Preface

Michael is a five-year-old boy I saw several years ago for a consultation after his parents were asked to remove him from two different pre-schools. His teachers found him to be very disruptive and uncooperative. He constantly ran out of his class and frequently hit other children. The school had suggested that Michael might have attention deficit hyperactivity disorder (AD/HD) and that his parents should consider putting him on medication. The parents expressed their frustration with the situation and were very concerned about doing what was best for Michael. They had many reservations about putting their son on medication, especially since they felt they were able to handle his behavior when he was at home. They also wondered if there were other options that might help Michael, besides medication.

This scenario is played out repeatedly in many doctors' offices. The decision to put your child or teenager on an AD/HD medication is a tough one. Daily, there are reports in the media about AD/HD medications. In a recent cover article, TIME magazine posed the question: "Are we giving kids too many drugs?" The article, titled "Medicating Young Minds," highlighted the stories of several children and teenagers put on medication to help them with underlying emotional and behavioral difficulties. This article discussed several of the important, yet controversial issues, surrounding the use of medications in children and adolescents. Dr. David Fassler, Professor of Psychiatry at the University of Vermont, noted: "We know that kids are not just little adults, they metabolize medications differently." Dr. Glen Elliott of the University of California, San Francisco pointed out: "The problem is that our usage has outstripped our knowledge base. Let's face it, we're experimenting on these kids without tracking the results." The piece went on to discuss what necessitates the use of medication, and how medication potentially benefits children and adolescents with emotional and behavioral problems.

Many articles and reports have discussed the use of medication in children and teenagers, both before and after the TIME article. The dilemma is that some reports tell us about the benefits of medication, while others talk about the dangers. In December 2004, the Food & Drug Administration (FDA) issued a warning regarding one of the commonly prescribed AD/HD medications due to concerns about potential liver problems. Two months later, Health Canada (the Canadian equivalent of the FDA) suspended all sales of another AD/HD medication amid concerns about sudden deaths of patients while on this medication. Then, in August 2005, Health Canada reversed its decision and reinstated the medication. It is becoming more difficult for parents to make medication decisions on behalf of their children. The conclusion of the TIME article was that parents must be knowledgeable and well-informed regarding their child's condition. In addition, they must be aware of the various treatment options available. This guide will enable you to make the most-informed decision regarding your child's care. Sooner or later, every parent of an AD/HD child or teenager will face a decision regarding the use of medication. This guide will prepare you with the indispensable information you need to make the right decision.

The information in this guide is presented systematically. The initial sections are the building blocks of information you will need prior to making a decision regarding treatment. Certain sections such as "Medication Rules," "Different Available Medications," and "Helpful Resources," while part of the overall context of the book, also serve as handy reference sections you'll refer to again and again.

This book is divided into five sections: Section one reviews basic information regarding AD/HD, as well as the consequences of not treating AD/HD across the life span. Section two outlines some essential rules regarding the use of medication in the treatment of AD/HD. Section three provides detailed essential information for the most commonly prescribed medications for the treatment of AD/HD. This section is divided into two parts. The first part covers the stimulant medications while the second part covers the non-stimulant medications. The sections on the stimulants and Atomoxetine are significantly larger than the other sections; primarily because there have been more research trials of the stimulants and Atomoxetine in the treatment of AD/HD, resulting in more data on these medications. Section four covers the answers to frequently asked questions that many parents have regarding AD/HD and its treatment. The last section contains helpful resources and references for additional study. Throughout the book I have used many scenarios involving patients that I treat. The names and some of the details have been altered to protect the privacy of my patients.


Making the Connection

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