Strattera for ADHD

[tejodouro]

I have a 9 year old child who takes Metadate CD (30 mg per day) for ADHD. One of the side effects that my  child shows is that she bites and pulls her nails. Yesterday, I noticed that you suggested Strattera to another mom for tics.  Our doctor told us also to change to Strattera.  My husband did research on Strattera and came to the conclusion that: (1) The Strattera success rate is not as high as stimulants to control ADHD (2) When there is a side effect with Strattera the risk is much higher of how serious the side effect will be due to the fact that this med impacts the liver and also the lawsuits seem to be much more serious than the lawsuits for stimulants.  My husband  decided that we should not change to Strattera.  My questions: (1) What is your opinion on Strattera for ADHD and how much should a 90 pound child take (2) If we continue with a stimulant, can the tics get worse and is the fact that she has this tic a sign that the stimulant is causing something negative to her body (3) Would you recommend that we change to Strattera. Thank you for your help.

[tejodouro]

Thank you for your input.  I did talk to my child's doctor and she stated that usually she does not think that there is a need for blood work for liver function before starting Strattera, but if I want she will request the appropriate lab papers for testting.
I have another question regarding ADHD.  My child has average IQ tests.  Most of the components of her IQ are actually above average with the memory component in the mid 80 (low / borderline) resulting on an IQ score of average (101). The psychologist that performed her evaluation recommended Cogmed as a program that my improve her memory and therefore help her IQ.  As you know Cogmed is expensive.  I was told that the MIND institude was actually doing a scientific study on how effective this program is.  I was wondering if you have an opinion on Cogmed for improving memory in ADHD children.  What age is optimal for a child to do the Cogmed program (my child is 9)? Summer is coming and I was told that usually it is better to have the child go through the program during the summer vacation. Thank you again for your input.

[Kevin Kennedy, Ph.D.]

Good questions. Yes, if a child is experiencing tics as a side effect of stimulant medication, we almost always suggest a different medication. Since there is no reason to think that another stimulant medication would be any better, Strattera is certainly a sensible alternative. All medications carry the possibility of some side effect(s), and the decision to procedd can be difficult, depending in particulalr on what the possible side effects might be. Hepatotoxicity is possible, though of course not probable, with Strattera, and lab work would be ordered before starting it and during tretament with it. In the 3+ years between January of 2005 and April of 2008, a number (6) of caes of liver illness were reported to the FDA. I would suggest talking with the prescribing clinician and reviewing the options. There are alternatives in addition to Strattera. Relative to the efficacy of Strattera, it is actually performing quite well, and some prescribers are employing it as a front line (vs alternative) tretament for ADHD.