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The Informed Parent

Patching Up ADD

by Louis P. Theriot, M.D., F.A.A.P.
Published on May. 05, 2008

Attention deficit disorder (ADD) affects approximately 3-5 percent of all school age children in the United States. This is also the incidence that is reported in Western Europe and Japan. ADD is not a single entity; rather, it is a constellation of symptoms that include inattention, impulsivity and hyperactivity. The symptoms are usually detectable before the age of seven years. However, this may not be so readily evident. A child does not have to have all three symptoms to be diagnosed with having ADD. He or she may simply have pure inattention or poor impulse control and still carry the diagnosis of ADD.

Physicians and psychologists have come a long way in recognizing and treating ADD over the last forty years. If a child was struggling in school during the 1960’s there was a good chance that he would be labeled as “being slow,” or a student that “just didn’t care.” He was often left to flounder on his own. In the late 1960’s the stimulant medications Ritalin and Dexedrine were found to be very successful in the treatment of ADD, although it was not exactly known HOW they worked. In fact, it is a bit paradoxical that one would treat a child that is hyperactive with an amphetamine, but it worked.

Over the next couple of decades physicians, psychologists and educators became better at recognizing and diagnosing ADD. It also became apparent that a child with ADD had a 50 percent chance of also having a specific learning disability such as a visual or an auditory processing problem. Nowadays, if a child is struggling in school, there is no excuse for that child to not be properly evaluated in a timely manner.

The history of medications used for ADD is an interesting one. Ritalin and Dexedrine have been successfully used since the mid-1960’s. The problem with them is their short duration. A dose of either will last around four hours. This is not practical for a child who goes to school from 8 o’clock until 2:45, and then does his homework from 3:30 until dinnertime.  If the stimulant medication does work well for this child he would have to take a dose before school, go to the nurse’s office during lunchtime for another dose, and then take a third when he gets home from school to help him complete his homework.

This is fraught with problems. First of all, the morning dose may not last until lunchtime. Therefore, a child may have significant problems with staying on task throughout the latter part of the morning when he has a difficult class that requires his full attention. The second problem is the fact that most children will not go to the nurse’s office during lunch. They either forget, or just outright refuse to do so.

To remedy this problem the pharmaceutical companies developed wonderful “long acting” preparations of both Ritalin and Dexedrine. These preparations are designed to last up to 8-10 hours and have tremendously improved the treatment of ADD. This allows patients to take a dose in the morning and be confident that they have a therapeutic level of the medication in their bloodstream to get them through the entire day.

In the past few years a new preparation was licensed that has given physicians another tool to use in the treatment of ADD. It is called Daytrana, and it is a trans-dermal patch of Methylphenidate (Ritalin). This is a small, clear, paper-thin patch, about the size of a book of matches. It is applied to the skin in the hip area and will last for up to ten hours. When it is removed at the end of the day it is discarded, and a new patch is applied the next morning. It works very well for the appropriate individual, usually a person who is known to do well on Ritalin or its associated preparations.

One side effect is that it may cause some skin irritation where it is applied, although there are ways to easily deal with this. A real benefit of Daytrana is that it allows more flexibility in dosing. In other words, if a student has around three hours of intense homework to do on the weekend, delaying the start time until mid-afternoon, a patch can be applied shortly before starting the work, then taken off when it is finished. When the patch is removed the beneficial effects will last for around 1-2 more hours.

This is what makes Daytrana different from the long-acting oral preparations. When one takes a long-acting tablet or capsule, it is in the body until it is fully metabolized. Therefore, a patient may not want to take a pill later in the day since they do not need the benefit of the medication late at night.

If there is one absolute about ADD it is the fact that each person having this disorder is unique and individual. Not all patients with ADD will respond to Ritalin or Dexedrine and, if so, their dose must be individually determined. Not all patients with ADD will necessarily do well on Daytrana and, if so, their dose must be determined individually as well. With the dosing of ADD medications, one size does not fit all.

Daytrana allows the physicians another valuable tool in treating ADD with a bit more flexibility. The treatment of ADD has sure come a long way in the past twenty years.

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