Q: My nine-year-old son was recently diagnosed with ADHD by a psychologist who gave him an extensive battery of tests including teacher and parent observations. His teachers have been concerned with his short attention span and difficulty focusing in school since the first grade. He’s falling behind in reading and mathematics and I’d like to do whatever I can to help him to stay up with the other children in his class. He goes to tutoring twice a week and that has helped somewhat, but he has difficulty completing his work in the classroom, and getting homework done is quite a battle at our home on a nightly basis. I’ve decided to try medication but have many questions and concerns. The psychologist suggested that I speak with his pediatrician about medication, but I’m thinking that we should be seeing a specialist. What’s the best way to get started on this?
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A: I’m hoping that you’ve considered, before using medication, other common avenues for helping youngsters with attention problems. These would include exploring nutrition, allergy and environmental issues, as well as making sure that your son’s academic environment is appropriate for his needs. In addition, it’s tough to pay attention in school if you haven’t had enough sleep, are worried about personal or family problems or have academic skill deficits that make learning in the classroom difficult. If you’ve dealt with these issues with the psychologist and you feel comfortable that they are not at the basis of the problem, then it may be appropriate to consider medication. But, be an informed consumer and be ready to ask a lot of questions!
Once you’ve made the decision to try medication, I would concur that your pediatrician is an excellent place to start. Most pediatricians routinely deal with medications for ADHD and can effectively answer your questions, describe side effects and help to ascertain which medication might be the most effective for your son. Your pediatrician will want to see the psychological report, so be sure to bring an extra copy with you to the appointment. Better yet, send it ahead of time so that the doctor will have had time to review it before speaking with you and your son.
Since medications for ADHD fall within the categories of stimulant (Amphetamine, Dextroamphetamine, Methylphenidate, Dexmethylphenidate and Methamphetamine) as well as non-stimulant (Atomoxetine) you’ll want to do some research on your own so that you’ll know what questions to ask during your visit with the pediatrician. Your local library will have many good books on the subject, or you can check out the CHADD (Children and Adults with Attention- Deficit/Hyperactivity Disorder) website at www.chadd.org. Coming prepared with a list of questions — how to tell if the medication and dosage are correct, what to look for if the dosage is too high or too low, and information about common side effects are basic questions that pediatricians are well prepared to answer. Many offices will provide you with pamphlets or other reading material to answer frequently asked questions.
Please realize that medications used for ADHD range from short-acting agents (effective for 3 to 4 hours) to intermediate-acting formulations (6 to 8 hours) to long-acting agents (effective for 8 to 12 hours). Also understand that every child is different and that your child’s reaction to a particular medication and dosage level may be very different from how other kids respond. Stay in close touch with the teachers to determine if your son’s focus within the classroom improves and note whether the medication continues to be effective during homework time in the afternoon. Initially many parents stay in close touch with the pediatrician’s office — often providing weekly reports including behavior, mood, focus as well as any side effects that are of concern. Expect a decrease in appetite (especially at lunchtime) and be sure that your son’s daily caloric intake is adequate. You may want to consider nutritional supplement drinks to increase his daily caloric intake if he becomes a picky eater.
Probably the most common problem that I’ve encountered when working with children and ADHD meds is that many parents are not sure whether it’s useful, yet the child remains on the same medication and dosage month after month, without an analysis of effectiveness. It’s imperative that you monitor, with the teacher’s guidance, what benefits your son is deriving from the medication. If it’s not enhancing focus, work completion and skill acquisition, or the side effects become uncomfortable (weight loss, insomnia, mood swings) it’s extremely important that these issues are brought to the attention of your pediatrician. Children should not remain on medication that is not effective, nor should they be losing weight, sleep or their good mood.
I’ve found that some children do not respond to the “typical” ADHD medications and may fare better on alternate substances. A pediatric psychiatrist or pediatric neurologist would be the appropriate person to explore these options.
Medication for ADHD can be very helpful, but it’s imperative that your son is correctly diagnosed, that alternate bases for inattention have been explored and ruled-out, and that academic remediation and/or other therapeutic interventions have been considered before taking this step. Understand what medication can and cannot do for your child and be assertive (but pleasant!) with his physician if you feel that an adjustment is in order.
Dr. Peters is a clinical psychologist and regular contributor to “Today.” For more information you can visit her Web site at www.ruthpeters.com. Copyright ©2006 by Ruth A. Peters, Ph.D. All rights reserved.
PLEASE NOTE: The information in this column should not be construed as providing specific psychological or medical advice, but rather to offer readers information to better understand the lives and health of themselves and their children. It is not intended to provide an alternative to professional treatment or to replace the services of a physician, psychiatrist or psychotherapist.
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