Medication Holidays, ADHD, and the outdoors

[scoutldr]

I agree, flushing meds is not the best environmental solution, but do you have a better idea? The school is closed for the summer, and open for maintenance work. She cannot leave controlled substsances in the clinic unattended. If the parents won't come get the meds, I guess she could bring them home for the summer, but that's above and beyond the call. It should be noted that most in this area are military dependents and meds are free (courtesy of the taxpayer). In September, they just get more.

 

Being in the Public Health field, I have read there are concerns with the upcoming pandemic flu...when millions of doses of Tamiflu start getting flushed, the Avian flu virus will quickly mutate into a resistant strain. This is scary stuff...

[DanKroh]

Hmm. I'm glad to see that some of the misinformation presented early on in this thread has already been corrected, but I'd like to add my belated 2 cents, as well.

 

As a mental health professional and parent of two boys with ADHD, one of whom also has Asperger's, I can tell you that ADHD and Asperger's are NOT the same thing. My older son with AS behaves very, very differently than my younger son who only has ADHD.

 

As far as medication holidays, yes, they were mostly advised for kids on Ritalin, but Adderall and Concerta are both still amphetamine derivates, and have the same appetite suppressing/growth inhibiting effects as Ritalin. The only medication currently used for ADHD that is not a stimulant (amphetamine) is Strattera, but many docs hesitate to prescribe it because of reports of liver problems. My older son who takes Strattera (because the stimulant meds exacerbate other symptoms he has) has to have his LFTs checked every 6 months.

 

Now while I don't give either of my boys medication holidays because their ADHD symptoms are severe enough that they can't function without the meds, I know others both professionally and privately who do. But they only do it on the advice of the psychiatrist who monitors their children. Are there parents who might skip dosages to stretch scripts that are costly? Quite probably, given the sad state of drug costs and lack of insurance some folks have to deal with. But I think it is unfair to paint all parents who do medication holidays with that same brush.

 

As far as the overdiagnosis of ADHD (and Aspergers), I agree and disagree with that. I think a lot of people don't understand that the rise in diagnosis of these conditions is mostly due to a better understanding of these disorders, and better diagnostic criteria, even in the last 10 years. On the other hand (and this is a pet peeve of mine), pediatricians should not be in the business of diagnosing ADHD or any psychiatric disorder, IMO, and I think that is where most mis- and overdiagnoses come from. ADHD should be diagnosed by a qualified psychologist or psychiatrist who specializes in pediatric disorders. Once the diagnosis has been made and medication has been tried and settled on by a psychiatrist, then I have no problem with a pediatrician continuing to provide scripts for that medication. But a psychiatrist will still need to be consulted every 6 months or so because dosages change very quickly sometimes for growing children.

 

 

[Gonzo1]

DanKroh,

When the criteria changes, of course there will be more diagnoses.

Here's another example: 15 or 20 years ago, a person was over weight at 20 pound over "ideal" body weight and obese at 50 pounds over "ideal" body weight. Nowadays, a person is obese at 20 pounds over ideal weight.

 

so, if criteria changes to diagnose ADD (etc), then there will be more people diagnosed with it. I also believe that some of the diagnoses are just plain wrong. It's my understanding that MD's get kick backs from pharmaceudical companies from prescribing certain drugs. I don't know, I don't get kick backs AND I'M NOT ACCUSING ANYONE HERE OF RECEIVING KICK BACKS.

 

Let me state it again: Add is over diagnosed. Ritalin and Adderall are over prescribed. Some, but not all teachers don't want to manage kids who are ADD, some, but not all parents are bad parents and can't control these kids. Some kids need the medicine. Some kids are bored, they go outside and climb trees, they're kids, kids climb trees.

 

If a child is truly, and I mean sincerely ADD, not the kid who doesn't pay attention in class or who gets bored with school work because he is actually a genius, but truly ADD, the kid NEEDS to take medication as prescribed. Anyone who has a prescription should follow it, otherwise don't waste your time and your doctor's time.

 

I believe that if a parent gives the kid a holiday during a campout, the parent is risking the child's health, safety of others and puts undue (and unfair) stress on the adult and youth leadership during the campout.

 

I will be the first to say that if a person's only tool is a hammer, the only solution they see are nails. I see chiropractic solutions to health problems. I'm a chiropractor, not a psychiatrist.

 

I've had patients with ADD who get better with spinal adjustments

I've had patients with ADHD who get better with spinal adjustments

I've had patients with Asperger's who get better with spinal adjustments

I've had lots of patients who get better with spinal adjustments.

 

What people don't understand is that many health problems are actually caused by misalignments in the spinal column. Problem is, people take pills for health problems that MIGHT be helped with chiropractic care.

 

[DanKroh]

Gonzo,

 

"When the criteria changes, of course there will be more diagnoses."

