Simon Currigan: 0:44

Look. The truth is deciding whether to medicate your child for ADHD is hard for any parent. How can you be sure it's the right call? This week on the School Behaviour Secrets podcast, we tackle this critical question with developmental pediatrician and author, Dr Walt Karniski. Don't miss this insightful conversation that could help you make a more informed choice for your child and your students' well-being as we sweep aside the myths and misconceptions around medication and ADHD. Welcome to the School Behaviour Secrets podcast. I'm your host, Simon Currigan. My co host is Emma Shackleton, and we're obsessed with helping teachers, school leaders, whole school strategy, and more, all with the aim of helping your students whole school strategy, and more, all with the aim of helping your students reach their true potential. Plus, we'll be letting you eavesdrop on our conversations with thought leaders from around the world. So you'll get to hear the latest evidence based strategies before anyone else. This is the School Behaviour Secrets podcast. And this is one thing I that tallies with my experience of working with lots and lots of kids with ADHD is they often engage in behaviours in the moment and then really regret it afterwards. And they almost get into a shame spiral sometimes about their behaviour in school because it's something that's kind of beyond their control.

Dr. Walt Karniski: 2:14

Exactly. It is beyond their control, and yet they're continued able to do all of the functions that you would expect them to do. They can listen and attend and focus on something as highly interesting like a video game. And parents say, well, that's a sign that this is not medically related because they can focus on the video game. But the video game is giving them constant feedback or the book that they have in front of them is just sitting there waiting for them to process the information. It takes a different way of thinking. The other thing I should mention is that how the brain communicates is by sending messages from one nerve cell to another. And at the end of those nerve cells are chemicals called neurotransmitters. And there are 2 neurotransmitters in the three areas of the brain that we talked about that predominant, norepinephrine and dopamine. And it's been found in the children with ADHD, those areas of the brain have a decreased activity of those two substances. Now they don't have the same amount. They don't seem to be working as well. The medications that are used today look almost exactly like those 2 neurotransmitters that are normally functioning in the brain. So when you take the medication, all that is happening is that that area of the brain is getting an increase in those chemical substances back to the level that you would expect them to occur so that the child can focus and attend. These medications are not suppressing a child. They're not sedating a child. They're not changing the brain activity. As a matter of fact, what they're really doing is bringing the brain back to a more average, normal functioning state. Medication doesn't teach a child anything, but it gives the child the ability to learn from normal teaching methods.

Simon Currigan: 3:59

And if you're listening in the UK, I think you used the term epinephrine now. I think we use adrenaline and I think norepinephrine. We call that noradrenaline in the UK.

Dr. Walt Karniski: 4:06

There's actually about 200 different neurotransmitters in the brain. And the way that medication affects just certain functions in the brain is by targeting certain neurotransmitter. So we know that those 2 neurotransmitters are dysfunctional in the brain. And when medication corrects it, it only only changes the activity of those 2 neurotransmitters, not the other 199. As a result, you can use the medication to focus on just specific brain activity.

Simon Currigan: 4:38

So you've touched on this already. You've you've talked about sedatives and I think there is sort of popular belief out there that medications are for ADHD are like sedatives and sometimes parents talk about their kids, you know, becoming like zombies. But you've touched on that that's not the truth. So what are these substances that are used to, medicate ADHD?

Dr. Walt Karniski: 4:55

When we treat children with ADHD with medication, we have 2 major choices of medication, either the stimulants or the non stimulants. The stimulants are more effective than the non stimulants. They're highly effective in treating the symptoms of ADHD, whereas the non stimulants are moderately effective. The difference is that all of the side effects that occur with the stimulants, and we we can go into what those side effects are, are minimized by the non stimulants. So if a child develops significant side effects on a stimulant, then we can switch to a non stimulant to minimize the side effects. If we go back to the stimulants versus the nonstimulants, there are two main stimulants, methylphenidate and amphetamine. Methylphenidate is the main ingredient in Ritalin, Concerta, Medidate, and a number of different medications. Amphetamine is the main medication involved in Adderall, Vyvanse, and many other medications as well.

Simon Currigan: 5:52

When you say amphetamine, to me as a layperson, a nonmedical person, the first thing I'm thinking of is street drugs.

