Although many parents are nervous about using medications they should know that medications are by far the most effective treatments for ADHD. They work quickly and often with few side effects. We generally use ‘stimulant’ medications to treat ADHD, these include Vyvanse, Adderall, Concerta, Ritalin, and others. To cut down on costs for the patient we tend to prescribe generic medications. Every child responds differently to these medications and it may take a few months to find the right dose to treat your child’s symptoms. We generally start with very low doses and gradually increase so that the medication works, but without causing too many side effects. For parents who are nervous about stimulant medications there are other options (Strattera, clonidine, guanfacine) but they don’t work as well.
For children who require medication, we usually see them once a month until we find a dose that works for your child. Once we are stable on an effective dose and feel comfortable with the side effects we can space out appointments to once every 3 months.
Once we are on a dose that works we tend to keep patients on the medication for at least 6 months. At the point we, together, can decide whether to continue or to do a trial without medications.
INTRODUCTION TO ADHD:
Attention Deficit/Hyperactivity Disorder (ADHD) is a mental health condition that causes children, teens and adults to become hyperactive (restless, unable to keep still, fidgety), inattentive (difficulty focusing or paying attention), and impulsive (acting without thinking about the consequences of their actions). These symptoms get worse in situations that require lots of concentration (such as taking exams in school).
ADHD is very common. It is seen in about 10% of children both in the United States and 5% of children across the world. The inattentive subtype (ADD) is more common in girls. The hyperactive/impulsive subtype (ADHD) are more common in boys.
Sometimes ADHD can be overdiagnosed because the symptoms of ADHD can look identical to the symptoms of other problems. For example, sleep deprivation, anxiety, depression, and trauma can all have symptoms that look like ADHD. It takes a skilled clinician to distinguish the root cause of a child’s behavior problems. Most of the time a child’s symptoms have more than one cause.
Yes, ADHD can be under diagnosed because many parents and school employees do not believe that ADHD is a real condition, or they assume that the symptoms are caused by poor parenting, poor diet, or something else. As a result, these children wait needlessly for many months, even years before receiving treatment.
There is no blood test or brain scan that can diagnose ADHD. ADHD is diagnosed by a skilled pediatrician, psychologist or psychiatrist who is trained to do so. To diagnose ADHD the pediatrician will need to ask questions (in person and on paper) from adults who spend the most time with the child. Usually this includes parents, grandparents, school teachers and guidance counselors.
In order to make a diagnosis of ADHD the child’s symptoms must:
- Be present before the age of 12
- Interfere with the child’s ability to function
- Be inappropriate for the child’s age
- Be present in more than one setting (e.g. school and home)
The symptoms of ADHD can be broken down into 3 major categories, Hyperactive/Impulsive, Inattentive, and Combined.
- Hyperactive/Impulsive subtype (need to have 6 of these)
- Fidgets / can’t stay still
- Gets up from seat
- Runs around/climbs
- Trouble with leisurely activity
- “On the go”, “driven by a motor”
- Talks excessively
- Blurts out answers
- Trouble taking turns
- Interrupts others
- Inattentive subtype (need to have 6 of these)
- Makes careless mistakes
- Has trouble keeping attention on tasks or play activities
- Does not seem to listen
- Does not follow through on instructions and fails to finish work
- Loses things needed for tasks and activities
- Has trouble organizing activities
- Avoids things that take a lot of mental effort for a long period of time
- Easily distracted
- Forgetful in daily activities
- Combined Subtype
- Has a combination of symptoms from the above categories
We don’t usually diagnose ADHD until age 7 or 8, however in some cases it can be diagnosed earlier.
It is natural for young children to be active and interested in exploring their surroundings. What sets children with ADHD apart is that their levels of these behaviors are more than what would be expected for a child their age AND are negatively affecting their lives (e.g. preventing them from learning in school or doing daily tasks well). ADHD symptoms must be compared to children of the same age. So for example, ALL 2 year old children are hyper, impulsive, and inattentive, but by the time a child is 9 years old you would expect them to have more self control.
We still don’t know what causes ADHD, though it is likely due to a combination of environmental and genetic factors. For example, if one parent has ADHD it is very likely that at least one of their children will also have ADHD. ADHD is NOT caused by bad parenting.
While we do not know what causes ADHD, there are a few factors that can increase the chance that a child will have ADHD, these are:
- Having a relative with ADHD
- Lead poisoning
- Mother using tobacco/drug use during pregnancy
- Low birth weight
ADHD TREATMENT AND SUPPORT
Treatment of ADHD requires a broad approach and support from the entire ‘village’ (parents, friends, family, teachers, medical providers, counselors, etc.).
Sleep- Most children with ADHD do not get enough sleep, and this can make their symptoms much worse. The most common cause of sleep problems are electronic devices being used late at night (like TV’s, cell phones, video games, youtube, netflix, and other streaming devices). The child should sleep in a room that is free of electronic devices. Bedtime should be regular, predictable and strictly enforced. Instead of falling asleep with an electronic device (like TV or netflix) children who have trouble falling asleep should read a book or magazine or participate in a ‘quiet’ activity like writing or coloring. Many children will say that they can’t fall asleep without these devices. Children who fall asleep with electronics are keeping their brains awake all night. Sleep deprivation symptoms look a lot like ADHD symptoms, so it’s important to try to fix the child’s sleep before making a diagnosis of ADHD.
Parent Coaching- Children with ADHD can be MUCH more difficult to manage than children without ADHD. There are special techniques that parents can use to help the child, these can be taught by a trained specialists. In general we advise parents to identify and address the major causes of stress in their own lives. All parents will agree that they are better parents when their stress levels are lower. Parents can be taught techniques to reduce their stressors and their response to stress.
