Predominantly Inattentive ADHD Response to Treatment 'Hauntingly' Similar to Normal Child Response

A few years ago I read a quote by Dr. Russellactivity and response times that are probably not
Barkley PhD, an ADHD expert that really got mybeneficial to their overall learning.
attention. This quote, from one of his papers writtenChildren with Predominantly Inattentive ADHD are
in 1996 motivated me to learn more about howmostly normally active or somewhat sluggish. When
stimulant therapy affected children withmy son took Ritalin for several months last year his
Predominantly Inattentive ADHD (ADHD-PI). Barkley'steachers reported that he acted like a zombie. He
quote was this: "Stimulants may not be thewould pay attention but he was totally 'frozen'. My
medications of choice for the PI type of ADHD; theirson reported that the Ritalin made him 'sad'. His
response is hauntingly familiar to that seen in normalteachers asked us to lower his dose. He was on
children placed on stimulants."10mg of Ritalin and we dropped the dose to 5mg.
So what is the response to stimulants of 'normal'That dose still made him a bit sad but his teachers
children that haunted Dr. Barkley? Dr. JL Rapoportsaid that he was more active. He had started drinking
studied the answer to that question. I am not surecoffee on the weekends and we decided to give him
that you could do these studies today but I guessa trial of coffee every morning instead of the Ritalin.
they were allowed in the 70s. It turns out that Dr.He has been on that regimen since this school year
Rapoport gave 14 boys who were about 11 yearsstarted. He is less sad and more involved in the
old amphetamines at a dose of.5mg per kg. Thisclassroom but he is also a bit less focused than when
amount corresponds to about 20 mg of Adderall forhe was on the Ritalin. For now we have made the
the average 90 pound 11 year old. What Dr.decision to stick with the caffeine and see how it
Rapoport found was that these boys developed agoes.
marked decrease in motor activity, a markedInterestingly, Dr. Rapoport also looked at coffee and
decrease in response time, and improved cognitiveits response in 'normal' boys. He found that caffeine
performance after being treated with the stimulant.was similar to amphetamine in that it increased
He concluded that the effects of the amphetaminevigilance and decreased reaction time but unlike the
on ADHD children was not 'paradoxical' at all but thatamphetamine, caffeine increased motor activity. Dr.
it was, in fact, exactly what you would expect if youRapoport concluded, "Separate biological systems
gave amphetamines to any child.may be differentially affected by these two
Amphetamines do have a paradoxical effect onsubstances."
children when their response to stimulants isOther studies have shown that caffeine increases
compared to the adult response to stimulants. Dr.both focus and activity in children. It would seem
Rapoport found, in a different study, that if you givecounterproductive and unnecessary to give children
stimulants to adults, the adults feel euphoric. Childrenwithout hyperactivity a treatment that would
do not feet euphoric. Children reported feelingdecrease motor activity. It is irresponsible to give
different or tired.children who are sluggish a medication that would
If you have a child with ADHD who is hyperactive,further decrease their activity.
impulsive, and inattentive, clearly a medicine thatCaffeine may be a better choice for some children
reduces reaction time and motor activity andwith Predominantly Inattentive ADHD. If a stimulant is
increases cognitive performance is going to addressused, care must be taken to use a low enough dose
this child's ADHD symptoms. But what happens whenso that the activity levels of children with
you have an inattentive child that is neitherPredominantly Inattentive ADHD are not adversely
hyperactive nor impulsive and you give that child aaffected.
stimulant? Those children will develop decreases in