Monday, August 1, 2011

On Call with Dr. Lona Yegen, Pedimedica, Closter Office

Understanding ADD and ADHD and their treatment options from a medical and behavioral approach.

Q.What is ADD and ADHD?
A. Attention Deficit (Hyperactivity) Disorder is a condition in which the child has the following symptoms that may or not be accompanied by hyperactivity:
1. Difficulty in paying attention and focusing.
2. Difficulty with impulsivity.
3. A lack of organizational skills.

Q.How do we diagnose ADD?
A.This is a clinical diagnosis.  It is usually diagnosed after a child enters school and because he/she is having difficulties there.  A child should have a complete physical exam with a Pediatrician to confirm that there are no medical problems that could be causing these symptoms including testing a child's vision and hearing.  There should be an evaluation by the child's' teachers and parents using guidelines to evaluate behavior. The child may be evaluated by a Neurologist, developmental Pediatrician, or a Psychiatrist to make certain the child fits the categories for ADD/ADHD and make sure there are no other concerns e.g. learning disabilities.

Q.How do we treat ADD/ADHD?
A.The medical therapies fall into three categories:
1. Stimulant medication e.g. Ritalin, Concerta, Focalin, Daytrana
2. Non stimulant medication e.g. Straterra
3. Anti-depressants e.g. Wellbutrin
Stimulant medications are the most commonly used medications.  There are side effects to all three classes of medication.  For example, stimulant medications can suppress appetite and growth and can cause difficulty with falling asleep. Therefore, they must be used with supervision by a medical professional to make sure they are well tolerated. The medical therapies will be managed by your pediatrician, neurologist, or psychologist so let us talks about behavioral therapies.

Behavioral therapies are multiple.
1. In managing behaviors there are technologies to improve memory and focus.  For example, while riding in a car, tell the child you are going to play a game.  You are going to name three things and you are going to ask the child to name them later. So, at the beginning of the ride, name three items, e.g. ice cream, bicycle, mountain and at the end of the ride, ask the child to list them.  If the child can name three things consistently, then go to five things.  There is also a board game called Memory which works on the same skills.
2. We also want to teach the child organizational skills.  Organizational skills can start at the beginning of the day.  Ask the child to list “what do I need for the day in school?” and make a check list of all items and assemble books, assignments, clothes e.g. gym clothes, lunch so that he/she is ready for the day.  If the morning is too hectic this can be done at night.  Organizational skills should be done throughout the day.  Give the child a notepad so he/she can write down assignments and a check list for all books so the child is prepared when he/she gets home.  Organizational skill should continue after school.Teach the child to make a schedule for what homework and chores need to be done that day and allot specific times for each subject and task with scheduled breaks for sports, play dates, and hobbies like music lessons.
3. School strategies include placing the child with ADD/ADHD in the front of the class so it is easier to focus on the teacher.  Also, the teacher and child can have a special signal that they choose to remind the child to stay on task.  For example, the teacher can raise her right thumb up as a sign so the child needs to look and listen to her.  No one else will know this special signal.
4. Homework should be done in a quiet place without distractions.
5. Goal setting should be clear and concise.  When a goal or assignment is completed there should be verbal rewards or approval with extra time for a pleasurable activity.
6. There are Psychologists and social skills courses for children who need help with their behavior or relationships.
Q.When should we use medication?
A.Consider the following indicators:
  • When all the behavioral and psychological therapies are not working.
  • When the child's school performance is below expectations due to his/her inability to concentrate on set skills.
  • When the child is not able to control impulsive behaviors leading to relationship problems or when the child is disruptive to others in class.
  • When there are concerns that poor academic performance is leading to low self esteem.
Q.When should we not use medication?
A.Consider the following indicators:
  • The child is doing well academically in school.
  • The child's behavior is not disruptive in class.
  • The child's peer and family relationships are good.
  • When the parents are concerned about long term use of medication.