School Accommodations- By law all schools that accept public funding must provide adequate accommodations for children who have a disability (ADHD is legally considered a disability). These accommodations can include having more time to take exams, having an aide in the classroom, etc. Speak with your school guidance counselor about accommodations. We can also provide you with a supportive letter that you can bring to your school. Children who go to schools that are not supportive may benefit from speaking with a representative from the local education law center.
Therapy- many children will respond to support form a skilled therapist. The goal is to help children identify triggers for acting out and teach them how to respond more appropriately in the future.
Environmental modifications and discipline- Children with ADHD require more structure than other children. When disciplining children with ADHD you must make sure not to over-react, or you might say something that you regret. The rewards and consequences for good and bad behavior need to be very clear to the child, this allows them to learn very quickly what to do and what not to do.
Time- In most cases significant aspects of the ADHD will improve with time and with skill building. For example, as children get older (and with therapy) they learn to control their impulses better. In most cases the hyperactivity aspect of ADHD will improve dramatically over time, however the inattentiveness (difficulty focusing) tends to persist into the adult years.
Medications– see below for more information about medication management
Common side effects of stimulant ADHD medications include:
- Reduced appetite
- Trouble falling asleep
- Weight loss
- Abdominal pain
Stimulant medications only stay in your body for one day. So all side effects, if any are gone the next day.
Stimulant medications can increase your heart rate and blood pressure so any child with a severe heart condition or with a strong family history of a heart condition in a parent or sibling would need clearance from a cardiologist before trying stimulant medication.
No, many children with ADHD will not need to take medications at home on weekends or on holidays. Only children with severe symptoms at home will need to take medications on non-school days.
ADHD medications are not addictive and you can choose to stop giving them whenever you’d like. Most children will significantly improve in their ADHD symptoms over time and should eventually be able to live relatively normal lives, without support from medications. Children who receive therapy services generally need less medication and they need it for a shorter amount of time.
You will know the treatment is working if your child’s symptoms, school performance, and ability to function improve after starting the treatment. To assess the effectiveness of medications we look at the 6 F’s of disability: Function, Family, Fitness, Fun, Friends and Future.
Function: Does the child’s ADHD interfere with their ability to accomplish basic tasks, such as performing chores, getting ready for school, studying, behaving in school or doing homework?
Family: Does the child’s ADHD interfere with the child’s ability to develop effective relationships with their family? Does the family enjoy spending time with the ADHD-affected child?
Friends: Does the child’s ADHD interfere with the child’s ability to make and sustain friendships? Does the ADHD-affected child interact well with other children? Do other children want to be around your child?
Fitness: Does the child’s ADHD interfere with their ability to stay physically safe and healthy? Is the child at risk for injury because of their hyperactivity or impulsivity?
Fun: Does the child’s ADHD interfere with their ability to enjoy life? Does the child have good self-esteem?
Future: Does the child’s ADHD interfere with the ability to succeed in school? Does it interfere with their ability to become successful and happy as an adult? Does the ADHD cause the child to make mistakes that could have long term consequences (such as fighting, unprotected sex, dangerous driving, etc)?
A handful of alternative treatments for ADHD exist, including dietary changes and supplements, acupuncture, and homeopathy. The current research does not support alternative therapies, however we will support your decision to try any therapy that is safe. For example, cutting sugar from the diet doesn’t necessarily help ADHD, but it’s a good habit to have anyway!
In young children untreated ADHD has been associated with worse school performance, repeating a grade, poor self-esteem, and poor family relationships. In older children untreated ADHD is associated with higher chance of unprotected sex, car accidents, and other impulsive, risky behaviors.
ADHD has nothing to do with how smart a child is or their IQ. Children with ADHD are just as smart as everyone else, they just have trouble learning in the traditional educational setting. This is why school accommodations are so important.
Yes, absolutely! As your child gets older they will naturally gravitate towards activities and fields where their ADHD traits can be a strength! Some of the most successful professionals in our society have ADHD.
Stress can cause or worsen many medical and behavioral problems, including ADHD. Promoting a calm, predictable environment can help a lot. Decreasing your child’s exposure to screens will also help, this means less TV, Netflix, video games, texting, youtube, etc.
ADHD often appears alongside other behavioral or psychological issues. Among these are tics (noises or movements your child can’t help but make), Obsessive-Compulsive Disorder , Oppositional Defiant Disorder, Anxiety, and Depression. We will screen for these and address them if we identify them.
You can start by explaining to them that every person is different and that is what makes us special. You can then explain that one thing that makes him or her different is that his or her brain has a hard time letting him or her concentrate or sit still (depending on your child’s symptoms). Because of this, he or she may need a little extra help in school and/or at home. This would be a good way to segway into explaining any treatments you and your child’s doctor decide on. Another thing you might want to emphasize is that this diagnosis does not mean your child is dumb, but that it just takes a little more effort for him or her to do certain things and that this is okay. Please note: these are merely suggestions of what to say. The important things are to explain this to your child in a way that he or she will understand based on his or her age and that you remind him or her that he or she is still loved and supported. We can help you with this.
Like explaining this to your child, the amount of detail you give and the way you say things will change based on the age of the person you are talking to and how comfortable you are sharing this information with that person. Like before, the important things to explain are that a diagnosis of ADHD does not make your child any less smart or important than anyone else. We are happy to speak with your family members to explain things to them.
ADHD stimulant medications are controlled substances. They are highly regulated and can only be prescribed by certain types of medical professionals. Because they are so effective at helping children focus they are often abused or sold to other college and high school students who are looking for an advantage in test taking. This is illegal and punishable by law. You should explain to your child that he or she should be the only person taking this medication. If your child is old enough, you might also want to explain that selling or giving away the medication can have negative consequences. If we suspect that a parent or child is misusing or selling their medications we will no longer be able to prescribe them.