Conversion disorder

Q: I keep reading about teenagers abusing stimulant medication. How much of a concern is this?

A: In recent years, there has been a significant increase in the number of youth and adults diagnosed with ADHD and treated with stimulant medication. Not surprisingly, there has been a parallel increase in the number of anecdotal reports of abuse of these medications, primarily by high school students and college students. Although the stimulants are recognized as a safe and effective treatment for ADHD when taken as prescribed, these medications, like many others, nonetheless do have the potential for abuse. However, it's important to note that different stimulant medications may have different abuse potentials. Methylphenidate and amphetamine tablets, for example, if crushed and snorted, or diluted in water and injected intravenously, can pose health risks. Conversely, it appears that Concerta does not readily lend itself to conversion to an easily abusable form. Fortunately, in the majority of cases of stimulant drug diversion--an ADHD patient sharing her/his medication with another individual, for example -- the medication is most likely to be taken orally with few if any significant adverse effects. Careful selection of a stimulant therapy, together with close monitoring, can ensure both treatment compliance and minimization of abuse potential. Patients, parents and clinicians should always take appropriate precautions in the storage and handling of these, and all other, medications.

Andrew Adesman, MD, Director Developmental & Behavioral Pediatrics Schneider Children's Hospital New Hyde Park, NY

Q: What can parents do to help their grade school-age daughters with ADHD?

A: Parents need to be educated about this disorder as best they can, and so does the girl. It's important to anticipate problems that might occur, perhaps through role-playing. And it's never too early to discuss the pitfalls of risky behavior, such as substance abuse, smoking and sex. You need to take steps to make sure that things don't go wrong, rather than leaving it up to your daughter. Make sure you get the homework assignments, maybe have them e-mailed to you. If your daughter keeps forgetting her books, get an extra set to keep at home. Work out an organizing system with your child that she can use, with your help. Overall, understand that while it's important for children to be autonomous and responsible, you can't expect a child who is biochemically unable to do that to do it. So you have to protect your child from her own problem.

In the classroom, children with ADHD need not only as much structure as possible, but they also need emotional support from ADHD-sensitive teachers who recognize the significant anxiety and fear of embarrassment these children experience. Helpful teaching strategies are ones that emphasize strengths to counteract the fears kids with ADHD have of "always messing up."

Robert J. Resnick, PhD, ABPP Professor of Psychology Randolph-Macon College Ashland, VA.

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