ADHD in Children NAMI Pa-Main Line September 7 2013 AITA SUSI MD AITASUSIMD.COM 610 308 8454 History Diagnosis  Need 6 criteria in 2 different settings Ex. School and home  Onset before age 7  Evidence of problems in daily living  2 basic varieties: inattentive and hyperactive  Many ways to diagnose Who How Inattentive Difficulties with details follow through organization distractions remembering sustained attention listening loosing things boring tasks Hyperactive  Difficulties with fidgeting climbing excessive talking interrupting “on the go” all the time staying in your seat quiet play taking turns blurting out answers Over diagnosis  Normal childhood behavior is diagnosed as illness  Behavioral problems are diagnosed as illness  Other conditions the can look like ADHD are misdiagnosed as ADHD (anxiety, depression, mania)  Provider inexperience Under diagnosis  “That’s just the way she is”  Daydreaming doesn’t catch attention  Chaos in the household due to parental or sibling mental illness, divorce, or other difficulties can pull attention away from a child with ADHD  Shame  Provider inexperience Multiple diagnoses Difficult aspects of ADHD  Excessive talking  Disturbs others (can’t sit still, hits)  Inappropriate comments  Doesn’t listen  Lose things  Homework difficulties  1-2 yrs delayed socially because don’t know how to read social cues  Engage in risky, impulsive behaviors  Risk of MJ and alcohol use if ADHD is untreated Parental stress  Managing calls from the school about behavioral      problems Handling homework that takes a very long time to complete Books, papers, hats, etc get lost Needing to repeat yourself Difficulties with social interactions What if the parent has ADD too? Take-home message: Be patient Positive aspects of ADHD  Creativity  Smart  Spontaneous  Works quickly  Good at problem solving  Emotional sensitivity  Exuberance Some famous people with ADHD  Robin Williams  Leonardo da Vinci  Walt Disney  Albert Einstein  John Lennon  Galileo  Russell White  Henry Winkler  Greg Louganis  Henry Ford  Thomas Edison  Jason Kidd  Dustin Hoffman  Dwight D. Eisenhower  Michael Phelps  Salvadore Dali Myths vs facts  Caused by poor parenting  Biological and often genetic  If 1 child has it, all of my children will  Not all children in a family will have it  ADHD is not a disability  ADHD is recognized as a disability by ADA and IDEA  Medication is the only treatment  There are several treatment options  Kids with ADHD want to behave badly  Kids with ADHD cannot be consistent in their behaviors The ADHD brain ADHD treatment  Get the ADHD brain “on line” with medications that stimulate the brain  Provide behavioral modifications via rewards that stimulate the brain  Teach family members and teachers how to work with an ADHD brain to get the best results possible Take-home message: The ADHD brain needs to be stimulated MTA study  14-month study with 500+ children ages 7-10  4 groups of children - Medication - Behavioral therapy - Combo - Usual community care (2/3 received some meds)  All 4 groups had a reduction of ADHD symptoms  Significantly greater improvement in the medication and combo groups with those in the medication group doing a little bit better Take-home message: Medication is the best MTA follow-up  2 yrs after the end of the study  Symptoms remained better than baseline in all groups  There were no differences in symptoms between any of the groups Take-home message: It doesn’t matter what you do, but do something Risks of not treating  Poor academic performance  Low self-esteem  Less emotional stability  Less success in the future  Physical injury  Higher rates of substance abuse Take-home message: Less chances of living to their full potential Medications  Short acting and long acting  2 basic types  Amphetamines (ex. Vyvance, Adderall)  Methylphenidate (ex. Conterta, Methadate)  Used less often  Atomoxetine (Stratera)  Alpha agonists (Clonidine, Guanfacine) Behavior modifications  Behavior breaks down when the demand placed on a person exceeds their ability to complete the task  Want your child to develop skills to master life  Learned helplessness can be the result of not taking the time to teach a child how to master life with an ADHD brain Take-home message: Pills don’t teach skills What you as a parent can do  Pick 2 or 3 key areas to address  Discuss these with your child and set clear boundaries with clear consequences  Remain neutral when there are violations and simply institute the agreed upon consequences  Maintain a loving relationship with your child Take-home message: Clear consequences delivered with neutrality Tips and ideas  Use a timer  1 instruction at a time  Frequent praise (ratio of 3:1 at least)  Charts to check off items  Rewards to stimulate the brain  Provide choices  Give reminders and support Take-home message: Be creative, be patient Other points to keep in mind  All looks normal on the outside - inside there are things going on/not going on that we can't see  Keep your cool. When there's a problem - no raised voices, no pointing  ADHD kids are very needy. Recognize that & adjust to it but don’t judge  Get help for yourself when you need it Take-home message: Be patient and stay calm, remember your love for your child Resources - Books  Raising Boys With ADHD: Secrets for Parenting Healthy,     Happy Sons by Mary Anne Richey and James Forgan The ADHD Workbook for Teens: Activities to Help You Gain Motivation and Confidence (Instant Help Book for Teens) by Lara Honos-Webb The Survival Guide for Kids with ADD or ADHD by John F. Taylor Ph.D. Taking Charge of ADHD: A Complete Authoritative Guide for Parents by R. Barkley 1-2-3 Magic Effective Discipline for Children 2-12 by Thomas W. Phelan, Ph.D. Resources – Web sites  Children and Adults with ADHD www.chadd.org/  Jim Forgan Ph.D. http://jimforgan.com/  A magazine with tips for parents http://www.additudemag.com/ Further questions? Feel free to contact me Aita Susi MD [email protected] 610-308-8454