This great parody of the classic Calvin & Hobbes cartoons highlights the problems and ethical considerations of using medication to treat ADHD.

Many thanks to The Ephemerist for finding this.

Slowly overtime I refined my ideas about how cerebellum training should work and how a independent company without much in the way financial resources could develop and sell such a product in an ethical manner. One main stumbling block has been the cost and availability of the technology necessary to track a user’s limb movements and balance. So I’ve been watching the progress of the Wii and latterly the Wii Fit with interest. The technology needed for cerebellum training was finally cheaply and readily available. What’s more many people already own it.

Originally I intended to make an announcement after slowly develop a proof of concept over the next few months but with the collapse of Dore and the shadow that will cast over the cerebellum training field, I’ve decided to move my plans forward. So I’m pleased to announced the creation of WyyMi, a project to create a free, open-source, open-science cerebellum training program.

What is WyyMi?
WyyMi is a project to develop a cerebellum training program to help people with dyslexia, ADHD, dyspraxia and similar educational problems.

Project Goals
To develop a system that cost nothing (or as close to nothing as possible) to use; to do it using open-source software; and to make freely available as much scientific evidence on its effectiveness as possible.

How Will It Work?
The idea is to use cheap and easily available computer hardware that can monitor and assess gross motor movements and balance. At the moment the Wii Remote and Wii Fit Balance Board seem the best candidates but they need to be adapted to work on PCs and Macs because the Wii console itself is difficult to develop for.

Using this hardware and software on the website, users will be perform a series of exercises. The amount of time spent training and the accuracy of the user’s movement will be logged on the server so that the user can track their progress and so the server can inform the user which exercises to do next. This data will also be aggregated, made anonymous and published so that it can be analyzed by any interested 3rd party. Ideally, symptom specific measures (e.g. spelling tests) will also be included so that the training programs effectiveness in treating educational problems can be measured.

Other than a broad statement of goals and the planned route for achieving them, there is nothing else on site at the moment. Progress is likely to slow, not least because I am working on another project at the moment as well maintaining my existing portfolio of web sites. If you wish to help in anyway, please see the announcement for ways you can contribute, not matter what your skills are.

Myomancy will be continuing to report on anything and everything I think is relevant to dyslexia, ADHD and autism. Obviously as I am planning to create my own training program, that might create a conflict of interest when discussing other people’s approach. I will try and be as unbiased as possible and make my conflict of interest clear.

“Vision changes, such as seeing a blue tinge to objects or having difficulty telling the difference between the colors blue and green.” Also, “An erection that won’t go away”


“Babies born to mothers who have taken [this drug] in the latter half of pregnancy have reported complications, including difficulties with breathing, turning blue, floppiness, stiffness, irritability or constant crying.”

From Mental Floss

Methylphenidate (Ritalin) is widely used both legally and illegally. It apparently causes increased or decreased sexual desire dependent on the dosage. At higher doses, it may aggravate premature ejaculation and impotence and cause anxiety

On ADHD fourms (such as ADD Forums) you often find people taking ADHD medication and talking about sexual dysfunction (such as this thread). It seems to be quite a common problem but because most studies are done on children, it isn’t well documented. See Concerta Side Effects, Ritalin Side Effects and Adderall Side Effects for more information on ADHD medication side effects.

The only work I can find on the issues is The Management of Medication-Induced Sexual Dysfunction [ PDF ] which in turn references Methylphenidate and SSRI-Induced sexual side effects. Unfortunately that study is not available online.

The effects that ADHD medication like Ritalin and Adderall have on sex drive and sexual performance is real and is highly disturbing for those it effects. It is an area where more research it definitely needed.

See Jefferson Scientists Find Evidence Of Greater Sensitivity To Addictive Drugs In Adolescence for a write up of the study or Periadolescent Mice Show Enhanced Delta FosB Upregulation in Response to Cocaine and Amphetamine for the original study.

Drug companies and some charities have invested a lot in selling the idea that ADHD is a purely neurological disorder and that the child’s family life has little to do with it.

This study suggests that this isn’t the case, and that the child’s environment and relationships, in combination with possible genetic and neurological differences, have a significant effect on their behaviour.

