IS BERNARD LORD RIGHT ON WHEN HE SAYS - IT'S UP TO THE DOCTORS OR PARENTS FOR THE DRUGGING AND THE KILLINGS OF OUR CHILDREN???

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Posted on Mon, Apr. 17, 2006
BY JEREMY OLSON
Pioneer Press

Renewed concerns about side effects of ADHD drugs have not held much sway with parents medicating their children for the disorder. For many, a clear-thinking child outweighs risks.

At age 8, Gabriel Johnson has experienced the worst and best of drugs for attention deficit/hyperactivity disorder.

There was Adderall XR (extreme fatigue) and Concerta (aggression) and Strattera (hallucinations). Each time Gabriel switched medications to escape a side effect, another, more bizarre problem emerged. Meanwhile, his mother, Kari Lindholm-Johnson, kept hearing from teachers how Gabriel was more focused and ready to learn every day.

"I had people telling me at school, 'We have a new student,' " she said.

Lindholm-Johnson may not like the drugs, but the benefits of a clear-thinking child outweigh the risks. Her story helps explain why parents haven't reacted much to the latest federal debates over stimulant medications for ADHD and the rare risks of psychosis and heart problems. When it comes to this class of drugs — one that has raised arguments over everything from the biology of the brain to the erosion of society — many parents have already made their peace.

"It's a very hard thing to put your kid on a drug," said Sarah Lilja, a social worker who hosts an east metro support group for parents who, like her, have children with ADHD. "You probably don't ever let go of that worry. But then when you see the success …"

The first day Lilja's son came home from school after taking ADHD medication, he initially said the drugs made no difference. Then he paused — and thought — and the resulting response has made Lilja comfortable with her decision ever since.

"For the first time in my life," he told his mom, "I only had one thought in my head at a time."

Three to 5 percent of U.S. children are believed to have ADHD, which is marked by inattention, hyperactivity and impulsive behaviors. The primary medications are stimulants — Ritalin, Concerta and Adderall, among others — which are believed to work by increasing the production of brain chemicals that support attention and planning skills and impulse control.

The drugs have long carried stereotypes of turning children into zombies and encouraging addictions (despite research showing people with untreated ADHD are at greater risk of substance abuse). They also come with warning labels of known side effects, including weight loss, nervousness and insomnia. Reports of more severe medical risks emerged publicly in the past two years.

In February, one advisory panel to the U.S. Food and Drug Administration sought a "black box" warning on all ADHD stimulants after receiving reports of 25 deaths and 54 cardiovascular events among people taking the drugs. In late March, a similar FDA panel found that warning too extreme but also called for clearer warnings.

The FDA also warned last year that Strattera, a non-stimulant drug for ADHD, was linked to an elevated risk of suicide. And the Canadian government suspended sales of Adderall, an amphetamine, over potential risks of sudden death. That February 2005 suspension has since been lifted.

Given this buildup, Lilja was surprised when parents didn't bring up drug risks at this month's support group. Dr. Carri Borchardt, a child psychiatrist in St. Paul, couldn't recall any parents asking to take their children off medications either.

Parents have already wrestled with the risks of known side effects, so they were probably insulated from the latest controversies over ADHD medications, said Dr. Jason Nowak, an Eagan pediatrician.

Economic data suggest that the warnings might be having some effect. The prevalence of ADHD medication in children 19 or younger increased only 0.4 percent last year, compared with an average increase of 12 percent in the four previous years, according to Medco Health Solutions.

The slowdown probably reflects a change from previous years, when ADHD was a "fad diagnosis" and parents felt comfortable medicating their children even in marginal cases, said Ari Tuckman, a clinical psychologist in Pennsylvania. The new risks are probably reducing questionable uses of the drugs, he said, but aren't influencing parents whose children are thriving under the medication.

"The discussion of black box warnings may keep them up for a few nights," said Tuckman, speaking on behalf of CHADD, a national advocacy group for people with ADHD, "but when push comes to shove, those parents will decide it's worth it."

That's not to suggest that ADHD demands medication. Therapy alone can work in certain cases, and changes in diet and environment can have an effect as well. But taking children off successful medications means risking disruptions in their schoolwork, friendships and daily activities.

Lindholm-Johnson was told to put her son back on Adderall last year after he hallucinated while taking a different drug. He thought he saw someone running down the hallway of the family's Brooklyn Center home. The advice came just after Canada had suspended sales of Adderall.

She managed the stress of the decisions by painting, and the result on canvas was an abstract image of a boy surrounded by hands and objects symbolizing the opposing forces that made her decisions difficult.

"I just found expression in this turmoil," she said.

Lindholm-Johnson, a pastor at Evangelical Covenant Church, eventually found a drug regimen that her son could tolerate as well.

Gabriel now takes Adderall in a smaller dose each morning. It's enough to hold his attention span until the afternoon, but not enough to cause the fatigue he experienced the first time.

His school day is structured to give him 20 minutes of free drawing time — right when the drug wears off and attention problems resurface. The drawing is a mental break and allows Gabriel to return to regular classroom work with renewed focus.

After all of this, Lindholm-Johnson said, the latest debates over drug safety seemed like old news.

"When it came around this time," she said, "we had already weighed some of those concerns."

Jeremy Olson can be reached at jolson@pioneerpress.com or 651-228-5583. To get help

The District 622 ADD/ADHD Support Group will resume next October. Parents from outside the North St. Paul-Maplewood-Oakdale school district are also welcome to attend. Call 651-748-7585.