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ADHD & MAM, Part 1

Attention Deficit Hyperactivity Disorder (ADHD), commonly referred to as ADD, is one of the polarizing subjects. Some think it's a money-making scheme cooked up by pharmaceutical conglomerates, others think it's a legitimate disease and diagnosis, but most simply don't know much about it.

Related Article: ADHD & MAM, Part 2

It is vital that all summer camp personnel be aware of Attention Deficit Hyperactivity Disorder (ADHD), what it means, and the most common medications prescribed to treat it.

Here we'll discuss the high incidence of dispensation of psychotropic medications for children, while also identifying the highest prescribed medications for the treatment of ADHD.

Defining Terms

For the past five summers I have dedicated my time, service and commitment to camp nursing. During this time, I have witnessed the prevalence of campers on psychotropic medications rising dramatically. Where, once upon a time, camp nursing meant band aids, bear hugs and bug juice, it now means prescriptions, packets and Prozac.

Children who experience high levels of activity or are boisterous and disorderly, do not necessarily suffer from Attention Deficit Hyperactivity Disorder (ADHD).

ADHD, according to Mosby's (1998), is defined as "a syndrome affecting children, adolescents, and adults characterized by short attention span, hyperactivity, and poor concentration."

Those children diagnosed with ADHD are noted to always be in a hurry and have a heightened level of frustration when attempting to complete tasks. They give up accuracy for hastiness. They display moderate to severe distractibility, short attention span, impulsive behavior, and extreme mood changes.

Usually these children are in "societal and environmental overload."

According to Wong (1993), confirmation cannot be made until a series of tests confirm a learning disability. These include intelligence tests (these children tend to have above-average IQs), hand-eye coordination tests, and measurements of auditory and visual perception, comprehension and memory.

Psychotropic medications are defined as those meds that have an altering effect on perception or behavior and they are used to treat a myriad of behavior, emotional, and mental disorders, which include ADHD.

Many clinical trials for medications have proven effective for the treatment of ADHD. This does not mean, however, that the treatment is indeed necessary and should be prescribed for all hyperactive children. Many of the drugs under this classification cause more harm than good if over-utilized or abused.

The literature does not state whether the prevalence of ADHD has risen, but what is quite clear is that the number of children identified with the disorder who obtain treatment has risen over the past decade.

Some of this increased identification and increased treatment may be due to greater media coverage, coupled with consumer awareness, and the availability of the treatments.

A study by Medco Health Solutions Inc., recently reported that there is 23 percent increase in the use of medication for altering behavior for all children, including a 49 percent increase in ADHD drugs by children under five!

Americans are now spending more on drugs for ADHD and depression than they do on antibiotics, asthma or allergy medications for children. Some of these commonly used medications for the treatment of ADHD are Ritalin, Adderral, Strattera and Concerta.

Ritalin is a central nervous system stimulant and comes in tablets of 5 mg, 10 mg, and 20 mg. Ritalin also comes longer-acting: Ritalin-SR, sustained release tablets that come in 20 mg, and Ritalin LA, extended release capsules that come in 20 mg, 30 mg, and 40 mg.

Some side effects of Ritalin include: nervousness, decreased appetite, head aches, heart problems, rapid heart rate, trouble sleeping, nausea, stomach aches, joint pain, skin rashes and hives, peeling skin, skin redness and itching.

Adderral is a stronger form of the natural body stimulant adrenaline, which helps a child who has ADHD focus and reduces the child's excess fidgeting and hyperactivity. The side effects of this medication include restlessness, tremor, dizziness, anxiety, insomnia, nervousness, dryness of the mouth, diarrhea, and headaches.

Adderral is habit forming, as physical and psychological dependence may occur. Side effects include diarrhea, constipation, appetite loss, dry mouth, unpleasant taste in mouth, indigestion, nausea, and vomiting, fast heart rate, exaggerated sense of well-being (euphoria), over-stimulation, weakness, drowsiness between doses or after stopping medicine, weight loss, and stunting of growth in children (long-term use).

Another drug on the market is Stratterra. Treatment may not be indicated for all patients with this disorder. Strattera comes in capsules of 10 mg, 18 mg, 25 mg, 40 mg, and 60 mg. This drug works in the central nervous system to improve behavior, concentration and mood.

Of course, as with all of these medications, counseling for behavior and socialization is highly recommended. Side effects of Strattera can include nausea, vomiting, tiredness, mood swings, weight loss, constipation, upset stomach and dizziness.

One of the newer medications on the market, Concerta, must be prescribed with caution to emotionally unstable patients who may increase the dosage on their own. Concerta comes in cylindrical tablets of 18 mg or 36 mg and last for up to 12 hours.

Chronic abuse may lead to increased tolerance and psychological dependence accompanied by abnormal behaviors and severe mood swings. If a dose is missed, it must be given as soon as possible. However, if several hours have passed or if it is nearing time for the next dose, do not double the dose to "catch up" (unless told to do so by the doctor). If more than one dose is missed or it is necessary to establish a new dosage schedule, a physician must be contacted.

Lab tests are required during therapy. Tests include blood counts, platelet counts, and blood pressure measurements. The side effects include all those previously mentioned.

Necessity or Abuse?

While the idea of medicating children to change or control their actions and behavior is a fundamentally uncomfortable thought, we recognize that ADHD is a frustrating problem.

A number of alternative remedies have become popular, which include herbs and natural supplements, chiropractic manipulation, and dietary changes.

Some suggestions include, but are not limited to a healthy and assorted diet, with plenty of fiber and other basic nutrients including fresh fruits and vegetables, and plenty of water throughout the day, which is the diet that would be best for most children. Adequate sleep has been proven to help ADHD symptoms.

Children with ADHD need to be identified prior to the opening of camp sessions. Lines of communication must be open and the entire camp staff must be aware of all the defining characteristics of this disorder, and alert the medical staff when any symptoms of overload are noted, or of adverse medication effects.

Each child is different and we must do what is best for that specific child. Fostering self esteem and independence is a goal all summer camps mutually share, which is why it is imperative that camp directors, medical staff and camp staff are goal-oriented when it comes to this population of children.

Although, there are many specialty camps for behavioral and emotional disorders, there is no reason why we cannot integrate children with ADHD into mainstream summer camps, so long as the communication is open and continuously flowing, and consistent evaluation of child's tolerance to activities and socialization is occurring. We are there for the children; we want their experiences at summer camp to be memorable and fun!

"Many persons have a wrong idea of what constitutes true happiness. It is not attained through self-gratification but through fidelity to a worthy purpose."

HELEN KELLER (1880-1968)

Elizabeth A. Levine is a pediatric case management coordinator at Jackson Memorial Hospital in Miami and a doctoral student at Barry University in Miami Shores, Fla.

Sources & Resources

Anderson, K. N., Anderson, L. E. & Glanze, W. D. (1998). Mosby's Medical, Nursing, & Allied Health Dictionary, 5th Edition. St. Louis: Mosby-Year Book, Inc.

Baer, C. L., & Williams, B. R. (1996). Clinical Pharmacology and Nursing. Pennsylvania: Springhouse Corporation. Health Square. Com (May 27, 2004). http://www.healthsquare.com/drugmain.htm

Wong, D. L. (1993).Essential of Pediatric Nursing, 4th Ed. St. Louis: Mosby-Year Book, Inc.

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