Making the Connection: A Parent's Guide to Medication in ADHD

by Mohab Hanna; Washington, DC:
Ladner-Drysdale, 2006
117 pages • $10.85 (paperback)

Making the Connection: A Parent's Guide to Medication in AD/HD is a concise, user-friendly book intended for parents of children with attention-deficit/hyperactivity disorder (ADHD). The book focuses on common concerns parents have when deciding whether to treat their child with medication.

Section 1 provides a quick review of the prevalence and possible causative factors of ADHD. Key symptoms and possible comorbidities are also summarized. A chapter is devoted to illustrative case vignettes-which are also sprinkled throughout the book-that describe what might happen if a child with ADHD is not treated with medication.

Section 2 outlines 21 rules parents need to know when considering medication for their child. These rules include ensuring that the ADHD diagnosis is correct, having a good understanding of how the diagnosis was made, and exploring other explanations for the child's behavior. Other rules address the fact that medication is not the only treatment option, that the potential benefits of using a medication need to outweigh the risks, and that parents should not expect medication to fix every symptom.

However, the author does not point out that interventions not involving medication are often more effective when given in conjunction with medication. He also neglects to state that adverse effects of any medication should first be dealt with by decreasing dosages and not, as the text suggests, by discontinuing the medication entirely.

The text also does not mention that a small proportion of children may require higher dosages, particularly if no effects (positive or negative) are noticed while they are taking conventional dosages. Finally, the importance of teacher input in monitoring the effectiveness of medication treatment is not stressed.

Section 3 provides a brief review of available medications, including documented benefits and adverse effects. In this section the author states that we do not know the mechanism of stimulant action (page 60); however, we do know that stimulants block the reuptake of dopamine at the synapse cleft. The author also states that there are no studies showing the efficacy of melatonin (page 63) when, in fact, there are a few such studies.¹

The text does not mention the sexual side effects of atomoxetine (Strattera) and some of the other nonstimulants. In addition, although bupropion is recommended when there is a risk of bipolar disorder (page 82), mention should have been made that this medication may in fact trigger a manic episode if given without mood stabilizers.

Section 4 is written in a question- and-answer format that addresses common issues parents have about using medication for ADHD. Questions such as "Should the school be told that the child is on medication?"; "Can brain scans diagnose ADHD?"; "How long will my child be on medication?"; "Should an adolescent who refuses to take medication be forced to do so?"; and how to monitor the child's progress while taking medication are addressed in a direct and succinct manner.

Section 5 lists available medications, dosages, and duration of action.

Overall, this is a clearly written, well-organized book for parents, and will undoubtedly be a useful source for them. However, there are a number of significant omissions in addition to those already mentioned.

In "Understanding AD/HD," the section about conditions that look like ADHD needs to be expanded, since the conditions are merely listed and there is no clear description of the key characteristics and/or tests that distinguish these conditions from ADHD or what differential diagnoses should be considered.

In the diagnostic section (pages 22, 23), the author neglects to include the importance of having the clinician obtain a history of the pregnancy, delivery, and developmental milestones of the child from the parents.

Although the book recommends regular follow-ups with clinicians in Section 3, the frequency and monitoring of height, weight, blood pressure, and pulse as part of the follow-up are not stipulated.

In the section on "Stimulants," the book neglects to mention summer drug holidays in relation to growth suppression effects of medications. It would also have been helpful if a systematic approach for parents were outlined to determine whether medication is still needed.

Despite the omissions and oversights mentioned above, this remains a useful, concise, and generally accurate summary for parents about medication use in ADHD.

References:

Reference1. Weiss M, Wasdell M, Bomben M, et al. Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatry. 2006;45:512-519.