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Pay Attention To Risk Of Stimulant Drugs For Kids

Stimulants such as Ritalin, commonly used to treat attention deficit hyperactivity disorder (ADHD), have come under intense scrutiny as they may increase the risk of death from heart attacks. In February, a panel of experts in the United States led by leading cardiologist Steven Nissen of the Cleveland Clinic, recommended that Ritalin carry the highest-level warning - the "black box warning" - informing patients of potentially fatal side effects.

Subsequently, another panel of experts rejected the need for a black box warning, but recommended a new warning about psychiatric side effects, including hallucinations about worms and bugs. The drugs already carry warnings that they may increase risk of sudden death, hypertension and stroke in those with congenital heart defects.

However, experts have been arguing about the need for "stronger" warnings because they feel the drug is being overprescribed in the US. ADHD is the label given to a set of behaviours, including inattention, impulsivity and hyperactivity. They are believed to be caused by an imbalance in brain chemistry, and interfere with a child's ability to learn and function within a school setting.

This class of drugs, called methylpherudates, help children focus by stimulating the central nervous system. They have become increasingly popular in the US, where an estimated two million children and a million adults take them every month. 1n the past seven years, there have been 51 deaths among children and adults taking drugs for ADHD in the US. These drugs can raise blood pressure and heart rate and can cause heart problems.

However, most physicians say the current warnings are enough and that they do not want to scare parents. Explaining why he supported a strong warning, Dr Nissen told US media he wanted to "get people's hands to tremble a little bit before they write that (prescription)". But other specialists have pointed out that there is still no conclusive evidence to link the deaths to the use of stimulants.

Dr Robert M: Nelson, chairman of the second committee that reviewed the drug, said the benefits of Ritalin in children diagnosed with ADHD far outweigh the risks. He said only children with congenital heart problems should not be prescribed the drug. His committee also stated that the use of stimulants was more risky in adults than in children.

But other panellists said most children who died suddenly from heart ailments never knew they were at risk This is because most children put on stimulant therapy are not given thorough heart evaluations. For most parents, the choice to put their children on medication is a tough one. They opt for it because they feel the drug might be their child's only shot at learning and functioning better at school.

One mother who spoke on condition of anonymity said her nine-year-old son has been on Ritalin for the past year and that it has really helped him focus in school. "I heard of ADHD only when my friend's daughter was diagnosed with it. I became interested because my son was showing all the symptoms," she said. Her son had severe problems sitting still in class and concentrating on the lessons. "He also got into fights at school and teachers told me that he was too aggressive," she said.

This aggression and impulsivity often makes ADHD kids stand out painfully in regular schools. They not only fall back academically, but also feel left out socially. While she is relieved with the improvement in concentration, this mother also worries about the long-term side effects of the drug. "Hopefully, he can manage without it in a couple of months." This is a gamble most parents take, hoping that a year or two of drug therapy along with behavior management can help their child through the most crucial learning years.

Some parents try to avoid the risks of medication by trying alternative approaches such as nutritional therapy and behavioral therapy. Proponents of nutritional therapy believe children with ADHD are sensitive to certain additives in processed foods. Mr John, a nutrition expert, says he saw immediate improvements in his daughter's attention span when he altered her diet-by eliminating sugar and gluten.

Ultimately, parents have to balance risks with benefits - something that can be achieved in consultation with the doctor. Mr Joshua Ashton, 30, a special education teacher, supports this approach. Mr Ashton was diagnosed with "hyperactivity" as a seven-year-old growing up in the US. His mother decided to try nutritional therapy as she was wary of putting him on medication. 

She put him on an elimination diet called "The Feingold Diet" - named after Dr Ben F. Feingold, a paediatrician who designed it specially for children with attention problems. "One week after eliminating artificial colours, flavours and preservatives, I watched the first full episode of Sesame Street. For my mother, the proof was evident," Mr Ashton said. He went on to do a master's thesis on the current research regarding diet and nutritional therapies for treating children with ADHD.

He now teaches developmentally delayed students at an elementary school in St Paul, Minnesota. In his thesis, Mr Ashton came to the conclusion that diet and nutritional therapies help only a small percentage of the ADHD population and that it is difficult to identify what type of child would benefit from diet therapy. Based on his own experience of ADHD and his thesis, Mr Ashton has children with ADHD. "I would recommend that parents start with the least medically intensive therapies and move towards the more intensive.

On the other side of the spectrum, medicinal therapies that immediately help children function in their world and improve their relationships can start the road to stronger independence," he said. "However, I would caution that by and large ADHD therapies do not improve academic performance significantly but they help general functioning and improved relationships."


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