 

I disagree. Sometimes there will be more, sometimes there will be less. In the case of Asperger's, the diagnosis didn't exist before about 1994. For ADHD, the diagnostic criteria was refined in 1994, as well, in an attempt to differentiate exactly the kinds of things you are talking about; kids who have trouble with attention alone vs. kids who have hyperactivity/impulsivity, etc. Before 1994, diagnosing ADHD was a trial and error system; if the medication worked, that confirmed the diagnosis. We've found better tools since then to diagnosis ADHD, so yes, there has been an increase in cases. But to say that "Asperger's is the new ADHD", well, it just isn't.

 

"Let me state it again: Add is over diagnosed. Ritalin and Adderall are over prescribed."

 

I agree that ADHD is overdiagnosed, in children. I also think it is underdiagnosed in adults. However, I think trying to place the blame on teachers is also misguided. Teachers don't prescribe medications or make diagnoses. That should only be done by psychiatrists or psychologists after careful observation and evaluation.

 

"Anyone who has a prescription should follow it, otherwise don't waste your time and your doctor's time."

 

And parents are also following the prescription when they follow a doctor's advice to take the kid off of it for certain breaks.

 

"I believe that if a parent gives the kid a holiday during a campout, the parent is risking the child's health, safety of others and puts undue (and unfair) stress on the adult and youth leadership during the campout."

 

I agree with that, too. IMO, medication holidays should be for times when the kid is not going to be under pressure to conform to certain standards of behavior or to be asked to perform tasks that require focused attention. A campout is not one of those times.

 

"What people don't understand is that many health problems are actually caused by misalignments in the spinal column. Problem is, people take pills for health problems that MIGHT be helped with chiropractic care."

 

I'm glad that you've had patients who have shown improvement for these conditions under your care, and that you recognize that there are many who will not. I'm a great fan of alternative medicine, myself, but feel it is important to stay open to ALL possible treatments, including medication.

[Gonzo1]

DanKroh,

I'm glad we agree and disagree. I suppose I completely overlooked (in this discussion) the adult under-diagnosis. Wasn't trying to imply that teachers are diagnosing, rather, teachers do everything they can to not diagnose. I think teachers don't want to "deal" with a kid who might be re-directed.

 

I'm not sure what your area of discipline is, buthow bout this: I'll stick with my table, you stick with your couch.

 

No offense intended, we can't (IMO) continue in this in an online forum, it's too complicated. Best done in person.

 

I help lots of people, I refer out many. I'm sure you help many people too.

 

All the best

[MarkS]

Gonzo1 said, "Asperger's Syndrome is the "new" ADD by the way. So,don't be fooled if some parent says that their kid has Asperger's. It's basically the same thing with a different name."

 

This is an incorrect statement. While there are some common traits, there are several behavioral issues of Asperger's that are significantly different than that of ADHD. Simply put the symptoms of ADHD are inattentiveness, impulsiveness and hyperactivity to a point that are detrimental to a child's ability to function in a social setting. Asperger's includes inappropriate social interaction, poor or the lack of nonverbal communication skills, narrow interests and preoccupation with those interests, repetitiveness, stubbornness, lack of empathy, the inability to form friendships, and poor gross and fine motor skills.

[yelruh]

Asperger's is also a Specrum disorder, so not every boy has the same issues, or same levels in every area. Just because you've seen one kid with AS you haven't seen them all, you've just seen one!

 

You can also have ADHD and Asperger's just like a boy can have a broken arm and allergies to peanuts.

 

The problem with some meds and "holidays" is that you actually have a withdrawl period with some, even though the manufactures say they aren't addictive. Addictive means your body craves it, withdrawl means your body misses it, and is having problems, but doesn't know enough to tell the brain, I need my meds. So if a kid skips medication his body is used to, his behavior might be worse than if he had taken it, or had never been on it to begin with.

 

 

 

 

 

[Gonzo1]

OK gents, I said "basically the same thing" not exactly the same thing.

 

The main point here is that when a person is prescribed a medication, they should take it as prescribed. Not so much a disc ussion of ADD/ADHD vs. Asperger's and the similarities and differences.

[MarkS]

Well, I view Asperger's and ADHD as significantly different in the behaviors exhibited--we deal with both in our Troop. Not bascially the same. However, I agree totally, no medication holidays on Troop activities. That's the policy of our Troop.

[LongHaul]

I've got a question for Dan and other medical professionals. Is taking a child off meds for two days of any real value to the child? I took Ritalin while I could afford it and both my sons activly take Ritalin, I understand the long term concerns. I had scout in my troop that took Ritalin and his doctor took him off the drug for the summer months to give his system a rest. Clearing the system for 60 to 90 days I understand but 2 days? Does it...no let me rephrase...Can it really make a difference in combating long term use side effects?

LongHaul

[ASM915]

LongHaul,

It all depends on the drug and how the person reacts being off the drug. Some drugs have longer halflives then others, meaning it takes longer for the system to get rid of one drug compared to another drug. In comparision, some drugs require 1,2 or even 3 weeks to even get up to theraputic levels before they start to work.

