Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

So, you got your eyesight tested and found out you need your first pair of glasses. Or you found out you need a stronger pair than the ones you have. You put them on and everything looks crystal clear. But after a few weeks things look blurrier without them than they did before your eye test. What’s going on?

Some people start to wear spectacles for the first time and perceive their vision is “bad” when they take their glasses off. They incorrectly interpret this as the glasses making their vision worse. Fear of this might make them less likely to wear their glasses.

But what they are noticing is how much better the world appears through the glasses. They become less tolerant of a blurry world when they remove them.

Here are some other things you might notice about eyesight and wearing glasses.

Lazy eyes?

Some people sense an increasing reliance on glasses and wonder if their eyes have become “lazy”.

Our eyes work in much the same way as an auto-focus camera. A flexible lens inside each eye is controlled by muscles that let us focus on objects in the distance (such as a footy scoreboard) by relaxing the muscle to flatten the lens. When the muscle contracts it makes the lens steeper and more powerful to see things that are much closer to us (such as a text message).

From the age of about 40, the lens in our eye progressively hardens and loses its ability to change shape. Gradually, we lose our capacity to focus on near objects. This is called “presbyopia” and at the moment there are no treatments for this lens hardening.

Optometrists correct this with prescription glasses that take the load of your natural lens. The lenses allow you to see those up-close images clearly by providing extra refractive power.

Once we are used to seeing clearly, our tolerance for blurry vision will be lower and we will reach for the glasses to see well again.

The wrong glasses?

Wearing old glasses, the wrong prescription (or even someone else’s glasses) won’t allow you to see as well as possible for day-to-day tasks. It could also cause eyestrain and headaches.

Incorrectly prescribed or dispensed prescription glasses can lead to vision impairment in children as their visual system is still in development.

But it is more common for kids to develop long-term vision problems as a result of not wearing glasses when they need them.

By the time children are about 10–12 years of age, wearing incorrect spectacles is less likely to cause their eyes to become lazy or damage vision in the long term, but it is likely to result in blurry or uncomfortable vision during daily wear.

Registered optometrists in Australia are trained to assess refractive error (whether the eye focuses light into the retina) as well as the different aspects of ocular function (including how the eyes work together, change focus, move around to see objects). All of these help us see clearly and comfortably.

What about dirty glasses?

Dirty or scratched glasses can give you the impression your vision is worse than it actually is. Just like a window, the dirtier your glasses are, the more difficult it is to see clearly through them. Cleaning glasses regularly with a microfibre lens cloth will help.

While dirty glasses are not commonly associated with eye infections, some research suggests dirty glasses can harbour bacteria with the remote but theoretical potential to cause eye infection.

To ensure best possible vision, people who wear prescription glasses every day should clean their lenses at least every morning and twice a day where required. Cleaning frames with alcohol wipes can reduce bacterial contamination by 96% – but care should be taken as alcohol can damage some frames, depending on what they are made of.

When should I get my eyes checked?

Regular eye exams, starting just before school age, are important for ocular health. Most prescriptions for corrective glasses expire within two years and contact lens prescriptions often expire after a year. So you’ll need an eye check for a new pair every year or so.

Kids with ocular conditions such as progressive myopia (short-sightedness), strabismus (poor eye alignment), or amblyopia (reduced vision in one eye) will need checks at least every year, but likely more often. Likewise, people over 65 or who have known eye conditions, such as glaucoma, will be recommended more frequent checks.

An online prescription estimator is no substitute for a full eye examination. If you have a valid prescription then you can order glasses online, but you miss out on the ability to check the fit of the frame or to have them adjusted properly. This is particularly important for multifocal lenses where even a millimetre or two of misalignment can cause uncomfortable or blurry vision.

Conditions such as diabetes or high blood pressure, can affect the eyes so regular eye checks can also help flag broader health issues. The vast majority of eye conditions can be treated if caught early, highlighting the importance of regular preventative care.

James Andrew Armitage, Professor of Optometry and Course Director, Deakin University and Nick Hockley, Lecturer in Optometric Clinical Skills, Director Deakin Collaborative Eye Care Clinic, Deakin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.