Differential Diagnosis: ADHD or Akathisia as a Side Effect of Reglan?

Reader’s Question

My son was on Reglan for 13 months as an infant. Has seen two counselors. One counselor says he is definitely not ADD/ADHD, and the other counselor says he definitely has ADHD. I’m aware that a possible side effect of long-term Reglan use may be akathisia. Could this be confused with ADHD? My son reads slightly above grade level and seems to have no problems academically. Thank you for your time.

Our Clinical Psychologist’s Reply

Reglan is a drug that is typically used for a short term (less than 3 months) to treat some of the symptoms of gastroesophageal reflux disease (GERD), although it can be used to treat other conditions, and there may be unusual circumstances that require consideration for longer than typical length of treatment.

Akathisia is an inner feeling of restlessness accompanied by an inability to keep still. Akathisia sufferers will engage in behaviors like frequent foot-tapping, inability to remain seated, anxiety, jittery feelings, etc. Research data indicates that one cluster of possible side effects of Reglan use includes restlessness, agitation, jittery feelings, and trouble remaining still. These symptoms of course are very similar to the some of the cardinal symptoms of ADHD, and therefore making a differential diagnosis is often difficult. To make an accurate diagnosis, the clinician needs to be aware not only of the complete behavioral and medical history, but of all the possible or likely reasons for the manifestation of symptoms.

Generally speaking, the most central aspect of ADD is the inability to focus well enough to process information. ADD need not be accompanied by deficient impulse control and hyperactivity, but it often is. If your child is able to focus well enough to do well in school despite not being treated for an attentional deficiency, yet is still having problems being still, it is definitely possible he’s experiencing akathisia. Of course, there’s no way to really determine this remotely, so it’s important that he be soundly medically evaluated. Some of the side effects of Reglan have been known to occur not only after prolonged use but also upon withdrawal. By far the greatest concern about the long-term use of Reglan involves the possibility of developing muscle movement disorders such as jerky, involuntary movements and tremors that resemble Parkinson’s Disease or a much more serious movement disorder called Tardive Dyskinesia, which is characterized by repetitive, involuntary and rapid movements that seem purposeless, such as grimacing, lip smacking, rapid eye blinks, etc.

Not all counselors have the background or training to make an accurate or definitive differential diagnosis, especially when certain medical complications can so effectively mimic other mental health syndromes. It’s best to have the evaluation done by a professional or team of professionals with a broad enough background to faithfully consider all the facts before making a definitive call.