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News & Views - Jun, 1996 Issue #40 

By Paul R. Crellin, M.D., Director Medical Services
Yellowstone Treatment Centers 
Billings, Montana

(Dr. Crellin oversees medical management of all treatment programs at Yellowstone Treatment Centers. As founder of the Children's Clinic, and the Child Study Center, Dr. Crellin has practiced medicine in Billings for more than 35 years. Dr. Crellin consulted with schools in Montana, Wyoming, North Dakota, and South Dakota for 21 years through the Child Study Center.- Lon)

The evolution of the medical treatment of ADHD has been very interesting. When it was first recognized in the 1880's in the case of "Fidgety Phil," behavior modification was the only type of therapy. During the 1930's, in Providence, RI following an epidemic of encephalitis, Dr. Eric Denhoff and others at Brown University first tried "stimulant medication" in the form of Benzedrine. This drug is a stimulant, and the physicians obtained a "paradoxical" result, when, instead of being stimulated, the child became quite calm. From that time until after World War II this type of therapy was prescribed sparingly, without knowing why it worked. 

With the development of the Cyclotron, it became possible to do studies of brain function. Radioactive Glucose (sugar) was injected into a special breed of mice who were "hyperactive" and it was found that the Reticular Activating System was not working properly. When the radioactive sugar was injected into normal mice, it was noted that the Reticular Activating System was very active. When stimulant medication was given to the mice who were seen to be "hyperactive" the Reticular Activating System became active, thus giving the initial clue that this part of the brain was in some manner involved in the ADHD condition. 

Subsequent to this initial evaluation, much clinical study has been undertaken, and at this time there seem to be three main types of therapy that are effective in about 90-95% of children with ADHD. The most commonly used drugs are the "stimulants" and the most popular medications in this group are Ritalin, Dexedrine and Cylert. It has been found that these medications "Stimulate" the Reticular Activating System, but the exact mechanism of the action continues to remain unknown. Another type of medication is the "antidepressants", the most common of which are Imipramine, Desipramine and Amitriptyline which have chemical structures quite similar to the "neurotransmitters" Dopamine, Serotonin and Norepinephrine which are felt to be the essential chemicals needed for proper brain function. The third type of medication is an antihypertensive medication, Clonidine, which also acts on the Reticular Activating System for the control of high blood pressure. This latter medication tends to accentuate (help) the stimulants and/or antidepressants work more efficiently. Some of the newer antidepressants have also been tried in ADHD, but experience with them has been limited. 

These medications, properly used, are safe and effective. They do need to be carefully monitored, however, and the doctor/patient/family relationship is essential. Long term therapy is needed as about 75% of children with ADHD continue to have symptoms into adult life and continue to require medical management. In addition to the medications, counseling of both youth and other family members is essential, and the matter of possible associated Learning Disabilities must be considered. If Learning Disabilities are present, it is essential that they be properly diagnosed, and treatment plans developed to maximize the youth's strengths and minimize the weaknesses. 

Copyright 1996, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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