Thursday, January 31, 2013

Ask Dr. Momsie: New ADHD Diagnosis

One of Dr. Momsie's readers recently asked, "My grandson has recently been diagnosed with ADD. Is it normal course to go straight to drugs?"

I'm glad you asked!  It is important to be educated about your options whenever you or your child have been given a new diagnosis.  And, there are many options when it comes to ADHD.  In my experience, it heavily depends on the professional making the diagnosis as to what treatments are recommended.  A family physician or pediatrician may be more likely to prescribe medication immediately, while a psychologist or psychiatrist might recommend behavioral interventions prior to trying medications.  Research shows that a combination of medication and behavioral therapy is most effective in treating ADHD.  Unfortunately, because medication is often seen as a "quick fix" by overwhelmed teachers, parents, and other well-meaning adults involved in the child's life, the idea of behavioral therapy and interventions are often dismissed. 

Before I break down the treatment options, let me talk a little bit about making sure you have a correct diagnosis.  Unfortunately, I have heard many of my clients report that a family physician diagnosed their child with ADHD based on a quick parent report of current symptoms.  This is really poor practice! A good assessment will include a thorough developmental history that details evidence of symptoms at a very young age.  Further, a correct diagnosis will only be given after a clinician gathers information from a variety of settings and reporters (home, school, etc.).  Your doctor should rule out other factors that may be contributing to overactive or inattentive behavior such as grief, depression, trauma, anxiety, or a simple developmental transition.  If your doctor didn't look at all these factors, I might suggest seeking a second opinion.

Okay, that being said, let's assume you have a correct diagnosis.  Let's talk now about treatment options.  Most good clinicians will first suggest behavioral therapy or intervention.  Sometimes ADHD symptoms can be managed in the classroom (or at home) by modifying variables in the environment.  In simple terms, teachers and parents can learn techniques to help kids stay on-task, complete work in a timely manner, limit distractions, and limit motor overactivity.  Children can learn to self-monitor their inattentive and overactive behavior as they grow older, and learn strategies to manage the behaviors on their own.  A good school psychologist can help develop an intervention plan for your child to address your child's specific needs.  Most schools will have a school psychologist, just ask your school counselor or principal.   For those of you itching for a few tips, I'll try to share a few of my favorite strategies within the next couple weeks.

Now, to medication.  Some parents cringe at the idea, while others cheer with excitement.  There certainly are children who respond amazingly well to medication and the immediate results are amazing.  Yet many children need more than one trial of medication before they see adequate results. Dosages need to be monitored and different medications need to be tried.  And, of course, negative side effects are possible.  Many parents are aware of possible side effects, and the idea of weight loss or their child turning into a "zombie" is enough to shy them away from considering medication. 

However, the newest medications for ADHD are known for having less drastic side effects than the stimulants many of us are familiar with (eek! Ritalin!).  With a good doctor and a patient parent willing to try different trials of medications and dosages, a family is likely to find an ADHD medication that works well for their child.  There are so many new options that are proving to be effective - new stimulants that carry less side effects and can last all day such as Concerta, Vyvanse and Focalin; a nonstimulant medication - Strattera- that has been showing amazing results with many children and adolescents, and even a hypertension medication - Intuniv - that is working amazingly well. With all these options, it is SO important that a parent communicates with their physician about side effects, levels of symptoms, and overall acceptability. 

So, dear reader, maybe medication isn't the best first option.  But, if your grandson's parents decide medication is right for them and they are working with a knowledgeable professional, don't worry too much.  We've come a long way since Ritalin.  Encourage (with love) your grandson's parents to consider behavior therapy and to work with their school to implement some strategies in the classroom that might help your grandson be successful.  Most of all, encourage your grandson that he is not his diagnosis - he is more than ADHD!  He can learn strategies to monitor his inattention as he grows older and he can be very successful! The unconditional love of a grandparent can make all the difference.

(For those of you wondering, ADD stands for Attention Deficit Disorder and ADHD stands for Attention Deficit - Hyperactivity Disorder.  If your doctor gives a diagnosis of ADD, your child probably has symptoms of inattention and distractibility without the severe problems with overactivity experienced by children with ADHD. The correct lingo, actually, is ADHD - Hyperactive type - for those just with hyperactive symptoms, ADHD Inattentive type - for those with inattentive symptoms only, or ADHD Combined - for those with symptoms of both.  The distinction is important because different symptomology lends itself to different treatments or interventions).

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