So what is the response to stimulants of 'normal' children that haunted Dr. Barkley? Dr. JL Rapoport studied the answer to that question. I am not sure that you could do these studies today but I guess they were allowed in the 70s. It turns out that Dr. Rapoport gave 14 boys who were about 11 years old amphetamines at a dose of .5mg per kg. This amount corresponds to about 20 mg of Adderall for the average 90 pound 11 year old. What Dr. Rapoport found was that these boys developed a marked decrease in motor activity, a marked decrease in response time, and improved cognitive performance after being treated with the stimulant. He concluded that the effects of the amphetamine on ADHD children was not 'paradoxical' at all but that it was, in fact, exactly what you would expect if you gave amphetamines to any child.
Amphetamines do have a paradoxical effect on children when their response to stimulants is compared to the adult response to stimulants. Dr. Rapoport found, in a different study, that if you give stimulants to adults, the adults feel euphoric. Children do not feet euphoric. Children reported feeling different or tired.
If you have a child with ADHD who is hyperactive, impulsive, and inattentive, clearly a medicine that reduces reaction time and motor activity and increases cognitive performance is going to address this child's ADHD symptoms. But what happens when you have an inattentive child that is neither hyperactive nor impulsive and you give that child a stimulant? Those children will develop decreases in activity and response times that are probably not beneficial to their overall learning.
Children with Predominantly Inattentive ADHD are mostly normally active or somewhat sluggish. When my son took Ritalin for several months last year his teachers reported that he acted like a zombie. He would pay attention but he was totally 'frozen'. My son reported that the Ritalin made him 'sad'. His teachers asked us to lower his dose. He was on 10mg of Ritalin and we dropped the dose to 5mg. That dose still made him a bit sad but his teachers said that he was more active. He had started drinking coffee on the weekends and we decided to give him a trial of coffee every morning instead of the Ritalin. He has been on that regimen since this school year started. He is less sad and more involved in the classroom but he is also a bit less focused than when he was on the Ritalin. For now we have made the decision to stick with the caffeine and see how it goes.
Interestingly, Dr. Rapoport also looked at coffee and its response in 'normal' boys. He found that caffeine was similar to amphetamine in that it increased vigilance and decreased reaction time but unlike the amphetamine, caffeine increased motor activity. Dr. Rapoport concluded, "Separate biological systems may be differentially affected by these two substances."
Other studies have shown that caffeine increases both focus and activity in children. It would seem counterproductive and unnecessary to give children without hyperactivity a treatment that would decrease motor activity. It is irresponsible to give children who are sluggish a medication that would further decrease their activity.
Caffeine may be a better choice for some children with Predominantly Inattentive ADHD. If a stimulant is used, care must be taken to use a low enough dose so that the activity levels of children with Predominantly Inattentive ADHD are not adversely affected.
Science. 1978 Feb 3;199(4328):560-3.
Dextroamphetamine: cognitive and behavioral effects in normal prepubertal boys.
Rapoport JL, Buchsbaum MS, Zahn TP, Weingartner H, Ludlow C, Mikkelsen EJ.
Arch Gen Psychiatry. 1980 Aug;37(8):933-43
Dextroamphetamine. Its Cognitive and Behavioral Effects in Normal and Hyperactive Boys and Normal Men.
Rapoport JL, Buschsbaum MS, Weingartner H, Zahn TP, Ludlow C, Mikkelsen EJ.
Thank you for a very interesting post!
ReplyDeleteHave your son (or you) ever tried amphetamines (like Adderall)? - I heard they can be better for ADHD-PI.
What kind of coffee do you use?
Thanks for your kind comment.
ReplyDeleteHe has tried Adderall at a dose of about 3mg (1/3 or a 10mg LA). He was more focused but still a little 'sad'. The sadness was about the same as on the Ritalin but his activity level was better than when on the Ritalin. If we started a stimulant, it would be the Adderall.
He drinks brewed Seattle's Best Coffee about 12 ounces twice a day, at 7:30 and 3pm.
