ADHD in Children NAMI Pa-Main Line September 7 2013

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
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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,
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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