Child Ritalin use doubles after divorce

How Vyvanse Works

The active substance in Vyvanse is lisdexamfetamine and is chemically very close to Dexedrine Spansules, a stimulant occasionally prescribed for ADHD. The advantage of lisdexamfetamine over methylphenidate (used in Ritalin and Concerta) is that it has a long lasting effect. Taken in the in the morning, the peak effectiveness last one to four hours but had a notable effect on symptoms for 12 hours.

Traditional ADHD medications have been easy to abuse and this has led to dependency problems. Vyvanse is a prodrug, a substance that is inert until it is digested. This mimics how the body creates useful chemical and vitamins from our food. As Vyvanse only acts as a stimulant once it is broken down by the stomach you cannot get a high from grinding it up and snorting it. Swallowing higher than prescribed doses (150mg compared to the recommend max of 70mg) will still produce a high indistinguishable from that produced by a comparable dose of Ritalin.

Vyvanse: Four Times More Side Effects

Because Vyvanse is new it has only been used by those adults and children who took part in the drug’s trials. In total, less than 1000 people. With such a small sample (compared to the millions who will end up taking the drug) there is very little first hand knowledge of the drugs effects. With each of the other major drugs, Ritalin, Adderall etc, different people can have very different reactions to the drugs. Someone who is fine on one drug may have numerous side effects from a chemically very similar drug. The body and brain are very complex chemical systems and stimulants are a very crude tool.

Currently we only have the Vyvanse prescribing information to go on as a guide to its effects but one things is very noticeable. In trials 10% of users stopped taking the drug due to adverse effects (i.e. side effects). This is much higher than Adderall where only 2.4% of participants were effected. In the Adderall trials more people stopped using the placebo than the real drug but for Vyvanse only 1% of placebo users dropped out. The new drug has a side effect rate 10 times higher than the base line and four times high than Adderall.

Vyvanse And The $1.5 Billion Goal

Shire PLC are introducing this new drug as a replacement for Adderall XR whose patent is running out. They hope to capture 50% of the market share with the drug and as the market is worth $3 billion, a 50% share will generate a lot of money. Expect to see a lot of advertising aimed at parents, not doctors, when Vyvanse is launched in July. In theory Vyvanse is a lot cheaper to make than competing drugs as its chemical formula is its key rather than the complex release mechanisms used by others drugs. However I expect that Vyvanse will retail at about the same as the other ADHD medications at about $130 – $150 for a months dose.

The new drug has been formulated to provide both the long-lasting effects of Adderall XR and to minimise the potential for abuse. ADHD medication are strong stimulants and can be open to abuse both by those it prescribed to and by those who acquire it illegally.

Shire Press Release: VYVANSE™ Receives Final DEA Schedule Classification, Clearing Way For Launch Of First Prodrug Stimulant For ADHD Treatment

What you need to know about ADHD Medications – their effects, costs, side effects and alternatives

What ADHD Medications are Available?

There are three main ADHD Medications: Ritalin (the original ADHD medication), Adderall and Concerta. Each has its own advantages. Ritalin is the oldest, the simplest chemical formulation, and the cheapest because it can be purchased as a generic medicine. Made up of methylphenidate, it is taken two or three times a day. Having been used since the 1960s as medication for ADHD its effectiveness is well documented.

Concerta like Ritalin uses methylphenidate as its active ingredient. Unlike Ritalin and other ADHD medications at the time, it was specially designed to provide a steady stream of medication through-out the day. Allowing parents to give their child one tablet in the morning before school and the medication will be effective all through the school day and into the evening. Concerta does this by placing the medication in a very cleverly design tablet which includes a laser drilled hole that allows the methylphenidate to slowly seep out.

Adderall is unlike the other ADHD medications because it uses a mix of different forms of stimulants. In theory this gives a smoother trip up to and down from the medication’s peak effectiveness. This avoids sudden peaks and troughs in the child’s attention span and energy levels. Adderall XR is a variant on standard Adderall designed to give a whole day’s supply in a single tablet, similar to the Concerta tablet.

With the introduction of Concerta and then Adderall XR, most users of ADHD medications switched to extended release formulas. To combat this loss of sales, Ritalin introduced two versions, Ritalin LA and Ritalin SR. For more information see Adderall XR and Slow Release ADHD Medications.

What Effect do ADHD Medications Have?

