Blackwell Publishing - Social stigma and feeling lifeless and/or alienated from one’s peers are some of the reasons why children and adolescents stop taking prescription stimulant medications used to treat attention deficit-hyperactivity disorder (ADHD), according to a new study published in the Journal for Specialists in Pediatric Nursing.

ADHD is a common neurobehavioral disorder, affecting 4.4 million children in the United States between the ages of 4 and 17. Following diagnosis, 56% are treated with prescription stimulant medications. According to the study, many stop using these medications even while they are still exhibiting symptoms of the disorder, despite research indicating these medications are effectively reducing hyperactivity, impulsivity and inattention.

The study also found that while ADHD is a chronic disorder, none of the adolescents interviewed had received ongoing education about their condition. As college students, many used the medications irregularly, sometimes in doses exceeding the prescribed amount, and often at night – factors that may exacerbate the side effects.

Julie B. Meaux, PhD, RNC, lead author of the study, suggests that “dialogue between the child, parents and healthcare provider about the general effects, side effects and potential abuse of prescribed stimulant medications is essential,” adding “careful administration of dosages, based on input from the child, is exceedingly important.”

Editorial note:  Careful titration of ADHD medication can be quite important for avoiding side effects that might prompt discontinuation of stimulant medication in those that really need it.  If a child or adolescent complains of feeling blunted, numb, flat, too even, not lively or animated enough, etc., it might just be that they are slightly overmedicated beyond what they need for enhanced attention span and decreasing problematic impulsivity. An “overfocused” state can appear slightly serious and not as “bubbly.” Sometimes a slight medication dosage adjustment can remedy this.

Another dimension of this problem is that novelty-seeking and stimulus-seeking children and teenagers might have difficulty distinguishing a calmer but natural spontaneity from over-the-top impulsivity, especially if other children give them more social attention for being a “class-clown” or daredevil or for being “bold” with authorities (i.e. inappropriate and impulsive in ways that do not really advance their cause or address their needs).  Thus the child will need help from caring and observant adults in making these kind of discerning judgements, and teenagers in particular could benefit from ongoing psychoeducation about how not to confuse internal distractibility with creativity, or impulsivity with “normal” spontaneity. If your child is on medication for ADHD and you have questions about side effects, be sure to review this with the prescriber, or perhaps get a more in-depth consultation with a child and adolescent psychiatrist - Dr. Z.