Dr. Walt Karniski: 5:59

Well, street drugs are similar in structure to these medications. They do work on the brain. But what you call speed, amphetamine on the street is really metamphetamine, which is a different chemical substance. And, yes, it shares the same basic molecular structure, but it has something to added on to it and change the activity of those neurotransmitters in the brain. So they're not acting in a normal way. So amphetamines that are used in treating ADHD are bringing the brain back to an average type of neural functioning, where if somebody who takes a a street drug are getting an enhanced effect on pleasure areas, the brain, and so on. And of course, that leads to addiction and other problems. These medications are not addictive. They do not give highs. As a matter of fact, one of the biggest problems I have in treating adolescents with ADHD is keeping them on their medication. The medications we're giving them a high, they would be glad to take it. In reality, when they're on their medication, they just feel normal.

Simon Currigan: 7:00

So these are safe, researched chemicals that don't have sort of adverse impacts on the brain? We're not putting anything particularly foreign to the body, and side effects can be well managed?

Dr. Walt Karniski: 7:11

Yes. There's actually no serious long term side effects of these medications. All of the side effects that do occur occur while the medications in the body. So for instance, Ritalin only lasts about 3 and a half hours. So if there are side effects to Ritalin, it's gonna occur during those 3 and a half hours. And once the Ritalin has worn off, it no longer has a positive effect and no longer has a side effect either. So there are no long term side effects. Let me give you an example of I had a mother child who I diagnosed with ADHD. He was about 9 or 10 years of age, and, we started him on medication. Mother brought him back in 2 weeks for the 1st follow-up visit. And I asked her, well, how are the things going? And she said, well, the teacher thinks that he is doing fabulous. He's focusing better in school. He's not hitting other children. He's learning better. His grades have improved better. But at home, I said, well, that sounds great. What's the problem? And she said, well, at home, he's depressed. Oh, really? What why do you think he's depressed? And she said, well, he comes home from school every day. He goes to his room. He opens up a book and he reads for 2 hours. And I said, yes. And what's wrong with that? And she said, well, he's never been that way before. He's usually running around the house, pulling the cat's tail, knocking over the lamp, yelling at me, running out the door when he's not supposed to be. Now he's just sitting. And I said to her, I said, if he had been born that way, would you have been concerned? She looked at me like I was crazy. She said, well, of course not. I said, then what you're seeing when your child is on medication is what he would have been like if he had been born with ADHD. And so the fact that he sits and reads for 2 hours is not an abnormality. It's not a sign of pressure. It's a sign of that the medication is working and doing what it's supposed to be doing.

Simon Currigan: 9:02

Just how effective are these medications in general? That's one sort of anecdotal story. But when we look at the statistics, what's the impact kind of on a wider scale when we look at 100 or 1000 of children?

Dr. Walt Karniski: 9:11

Okay. Well, first place I should mention that for every year for the last 20 years, there have been approximately 350 research studies published in the world concerning these medications. Most of those studies are looking at the effect of the medication on children's behaviour. And those 350 studies overwhelmingly show every year that the medications are safe and effective. So that's the first thing that's important. The second thing that's important to remember is what happens if you do not treat somebody with ADHD. And I could probably spend the next hour talking about some of the problems that occurred. But in just about every area, adults with ADHD who were not treated with medication as children have more likely to be in a car accident. They're more likely to have been fired from a job. They're more likely to have been arrested. They're more likely to have gone bankrupt. They're more likely to have abused drugs. They're more likely to smoke or drink excessively. And the amazing thing is that in the studies that have looked at the differences in adults is that those adults that were treated with medication have about the same problems in those areas as people who don't have ADHD.

Simon Currigan: 10:29

So, obviously, that was just a small section of my interview with doctor Walt Karniski. If you'd like to know more about how ADHD affects the brain, the outcomes of research projects into the effects of ADHD medication, or more key questions you should consider before deciding to use medication, then click the link at the bottom of the episode description to head back to the full interview. I definitely recommend you do. It's well worth a listen. Thanks for joining us for another enlightening episode of School Behaviour Secrets. Your feedback fuels our journey and helps us grow. So please take a moment to rate and review us. It only takes 30 seconds, but it means the world to us. It lets us know how we're doing, and, also, it helps prompt the algorithm to share School Behaviour Secrets with other podcast listeners. Thanks for listening today and I'll see you next time on School Behaviour Secrets.