ADHD medications are stimulants and have a similar effect to caffeine, nicotine and street drugs such as cocaine and speed. They stimulate the activity of central nervous system which increases energy levels and helps maintain concentration. How exactly this helps with ADHD is unknown. On the patient information sheets of the ADHD medications you will find the drug companies explicitly saying they do not know how their drugs work.

Current ADHD medications treat the symptoms of ADHD and not the underlying causes. When testing the drugs, patients were measured by teachers and parents on various behaviour scales. Typically these reported increases in concentration, a reduction in hyperactivity and a general improvement in behavior. For a parent’s first hand account on the effects of medication see this video: Lil’ Renetto… talking about ADHD… and making videos….

Side-Effects of ADHD Medication

No medicine is free of side effect and ADHD medications are no different. As they are stimulants their effects are very similar to drinking too much coffee. The most the common side effect is insomnia with loss of appetite and stomach upsets being close seconds. About 20 – 30% of mediation users will have one or more side effects. These are very minor but can cause further problems and lead to the use of sleeping tablets or appetite enhancers to combat the effects of the ADHD medication.

Unfortunately there are more serious side effects. A lot less is known about these because the drug companies do not run long term trials prior to their ADHD medication getting approval from the FDA. The longest trial run by a drug company is four weeks. This is for a tablet that is routinely used for months and years at a time.

Others have researched the long term impact of ADHD medications and found some worrying effects. Up to 9% of users over a 27 month period developed facial tics. Children with who took the medications for more then 12 months were found to grow 2cm less than their non-drug using peers. There is also concern that the constant stimulation of the central nervous system will train or acclimatize it high levels of stimulation. This may impact in adulthood and result in great use of illegal drug such as cocaine and other high risk behavior.

For more infromation on ADHD medication side effects, see: Adderall Side Effects; Concerta Side Effects; Ritalin Side Effects; and Ritalin and Cocaine Addiction.

The Cost of ADHD Medications

If your insurance or health care system doesn’t cover you for the price of your ADHD medications, treatment can get very expensive. For a month’s supply, the price of the drugs range from $26 for a generic versions of Ritalin up to $150 for Concerta and Adderal XR. The prices of the timed release versions of the drugs (Adderall XR, Ritalin LA or Ritalin-SR) are about twice the price of the normal versions. The reason for this is simple. The standard versions can be made by generic drug companies because the patents have run out. Where as the timed released version have several more years to run on the patent and so the drug companies can charge what they like for them.

When considering ADHD medication, its worth remembering this is a not a simple course of antibiotics. These a drugs that will be taken for months, if not years, because when you stop taking them the symptoms will return. Consequently the costs will added up, month after month, year after year.

If you are tempted by offers of cheap ADHD medication from online or foreign pharmacies then read this: Want No Prescription Adderall? – Read This Now!.

Alternatives to ADHD Medications

If you are not keen on everyday, giving your child a drug that can have serious short and long term side effects but doesn’t actually treat the problem then you need to consider the alternatives to ADHD medication. There are two problems with the alternatives to medication. Firstly, unlike the drug companies, the alternatives do not have hundreds of millions of dollars to spend marketing their products. Secondly, the alternatives take many months to have an effect. ADHD medication have an effect on the symptoms almost instantly. Tackling the underlying cause takes a lot longer.

Probably the best known and most widely available treatment is the Dore Programme of cerebellum exercises. These simple exercise are done everyday for a year or more and train up specific parts of the brain related to coordination, movement and self-control. It is an approach that has many critics but also many customers who have found them to work.

Another movement based approach is Interactive Metronome. This teaches the child a sense of rhythm, timing and control. There has been some very good research on how effective this can be as an alternative to ADHD medications.

A third movement based approach to ADHD is INPP’s primitive reflex training. Similar to Dore in some ways, this approach focuses on primitive reflexes that in normal children develop before they are 18 months. The INPP hypothesis is that in children with ADHD the reflexes are retained or not fully developed. Two books related to this are Stopping ADHD and Infinity Walk.

There are various herbal remedies that claim to be alternatives to ADHD medications. The science behind these is very weak but some people claim they work. See ADHD Natural Remedies Part 1, Part 2 and Part 3. Omega 3 fish oil supplements have also been promoted as an ADHD treatment. See ADHD and Omega Fish Oils for more information.