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ADHD: Attention Deficit Hyperactivity Disorder

ADHD Medication Contraindications

Margaret Austin, Ph.D., Natalie Staats Reiss, Ph.D., and Laura Burgdorf, Ph.D.

Contraindications are factors that should be carefully considered when selecting a particular medication to treat ADHD. These conditions may make the use of certain medications unsafe and too risky. Individuals who have tics (uncontrollable movements or sounds), Tourette's Syndrome, certain medical conditions, or who are pregnant or have a history of drug abuse may not be good candidates for specific medications.

group of pill bottlesTourette's Syndrome is a condition characterized by multiple tics, both vocal and muscular, that appears in childhood and often lasts for the rest of the individual's life. Doctors used to believe that the use of Ritalin caused Tourette's Syndrome. As it turns out, children with Tourette's usually exhibit restless and distractible behavior prior to developing visible tics. Therefore, some of these children were placed on Ritalin to address ADHD-like symptoms prior to a clear diagnosis of Tourette's Syndrome. Researchers now know that Ritalin is not the cause of this syndrome. However, a person who has tics or Tourette's should avoid using stimulant medication. For more information about Tourette's Syndrome, please click here.

People with active heart disease and high blood pressure should avoid stimulant medication, as it may exacerbate heart or circulatory symptoms. People with glaucoma should also avoid stimulant medication, because the associated increases in blood pressure can worsen related symptoms. People experiencing active psychotic symptoms (such as hallucinations and delusions) should avoid stimulant medication, which can increase the frequency and intensity of psychotic episodes. Similarly, people with liver disease should not take Cylert, which is suspected of triggering liver disease. Finally, any allergies to stimulant medication would contraindicate the use of similar medications

Dosing Strategies and Issues

Although working with a physician who has expertise in treating ADHD can help, finding the most effective medication treatment and dosage for a particular person can be a trial-and-error process. For a child with a complicated case or with other psychiatric diagnoses, consultation with or transfer to a child psychiatrist is prudent; at least until the medication regimen has stabilized. As previously mentioned, general practitioners are not necessarily the most qualified choice of professionals regarding ADHD treatment, especially for complicated cases.

Research has demonstrated that up to 80% of all children would perform better at school while taking Ritalin or other stimulant medication. Therefore, a positive response to this type of medication is not necessarily diagnostic of ADHD. In cases in which ADHD related problems are severe, moving forward with stimulant treatment early on in the diagnostic process might be helpful in providing immediate symptom relief. However, in all but the most extreme cases, medication treatment should not begin until the diagnostic process is complete.

Parents and children should be prepared for the sometimes lengthy and frustrating process of medication selection and "tweaking". There are no simple rules that can be used to determine the correct dose of medication for an individual. Unfortunately, unlike some medications, the recommended dosage cannot simply be calculated according to someone's weight. Each individual has a unique body chemistry that influences which medication will be most effective and at what dosage. Doctors aim for the smallest dosage that produces successful symptom control without creating (or minimizing) unpleasant side effects. Current recommendations are to start with the lowest dose and increase the dosage gradually as necessary.

Medication for ADHD should be taken according to the doctor's orders. Parents and school personnel must often take an active role to ensure that children take their medication as prescribed. Few children (and even teenagers) with ADHD can assume full responsibility for their medication. Treatment compliance is extremely important since the effectiveness of the medication depends on regular administration. If there is any question of unreliability or drug abuse potential in the patient's home, the medication should be administered at school. Each school has different guidelines, but a permission form is usually required for medication administration by a school official.

Many children take their medication only on school days with the idea that it is best for them to have a couple of days per week to be medication free. These children might even have a "drug holiday" for the summer or during holidays in order to let their bodies function without the medication for a period of time. Other children, especially those with extreme symptoms, may take medication every day. The theory of this daily dosing technique is that the child (and family) may experience significant benefits from the calming influence of medication. Positive experiences with family and friends can have a long-lasting beneficial effect that exceeds the concerns of taking a medication daily.

Closely evaluating medication effects is an essential part of treatment. Parents, teachers and the child, have a role to play in identifying whether or not the medication is effective in reducing ADHD symptoms. The assessment tools mentioned previously (self report and behavior rating scales completed by caregivers and teachers) are often used to monitor the child before and during treatment to determine whether medications are working.

 

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