these doctors, if you walk in the front door, they give you a prescription and there is danger doing things like that and there are also kids in college, they think are they are going to do better in college if they take an exam week, and there is some danger to that too, is it not?
Male2: Well, if you take it—there are people who do abuse Ritalin for other reasons and for attention deficits. There is no question that they have been doing this for a long time and people use it for test taking, for staying awake. People sometimes can actually ground it up and snort it and people have smoked it and there is an abuse of these medications.
Some of the medicines actually cannot be abused as easily as others, but there is an abuse of this, and it think that is a problem. There is also an over use of medications. As we said before, I think some people are not using an endpoint to see if this stuff works or not, so people are continuing it and they really should not be. So I think there is that downside to this medication and I think that is the fault of both physicians and patients.
Male1: What is the youngest age you ever seen a kid that was evaluated for ADD? What will be the youngest?
Male2: Well, we talk not about—we talk about not being able to diagnose ADHD until a child is—sometimes people say six. I think four to six is probably the earliest.
Male1: And we have indications before that, but you are suddenly like hesitant to make that kind of thing--
Male2: Right, it is very hard before that and it is because, the reality of it is, we are looking at—we are saying that your attention is less good than your intellectual functioning, so when you are very young, it is really hard to sort of separate those out because as you know, two of your older kids run around a lot, and that is normal. A three year old kid runs around a lot too, a little bit—
Male1: But a three year old who is not doing that, there is something wrong with them.
Male2: That is correct, so it is very hard to tell until you are older and you really have to do tests that require some concentration and sitting and that is when it really comes out. I think there are kids that we think are at risk, although, no one has really ever studied those children to see if how often do they really become ADHD or not.
Male1: Also, sometimes, you do not even know it until they get into some very complex thinking areas of education.
Male2: That is correct, the problem with ADHD is that it is a little bit of a spectrum clinically, in other words, some kids are really mild, some kids are more severe. And some kids are so mild, it is just a personality trait basically, it does not really, as we said, just maybe needs a little bit of organizational skills, and so there really is this continuum. A child that is very severe typically is a problem in kindergarten and I have seen children that have been thrown out of kindergarten because they cannot pay attention and they are climbing out the window in the middle of class and then there are children that are much milder that made you very well through school and then may get into trouble later. First grade is a common time, third grade is another tipping point there is a lot more work in third grade and the final tipping point that is—well again, I should not say final, but another common tipping point is when children go to middle school and require to change classes and have several tests on Friday and have to organize themselves. Some children like that may have done very well through all of grammar school and then really get in trouble in middle school.
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