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Q & A ABOUT MEDICATION

By Glenda Thorne, Ph.D.

Q: What medications are most often prescribed by doctors for attention deficits, how are they selected, and how do they work?

A: The class of medications that are most commonly prescribed to treat attention deficits is psychostimulants. The most frequently prescribed psychostimulants include Adderall, Adderall XR, Conserta, and Metadate CD. Other psychostimulants are Dexedrine, Ritalin LA and Focalin. While Ritalin has traditionally been the medication that was prescribed first, Adderall, Adderall XR, Conserta and Metadate CD have become increasingly popular. The reason for this is that these medications are effective for time intervals from approximately six to 12 hours. Thus, the need for a mid-day dose of medication during school is eliminated. This enables children to keep their anonymity regarding the use of medications. In addition, children who have attention deficits are often forgetful, and with long-acting medications, they do not have to remember to go to the office to take a second dose.

Generally, there is no way of knowing which medication will work best for any given child. For the most part, it is trial-and-error. Usually physicians prescribe a low dosage, have parents and teachers monitor the child's behavior, and increase the dosage until parents and teachers report that it seems to be getting the desired effect. Older children are also very helpful informants about the medication's effectiveness.

Medications for attention deficits have the overall effect of increasing the level of chemicals in the brain, especially in two areas that scientists tell us are important in attention deficits. These areas are the frontal lobes and the Reticular Activating System (RAS). The chemicals are called neurotransmitters. It is these chemicals that allow the cells in the brain to "talk" to each other. That is, neural impulses travel from one cell to the next by releasing chemicals into the gaps between the cells. The chemical that is put into the gap by one cell activates the next cell and causes it to release the chemical into the gap between that cell and another cell, and so on.

This overall increase in the level of chemicals in the brain allows those areas of the brain that control our ability to attend, focus our attention and inhibit certain responses to work better. Some children who have attention deficits are impulsive, that is, they act without thinking first. In order to think first, we must not act; we must inhibit our initial tendency to act or respond. This behavior is largely controlled by the frontal lobes. It is the frontal lobes that also enables us to perform in a consistent way. Children with attention deficits often have trouble with performance consistency. Some days they are really "on" and some days they are really "off". Therefore, medication helps them perform in a consistent way.

According to scientists, the Reticular Activating System is responsible for alertness and arousal. This area of the brain is at the base of the brain. Remember that we said it is helpful to think of the RAS as having a thermostat that turns up in the morning and enables us to feel aroused and alert. At night, it turns down so that we feel tired and can sleep. Children with attention deficits may have a "stuck" thermostat. Their RAS is not turned up enough in the morning, so they feel sleepy and tired. In fact, they often feel this way all during the day. They may even fall asleep in their classes at school. At night, they may complain that it is hard for them to get to sleep. They might avoid going to bed. They may awaken frequently during the night or be restless sleepers. The overall increase in chemicals in the RAS helps children with attention deficits feel more alert and aroused and less inattentive.

Although medications are often effective for helping children, adolescents, and adults, they are not a cure-all. Even when children are on medication, they may nevertheless have "bad" days. They still need to be taught strategies that enhance effective performance in school. These include such things as breaking tasks into small chunks and taking short breaks in between the chunks and using physical activity to increase mental energy.