Vyvanse For Young Patients–Give ’em a Break???

Anne writes in with a common worry:

I have a 7 year old son that has just received a diagnosis of adhd (combined type). we adopted him when he was 4 years old. our psychiatrist has said that she feels that his severe adhd and pattern of his other behaviours are typical of someone with an underlying brain damage causing the adhd. we had him on dexedrine 10 mg spansules which showed a night and day difference, however it wore off to quickly and was giving him some up and down days. we are just switching to vyvanse and have him on 40 which seems to be working. should i be worried that he is on vyvanse at such a young age and should i consider a point in time when i should give him a break from medication. that does seem a little scary though. any thoughts?

Typical ADHD symptoms can certainly emerge in a patient who has underlying brain damage.  This can be from actual trauma or from “micro-trauma” such as emotional trauma/deprivation or nutritional deprivation that will cause molecular or cellular damage that will not show up on an MRI or CT scan.  ADHD symptoms often run in families and part of your child’s difficulties may just be how he is genetically put together.  In any case, a child who meets criteria for ADHD deserves a try on medication to help get the symptoms under control.  Is it too early to medicate a child who is 7 years old.  Absolutely not.  By the criteria, the symptoms must be present before the age of 7.  Stimulant medicine to treat ADHD are routinely given to patients this age to help address their symptoms.  The medicines listed in your question are essentially the same.  The only difference being the manner of delivery of the dexedrine.  In my experience, Vyvanse is superior in it’s pattern of delivery of the active ingredient.

Looking to the future, should your child be given a break from the medicine?  Yes and no.  It is typical for parents to want to see how their child is off the medicine from time to time.  With the stimulant medication it is easy . . . you just don’t give it for a day or so.  If things are not good, put the child back on the medicine.  Children who are diagnosed with severe ADHD symptoms at this young age typically benefit from medications for years.  About half will grow out of the need for medication, half will not.  This typically does not occur until late teens/early twenties.  The data showing the benefits of treating ADHD symptoms vastly outweigh any potential difficulties with long term use of the stimulant medicine when prescribed in standard safe doses.  I encourage ongoing therapy for your child to help aid emotional development and improve coping skills and social skills.  It should also include some support for you since managing a child with needs like this can be a challenge.  Nutritional supports such as fish-oil, B-Vitamins and Vitamin D are also important over time.

A new tool that I have been using in my practice is the Quotient ADHD Testing System that allows for objective measurement of the core symptoms of ADHD including attention, impulse control and distractibility.  This can help guide treatment by objectively measuring the effect of the medicine and allowing me to determine a clear endpoint to medication titration.  You can get more information about that on my main website and the Quotient website and find a testing center near you if you are interested in that.

–Dan Hartman, MD

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