Eleven-year-old Joey came into my office as a new patient. He had been diagnosed with ADHD, and for years had been taking stimulant medications; Ritalin and Adderall. Neither seemed to be working well. He continued to have problems with his mood swings and his anger. He often would lose his temper and has even been guilty of destroying the furniture in the house. The younger brother has taken many a beating from Joey. Most frightening to the family of late is that he has been playing with fire and has been accused of torturing the neighborhood cats.
The greater family members suspect that this is a more serious problem than your routine ADHD. There is an uncle who has trouble with violent anger and is taking medication daily in order to control the mood swings. Mom’s question to me was, could the stimulant medication Ritalin or Adderall be causing the problem?
To answer her question we must consider several issues. The diagnosis of ADHD is one that is made after a careful assessment of a child’s functioning in all the areas of his life—his school, his home and his community. The triad of ADHD includes inattention, impulsivity and hyperactivity. If medication is determined to treat ADHD it would include the stimulants such as Ritalin and Adderall. Stimulants focus the child’s attention and aid in concentration and focusing.
Sometimes the stimulants themselves can cause transient side effects, such as crabbiness or irritability. These side effects are generally related to when the medication is given. Timing is very important. Occasional problems can occur with rebound hyperactivity. These are symptoms of worsening hyperactivity when the stimulant medicine wears off. Although this is a common side effect, if it becomes a concern discussing these issues with the pediatrician can be of help.
At this point it is difficult to determine if Joey has a more complicated problem than ADHD. Symptoms of a more serious mood disorder may include severe, prolonged temper outbursts, physical violence, fire setting and cruelty to animals. This behavior could become more frequent and longstanding, and will greatly interfere with his functioning in all areas of his life. He will have significant difficulty with school progress, both academically and socially. Very likely he will begin having unusual thoughts and ideas, such as racial discrimination. Sleeping patterns and appetite may be disturbed. Staying on one task at a time will become a problem.
We concluded that Joey needs to be referred to a pediatric psychiatrist where a thorough assessment of his current functioning can be completed. He may benefit from an additional type of medicine, such as a mood stabilizer. If the diagnosis of ADHD is correct, a more urgent assessment of these current issues is in order.