TO MEDICATE OR NOT TO MEDICATE: THAT’S THE QUESTION! – Dr. Leena Deshpande

Dr. Leena Deshpande

Management of Neurodevelopmental disorders in children is largely multidisciplinaryInterventional Programs with Early diagnosis and correct early intervention being a key to better outcome. However, there are certain conditions where medications have an important role in improving outcome.

ADHD is a neurobiological condition which means there is an imbalance in the brain neurotransmitters. This imbalance is the main cause of the core symptoms which we see in achild with ADHDi.e. hyperactivity, attention deficit and impulsivity. Though there is no medication which will cure ADHD, it is logical that any medication which helps improve the balance of brain chemicals will help in improving core symptoms of ADHD.

If core symptoms can be improved the child functions better in school and socially and will achieve better both socially and academically.

Stimulant medications like Methylphenidates are the medication of choice forADHD in children above6 years of age.They have a rapid onset of action and a long record of safety and efficacy.This onset of action of the medication is important to decide the timing of medication in a school going child. The effects are seen usually by 30 to 60 mins and continue for 4 to 8 hours depending on the type of medicine used.After an hour of this medication, though the child visibly calms down, there is no slowing down of brain as is a popular mythand parental concern, in fact it helps slow down purposeless activity and improves concentration.

The common side effects are poor appetite and poor sleep pattern, however with the help of your Doctor tailoring the dose and timing of the medicine to the child’s needs, these side effects are hardly ever concerning. A child with hyperactivity andimpulsivity who has problemswith peer relations may need medication every day, while a child with mainly concentration issues may need it only on school days A child who participates in after-school sports or activities on certain days of the week may require longer-acting preparations or more frequent dosing on those days.

It is important to discuss all these aspects with the doctor so that optimal regimen can be prescribed.

Atomoxetine is another medication useful in ADHD and its action lasts for at least 10 to 12 hours. There are some other medications which can also be used in ADHD after careful consideration of associated issues in the child.

If effective, the medications can be continued for several months to years. After the child has shown stable improvements in symptoms, trial of stopping medication can be done, to determine whether it is still necessary.

Many children with Learning disabilities like dyslexia, dysgraphia and dyscalculia haveADHDas a common occurrence. If management of ADHD symptoms is not done adequately, remedial education alone will not be effective in helping the child.

Management of Autistic spectrum disorder is also mainly Multidisciplinary therapy and behavioural programs based, however some associated symptoms like extreme irritability, repetitive behaviour, self-injurious behaviour, aggressive ness, anxiety, inattention, hyperactivity and other challenging behaviours can be controlled with medications.Thus, appropriate medications can improve the child’s functioning and the ability to participate in behavioral interventions.

Antipsychotics, SSRIs, Stimulants and nonstimulants are different groups of medications which can be used as per the symptoms. It is essential that children with ASD who are receiving pharmacologic therapy for target symptoms must be monitored regularly for efficacy and side effects.

Epilepsy both focal and generalised is a common occurrence in children with developmental disorders and needs to be identified and treated appropriately for learning and attention to proceed as expected.

Sleep disturbances are common and inadequate sleep will worsenbehaviour in any child, moreso in a child with developmental disorder. If usual measures fail, medications can aid improving sleep pattern and consequently behaviour and learning in class.

Many children with neurodevelopmental disorders are fussy eaters. This may be due to many reasons but, in itself leads to avariety of nutritional deficiencies which need to be kept in mind and treated appropriately. Constipation is common and treating this condition significantly helps behaviour issues in some cases.

It is natural that parents will be apprehensive about starting long term medications in their child, however there is a lot of scientific evidence that when used appropriately medications will improve behaviour and subsequent learning in children with Neurodevelopmental disorders. Hence it is crucial to take Paediatrician’s advice and, in some cases, Developmental Paediatrician or PaediatricNeurologist advice and understand if your child will benefit from medications.

Dr. Leena Deshpande: Developmental PediatricianMRCP (London), MD ( Pediatrics), DCH (Gold Medalist)

Dr. Leena Deshpande is a Developmental Pediatrician having experience of more than 20 years working with children with Neurodevelopmental disorders. After working in UK for 10 years she returned back to India and is practicing in Navi Mumbai and Mumbai.She is a faculty for various National Pediatric conferences across the country. She has conducted multiple workshops for parents, teachers, therapists and Doctors. Her main aim is to increase awareness about developmental disorders in children in the community. She has written articles in several newspapers and given talks on TV channels for this purpose.

 

 

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