WOW now I know I am not crazy. Thank you so much for this. I feel like fowarding this to the school Psychologist and my sons teacher and my Pediatrician.
ReplyDeleteI feel exactly the same way. My son is already sluggish and immmature motor activity. I knew treating ADHD and ADHD-PI were very different but trying to explain this to "professionals" is very difficult. They want to treat him for ADHD and he is so opposite. I am so glad to find this website! Thanks!
I echo the thanks for a thought provoking post! Very interesting line of thought about non ADHD kids reacting to stimulants. My PI son is taking Vyvanse 30mg at the moment. I really don't like the idea of stimulants. We will be exploring possible underlying causes for his ADHD via my Naturopathic Dr, a practice I have gone to for nearly 15 years. No straw is too small to grasp in the face of stimulant side effects. It's been nearly 2 weeks on the stimulants and my 13 year old loves the clarity he is feeling but a drug that causes reduced sleep quality and appetite suppression, increase in tendancy to anger (even though he is still mostly his peaceful self) is not a move toward balanced health.
ReplyDeleteThis is so interesting! I am an adult with ADHD including hyperactivity, but my main problems are innattentiveness and just restlessness. I hate coffee but I chug Dr. Pepper all the time, including at schoolt. (I'm an adult student.) I have noticed that Dr. Pepper helps me concentrate in class. (Doesn't help with the restlessness, though!!!) Interesting that caffeine may be a good alternative for kids with innattentive ADHD who can't tolerate the usual meds!
ReplyDeleteJust came back from a judo tournament in Memphis that took 23 hours much of it in a Boys and Girls club van with 11 kids. Our team won the Tournament 1st place team award and my youngest took home a bronze medal but only now getting to these wonderful comments.
ReplyDeleteNicki, I know a parent who swears by Dr Pepper for her inattentive daughter! Linda, maybe a lower dose of 15mg (just sprinkle half of the capsule on apple sauce) might work as well without the appetite and sleeping problems. Kathy, tell the physician and the school (as respectfully as possible) to read more about Predomininantly Inattentive ADHD.
Thanks so much for your comments
I found this extremly interesting. My daughter is ADHHHD, so much of this does not really pertain to her, except that our Pschiatrist originally told us that trying stimulants was a helpful diagnostic tool. If the stimulants helped and calmed her, we would know that it was ADHD we were dealing with. If she wasn't ADHD she would be more active on the stimulants.
ReplyDeleteAfter reading your blog and the reasearch of Dr Barkley this does not sound as if it is true at all. HMMMM....
I think what the psychiatrist probably meant to say is that in hyperactive children, when you place them on stimulants you really see an immediate improvement. This is often not the case with inattentive children as the stimulants, especially at high doses, can make them more subdued than they are already. I think that many psychiatrist have no idea what the effect of the stimulants are on normal kids. Kind of sad really!
ReplyDeleteThis is all very interesting. I am always amazed at how differently people's bodies process chemicals.
ReplyDeleteI'm an adult, though a very small, med-sensitive one, and...I cannot tolerate 10mg of Ritalin. Just ask my husband...holy smokes, I sound and act completely high. 5mg seems to be just fine, helps me focus a bit, feel more calm, less worried, etc! When you said your son was taking 10mg I was like "holy moly!". But these things are a little different for everyone I suppose :)
I do have another point here though...that the wrong dosage can cause weird things to happen, even in those who have ADHD who could benefit from the medication. I wonder how many times people try it, the effect isn't great and then change meds instead of just trying the same one at a lower dosage...hmmm.....
You are so right. My son actually does tolerate about 3mg of Ritalin really well but it helps him about as much as a cup of coffee so he does not take it as the coffee does fine for him. I tell folks that all our bodies are slightly different and a dose that will work for one person may not work for another. The Ritalin LA is actually 5 mg every 3-4 hours over an extended period and that was what he was taking but for him it was too much. Unfortunately, physicians often tend to move up in doses instead of down and sometimes moving down is what is appropriate especially with ADHD-PI. Thanks so much for writing!!
