ADHD article, Discusses substance abuse & ADHD

Studies Link Stimulant Treatment, of ADHD in Childhood to Lower Risk of Later Substance Abuse

Children treated for attention-deficit/hyperactivity disorder (ADHD) with stimulant medications are less likely to develop substance abuse disorders later in life than are children with ADHD who are not given stimulants, according to NlDA-supported researchers. Dr. Timothy Wilens and his colleagues at the Massachusetts General Hospital and Harvard Medical School in Boston reviewed long-term studies in which stimulant-treated and untreated children with ADHD were evaluated later in life and concluded that stimulant therapy cuts in half the likelihood of subsequent substance abuse disorders.

The researchers examined six studies with a combined total of 647 children with ADHD who had been treated with stimulants and 360 who had not. On average, the studies followed up on the participants for 6 years (range 4 to 15 years) after treatment ended and they were more than 20 years old (range 15 to 22 years of age). Four of the six studies included treated and untreated participants with similar severity in their initial diagnoses. The studies found less inci-dence of any substance abuse disorder in participants treated with stimulants. One study in which “the severity of initial diagnosis was not similar for treated and untreated groups found that participants who received stimulants were more likely to smoke and to abuse cocaine, but not more likely to abuse alcohol or marijuana. The other study in which diagnostic severity was not matched found that stimulant-treated participants were more likely, to abuse alcohol or marijuana.

“Considering all six studies, there was an almost twofold decrease in the likelihood of substance abuse disorders risk for youths treated previously, with stimulant medication,” Dr. Wilens said.

The Harvard group’s findings counter concerns voiced by some practitioners that exposure to stimulants might increase children’s disposition to subsequently abuse drugs. “These findings should reassure clinicians and families by providing compelling evidence that pharmacotherapy with stimulants for ADHD does not lead to substance abuse disorders, hut instead seems to have protective effects,” says Dr. Wilens.

Source
• Wilens, T.E, et al. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analvtic review of the literature. Pediatrics 111 (1): 179-185, 2003.

Tips for Attention Deficit Hyperactivity Disorder (ADHD)
As much as you may not believe it, children and teens with attention deficit hyperactivity disorder (ADHD) do not misbehave to spite their parents or other adults. ADHD often causes children to react impulsively and makes it difficult for them to learn and to comply with rules.
Many children with ADHD need behavior therapy to help them interact appropriately with others. Parent training in these techniques usually takes 8 to 10 counseling sessions of 1 to 2 hours per week. Behavior therapy for ADHD children generally involves two basic principles;
1) Encouraging good behavior through praise or rewards. (Praise for good behavior should immediately follow the behavior).
2) Allowing natural and logical consequences for negative behavior.

Preschool (5 and younger)
 Be aware of your child's need for routine and structure. Warn beforehand if something out of the ordinary is expected,such as taking a different route home from the grocery store. Even small changes in a normal routine upset your child.
 Tell your child exactly what you expect from him or her before activities or events throughout the day. For example, when you plan to go grocery shopping, make sure your child knows that he or she is going to sit in the cart or hold your hand. Also, let your child know before you go in the store specifically what items, if any, he or she will be able to pick out.
 Use a system to reward your child for positive behavior, such as token jars or sticker charts. After accumulating a certain number of tokens or stickers, plan a special activity for your child, such as going to the park.
 Use a timer to help your child anticipate a change in activities and to keep him or her on task. Set a certain amount of time for activities, such as coloring. Tell your child that when the timer goes off, that activity will be over and specify what will happen next (for example, "When the timer goes off, we will be finished coloring and then take a bath"). In addition, you can use the timer for chores, such as picking up toys. If your child finishes the task in the allotted time, you can incorporate the token or sticker reward system.
 Participate with your child in activities that build attention skills, such as puzzles, reading, or coloring.

School (6 to 12 years)
 Give instructions clearly so that the child is more likely to follow through with the task. Break tasks into simple steps. This makes it easier for the child to maintain attention.
 Increase the amount of attention, praise, and privileges or rewards given to the child for obeying household rules. A token, sticker, or point system may be helpful for keeping a record of the child's good behavior.
 Anticipate where the child may misbehave (such as in stores or restaurants or in the home when visitors come by). Make a plan with the child about how to manage the situation before problem behavior occurs.
 Explain what will happen if the child misbehaves. When misbehavior occurs, follow through with the consequences as soon as possible. Your child will usually respond better with consistent reactions while in different settings, so discuss your strategies with school personnel. Consider requesting daily report cards from your child's teacher to get a sense of how he or she behaves outside of the home.
 Model good behavior. Demonstrate patience, calmness, and understanding. Avoid angry outbursts and interrupting others; pay attention while someone else is talking.

Teenagers
 Allow your child to participate in planning rules and Consequences. Be willing to negotiate these rules periodically.
 Anticipate when major changes will occur, such as starting a new school. In addition, recognize other high-stress situations, such as a heavy class load or final exams. These are all times when symptoms may be more difficult to manage. Talk about what the child can expect and ways to meet the challenges successfully.
 Be consistent. Predictability reinforces expectations and will help your child develop positive behavior patterns.
When parents start a new system of limits and consequences, children will test those limits. Making effective change takes patience, imagination, creativity, and energy to carry out behavior management. Most importantly, effective change requires an incredible amount of consistency and persistence. The techniques offered above are often successful in helping a child behave appropriately and function well with others. However, if parents stop using the techniques, problem behavior usually returns.