Expert Q & A: ADHD

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Expert Q & A: ADHD

My son's teacher keeps sending notes home about his behavior at school and I don't understand the problem. He is fine with me, maybe a handful for his mother and his grandparents. Should I ask for them to change his teacher, or is there a problem?

You are fortunate to have good management skills that help you with your child's behavior. Parents often get confusing reports about their children, and there are many factors that need to be considered. A good starting point is a meeting with your child's teacher and school guidance counselor. Ask for another observation of your child in the classroom. If the problems continue, there are behavior rating scales that help to clarify the problem behaviors. The Vanderbilt Assessment Scales used for diagnosing ADHD are readily available and the standard in many communities. Your child’s doctor may be comfortable with the next steps in the evaluation or you might look for a mental health professional, such as a child and adolescent psychiatrist, to continue the evaluation process.

Are there side effects with ADHD medications that we should be worried about with children? What about adults taking ADHD medications long-term?

Like all medications there are important side effects that should be considered if a decision is made to try medications for treatment of ADHD. The most serious side effects involve the heart, primarily in children who have known heart problems. More common side effects are lack of appetite, sleep problems and moodiness. Usually these side effects can be managed with adjustments in the dosage, timing of dose or changing to another medication. Your child’s treatment will involve regular follow-up visits to monitor for any of these problems.

Most children with ADHD will continue having problems with concentration and focus during adolescence and adulthood. Research has confirmed that medications continue to be effective into adulthood. While there are few studies looking at very long-term effects it appears that the long- term benefit outweighs the risks.

My 17-year-old son with ADHD does not want to take his medication anymore. Should I continue to try to get him to take the medication?

Adolescents with almost any medical condition will insist that they can manage their treatment. “I would rather do it myself.” Fortunately, in most cases the physician has anticipated this and steps have been taken early to help your child learn about his condition, identify target symptoms that improve with treatment and encourage open discussion about side effects. Trials off medication are welcomed. Explore your son’s reasons for wanting to be off medication. It may be a side effect that he has not discussed with his doctor. Identify the likely changes that are expected during a trial off medication. Your son might be willing to identify a neutral observer (a favorite teacher, a coach) who can help monitor for problem issues. Their observations may feel less “parental.”

Are there non-medication ADHD treatments that are effective?

There are many steps that a family can take short of medication. Usually these involve close attention to a problem behavior and developing a strategy (not punishment) that might change the behavior. Some are straight forward – tighter routines in the morning while getting ready for school, close monitoring of homework assignments and school projects that require planning, or accommodations at school for tests. Some families benefit from counseling to examine conflicts at home.

There are many other “treatments” on the market that promise to be the answer for your child. Most of their claims have not been adequately tested for safety or long-term benefit. In this area parents have to be very informed consumers. A conversation with your child’s pediatrician is a good place to start.

Where should I go to have my daughter (8 years old) evaluated for ADHD?

This almost feels like a trick question because it sounds like someone has already put a label on her problem behaviors or school issues. Don’t jump so fast to a diagnosis, and don’t let the person helping with the evaluation jump to a quick conclusion either. The evaluation of learning and behavior problems is fairly straightforward. It requires a professional, usually a pediatrician or mental health professional like a child and adolescent psychiatrist. Most families start at the school with their child’s teacher, guidance counselor or other education specialist. They can help with screening tests for learning problems, observe your child in the classroom or help with behavior rating scales. This package of information is shared with you and your child’s pediatrician. The doctor may be comfortable continuing the evaluation or your family might be referred to a mental health specialist to complete the evaluation and work with you and your child on a treatment plan.

Is ADHD a disability under the Americans with Disabilities Act?

The ADA does not define medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet so some people with ADHD will have a disability under the ADA and some will not.

Parents of children who are struggling in school should discuss the problems with their child’s doctor and school professionals. Most children with ADHD do not require additional school interventions. Some will need a space with few distractions to complete work, or more time on tests. These “accommodations” can be specified in a “504 Plan.” Some children with more extreme learning problems may have a more extensive evaluation to determine if they are ESE (Exceptional Student Education) and require an IEP (Individualized Education Plan). You will find more information about these school based programs on the website for your state department of education.

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About the Expert:

Scott Benson, M.D.
Pediatric Psychiatrist
Pensacola, Fla.

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