ReplyDeleteLOL, Barkley and pushing stims seem to be synonymous these days.
ReplyDeleteHere's what parents should know about Mr. Barkley:
1. He's a Clinical Psychologist, Not a Medical Doctor.
2. He can't even prescribe the drugs he's pushing, again because he's not a medical doctor.
AND LAST BUT NOT LEAST: http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder_controversies#Financial_conflicts_of_interest
Russell Barkley, a well known ADHD researcher, admits to taking money from drug companies for speaking and consultancy fees.
"I chug Dr. Pepper all the time, including at school. (I'm an adult student.) I have noticed that Dr. Pepper helps me concentrate in class. (Doesn't help with the restlessness, though!!!)"
ReplyDeleteYou know what else the Dr. Pepper helps? The the Candida (fungus in the digestive tract) which thanks you kindly for giving it all the high fructose corn syrup it needs to grow out of control, leading to your mental fog and a laundry list of other symptoms.
People like us have no business drinking soda, which is poisonous in its sugar based form, and even moreso as the diet (neuro-toxic aspartame) version.
It's the toxic inflammation caused by garbage like soft drinks that trigger ADHD symptoms (dairy products, processed foods/MSG, animal products, etc). My symptoms evaporated after 20 days on a vegan diet.
http://www.youtube.com/watch?v=zk7GezE4cgE
Charles Parker among some other physicicans (mainly allergist) have long contended that sugar, additives, milk and wheat can cause hyperactivity and inattentiveness. Parker requires patients have IgG and IgM testing as well as specific test for food allergies prior to starting ANY medical treatment. Some studies have shown that up to 30% of kids diagnosed with ADHD may, in fact, have food or environmental allergies. It should not surprise us. When anyone is having allergy symptoms they do not breathe, sleep or think well. The rates of Asthma have risen exponentially in in the last 15 years and we are still trying to figure this out. Asthma also has an allergic component. There is no doubt that more people are being medicated and that some are being medicated unnecessarily for ADHD. I believe that ADHD-Pi and Sluggish Cogntive Tempo will respond amazingly well to cognitive training, sleep hygiene evaluation and treatment and appropriate nutrition including vitamins, antioxidants and a balance containing an adequate amount of protein.
ReplyDeleteA genius is measured by how long he retards his field. I agree with you that Barkley has met this criteria.
Yeah, so I've been diagnosed with ADHD-PI, am 19, and am taking 2 50mg Vyvanse pills. I started at a lower dose but as I got used to them, they bumped up the dose. I noticed that it indeed allows me to concentrate spectacularly, but I often feel like a drone. When I get upset, I can't help but concentrate on what made me upset. This further depresses my mood and is overall making me feel like crap. I don't feel hungry when I should be and I'm now classified as underweight, yet my mom ardently upholds that this medication makes me "normal". Of course, this only adds to any depressive symptoms, since I've now been labeled as a defective human being for not conforming to social norms and expectations. I know that legally she cannot force me to take Vyvanse now that I'm older than 18, but I do not want to ruin my relationship with my mother. What should I do?
ReplyDeleteThat is one of the problems with the stimulants is that they often make you more focused but they do not discriminate that focus so that you can become focused on your depression.
ReplyDeleteSee if you can make an appointment with a psychiatrist that has the time to talk to you about all this.
It is possible that some behavioral/cognitive/social therapy might be helpful but I do not know as I don't know what all is going on.
The psychiatrist might offer the above and/or do the followin:
Take you off the Vyvanse
Put you on plain short acting Adderall and give you a 10mg-15mg dose for starters to see how you did.
If you needed more after 4 hours because you were going to be doing something that required you to be focused you could take another 10-15mg dose 4 hours later.
If the above did not help enough then I would perhaps try to add another medication perhaps an antidepressant if you were still having depression on the lower Adderall dose or if depression was not the problem and more focus was needed, I would not add to the stimulant. Instead I would try maybe Intuniv or Strattera.
You are still young. Your brain is developing and as you age, your symptoms will likely improve.
Keep me posted, OK? Tess