Rather than address this letter individually, I thought I would publish a recent interview I did with a free-lance journalist. The journalist was preparing an article for a parenting magazine about ADD ADHD treatment and wanted to know my thoughts about the current treatments. Since she was on assignment in Brazil and I wasn't passing through Rio that week we decided to conduct the interview by email.

This is the scenario I was presented with:

A parent of a five year boy who is bouncing off walls comes to you and says,

"I hear stimulants work but that they have side effects. I also hear that researchers still don't know a lot about what stimulants do to a child's health in the long run."

"What do you recommend? Do you think stimulants are being pushed too hard by many professionals?"

Here is my response:

Are Stimulants Being Pushed too Hard?

I don't think that stimulants are being pushed too hard, but I do think that they are not being used properly. The main advantage of stimulants, like Ritalin, is that they help control the child's symptoms so that other interventions will be more effective. For the most part, this is not how stimulants are being used.

In conventional medicine the most reliable treatment for ADHD is a combination of medication, like stimulants, and behavioral modification. The advantage of stimulants is that they help improve the ADHD symptoms better than any other conventional treatment. Unfortunately, stimulants play no role in curing the condition nor do they provide any long- term changes in the condition.

Behavioral therapy helps the child work with the ADHD behavior and improves his responses to situations. It doesn't make the child into less of an ADD ADHD child. Rather, it helps direct his behavior so that he is an ADHD child who functions better.

When used together as part of an overall treatment plan, these two approaches are the most effective means of dealing with ADHD currently recognized by conventional medicine. I want to point out that they don't provide a cure, but they do help the child function more normally in spite of the problems.

In many and perhaps most cases, these two approaches are not being used together. The reason is the cost. It is fairly cheap to give a pill. It also doesn't take a lot of time on the part of the physician, and the parents see immediate results. Therapy requires hours of intensive high cost professional intervention and the results are not over night. Someone has to pay for this, and it is usually the parents. Most medical insurance plans will pay for doctor visits and medication, but they are less ready to cover months of psychological intervention. As a result, most children do not get behavioral therapy.

Side Effects of Stimulants

There are some problems with side effects from these medications. However, we currently have a number of different products and dosing schedules available. Basically, with the exception of loss of appetite, every common side effect of these medications can be eliminated either by changing the dose or by switching to a different drug. This is one of the advantages of having a psychiatrist who specializes in managing ADHD work with your child. They are much more adept at using these medications than the average family physician.

Health Risks of Stimulants

With regard to the long-term health risks of stimulants, I feel this concern has been blown way out of proportion. We have been using stimulants for almost 80 years. There is no other medication used in psychiatry today that has been so thoroughly studied. We know more about stimulants than any other psychiatric medication and they are also the safest drugs used in psychiatry. That doesn't mean that they are completely safe, but it does suggest that there are going to be no new surprises. After being used for 80 years, it is not likely that some catastrophic consequence of taking Ritalin that nobody knows about yet is going to pop up. It has been around too long.

An Approach to Treating ADHD in a Young Child

Given all that, concerning the theoretical child in question, I would definitely not start with medication. Since the child is only 5, then school is not a major factor yet. I would focus on trying to find other things that might be contributing to the behavior.

For instance, iron deficiency has been associated with bad behavior. It is also very common in young children. I think that there is strong evidence to link food sensitivities to ADHD symptoms. There was a big debate in medicine about food sensitivities thirty years ago. The research was pretty shabby on both sides, but the evidence is strong enough to suggest that in some children, food sensitivities contribute to their problems.

I also have personal experience with this. At one point we suspected that our son, who had been on Ritalin for four or five years, had sensitivities to certain foods. We took him off those foods. At the end of a week he came to us and said that he didn't need the Ritalin anymore. He has been off Ritalin for four years.

There are lots of other things I would look into before starting medicine in a child this age. Recently, I researched over two hundred books articles and scientific papers to determine which non-conventional treatments are effective. I found that of the many things people say cure ADHD, about 35 treatments have good support in the medical literature. I designed a treatment program to help parents use these treatments.

How to Use Non-Conventional Treatments

Although it is clear that many non-conventional treatments are effective, parents should not look for alternative treatments blindly. There are over one hundred things on the market today that people are selling and say will help. Even though they all quote testimonies of people who have been helped by what they offer, most of these treatments are completely worthless. Any positive results they do get are due to the placebo effect. These successes do not last long.

Even with things that do have scientific support, like certain supplement combinations, you still have to be careful. Most of the supplement combinations are dosed so incorrectly that they are completely ineffective. Some of the things being used are actually dangerous. The point is that you have to be careful. People have a misconception that natural medicines are harmless. They are not. There have been fatalities caused by taking supplements and herbal remedies.

The point is that medication would not be my first choice in a child this age. In an older child where school performance is an issue, I would opt for medication earlier in treatment.

Focusing on Behavior

I would start with counseling right away, particularly with parent training and social skills training. The parents are going to have trouble raising this child. Normal parenting skills and parenting books are not going to work. They will do their child and themselves a big favor if early on they learn how to address their child's behavior. I realize that this is going to be expensive. This is the reason I designed an ADD ADHD child behavior program. I wanted to provide parents with the tools to help their children without having to pay the $3-4000 that therapy usually costs. However, it is imperative that the parents learn how to control and guide their child properly. And the younger the child is when they start such a program, the happier everyone is going to be.

Focusing on Social Skills

These children often have trouble making and maintaining friendships. This is not the first thing on the parents' minds when they come to the doctor, but this is the biggest problem that these children will have when they are adults. Once they are out of school, most people can find some type of work situation that is compatible with their ADHD. However, children who never learn how to develop and maintain proper social relationships are headed for lifelong misery. It pays to focus on this as soon as possible.

Taking Action Early

I would like to emphasize that parents should not delay in seeking help. We can do a lot to help a five year old. Not a lot of damage has been done yet. It is more difficult to start with a teenager. You have to help mend all the years of suffering that the child has had to endure as well as address the actual ADHD problems.