If side effects is the concern and reason for breaks, try some of the newer med's on the market. My one son can't handle any stimulants at all because they send him manic. The other son didn't tolerate Aderal but had no problem with Concerta, apetite was good, never lost his sense of humor, never had personality changes associated with Ritalin.

60-90 days, My brother says now that he hated when my parents did that to him. He would rather have stayed on the drugs. It takes 2-3 weeks to get it all out. If you start it the week school starts, the your not giving the drug enough time to build up to working levels.

It's better to leave them on the med's and if there are side effects look at other drug options.

How do the kids act when off the drug is another consideration.

[DanKroh]

"I've got a question for Dan and other medical professionals. Is taking a child off meds for two days of any real value to the child? I took Ritalin while I could afford it and both my sons activly take Ritalin, I understand the long term concerns. I had scout in my troop that took Ritalin and his doctor took him off the drug for the summer months to give his system a rest. Clearing the system for 60 to 90 days I understand but 2 days? Does it...no let me rephrase...Can it really make a difference in combating long term use side effects?"

 

Pretty much what ASM915 said. Depends on the half-life. Most of the ADHD medications have a pretty short halflife, so yes, 2 days can see a drug cleared from the system. Is it worth the behavior problems that might crop up? Well, that would also have to be decided on a case-by-case basis.

 

Although, most of the kids I know who go off ADHD medications do it for the summer, so you are talking months of difference. The biggest side effect of these meds is appetite suppression/growth delays. While I have see that 2-3 months can make a big impact as far as catching up on yearly growth, I can't see it happening in 2-3 days, no. Maybe there are other side effects that are being considered here, that I don't have any experience with.

 

My nephew, who is now 21, used to stop Ritalin during the summer, and would have huge growth spurts during that time. He continues to take medication for his ADHD as an adult, and doesn't like to go off his meds at all because he doesn't like feeling "out of control". He tried a couple of years ago, since many with ADHD experience a alleviation of symptoms in early adulthood, but he couldn't function. But he now takes one of the new meds with fewer side effects.

 

But I am not a psychiatrist and I do not precribe meds (end disclaimer)

 

ASM915, my older son also can't take any of the stimulants because they exacerbate his Asperger's behaviors (ticks, compulsive actions, anxiety, etc). But my younger one does fine on Concerta (but he also doesn't have Asperger's). Does your son take Strattera? If so, does he also have his LFTs checked regularly?

[yelruh]

With some meds, and some people you can't cut down quickly or go cold turkey because of withdrawl problems. Doctors believe what the drug companies say. I've seen people weaned off of Paxil in a hellish 2 weeks, and a very comfortable 2 months. Yes it's more work, but a heck of a lot less stress.

 

Drugs also take some time to start working in your system, so stopping for a weekend really isn't helpful.

 

One benefit of stopping meds over the summer, is if you are changing medication. That way you clean out the system, and give the body a chance with the new medication.

 

 

[DanKroh]

"With some meds, and some people you can't cut down quickly or go cold turkey because of withdrawl problems. Doctors believe what the drug companies say. I've seen people weaned off of Paxil in a hellish 2 weeks, and a very comfortable 2 months."

 

Well, SSRIs and other depression/anxiety medications are a whole different animal than ADHD medications. (Paxil is generally not given for ADHD, although sometimes it can be given for comorbid depression or anxiety.)

 

No, stuff like Paxil should ABSOLUTELY not be stopped cold turkey, and even if they were, would not clear the system for 2-3 weeks.

 

But most of the ADHD meds, being amphetamine derivates, have a very short period of efficacy (even the "sustained release" ones); they generally require neither a "ramping up" period nor a "weaning off" period. Most. Strattera being the big exception that comes to mind.

 

Keep also in mind that most of the dosages of ADHD meds, even though they are amphetamine derivatives, are not high enough to produce physical dependancy or physical withdrawal symptoms. Psychological dependancy or withdrawal is another thing entirely.

[ASM915]

DanKroh,

He can't handle any of them. The main three Ritalin, Adderil and Concerta are front end drugs. They cause an increased production of the lacking neural transmitter chemical at the front end to flood the receptors at the back end.

Strattera is not a stimulant but a blocking agent at the back end to direct the the lacking chemical to the right receptors. Help me out here Dan.

 

The front end is like a soccer or hockey match with a player in a penaltybox. The other team has an increased number of players whose goal is to get to one receptor and the blitz is on.

 

The backend would be the like a football kickoff team. The numbers are the same but the receiving team is trying to direct the defense where they want them, to give the ball carrier a chance at getting to his goal or receptor, the endzone.

 

Hope the analogy helps.

 

Yelruh, good point on med changes.

 

DanK. Liver profiles and platelets for Depakote, TSH levels for HypoT caused from Lithium, (he's on Synthroid)and of course the Lithium levels.(This message has been edited by ASM915)