Treating ADHD at Home and School: A Doctor Q & A
To help you and your child get the school year off to a strong start, HealthCentral lined up a team of ADHD experts to answer your questions. Here are responses during a recent live discussion with Dr. Dorothy Stubbe, a board certified child and adolescent psychiatrist and Associate Professor and Program Director of the Yale Child Study Center’s world-renowned psychiatry program.
How do stimulant medications work in ADHD? Is Ritalin basically speed?
We don't know entirely how medications work in the treatment of ADHD, but we do know that they stimulate the sluggish parts of the brain that control attention, focus, and pre-planning. So, it is not "just speed," but a way to stimulate the frontal lobes of the brain-- the parts that can plan and make good decisions.
How does adult ADHD differ from childhood ADHD?
Adult ADHD tends to have less hyperactivity and more of a feeling of restlessness, but difficulties with focus and attention and organization remain.
Has the constant media attention and focus on ADHD affected how frequently and accurately patients are diagnosed with the disorder?
This may partly be true. However, there are international epidemiologic studies that suggest that ADHD impacts about 5% of children regardless of country.
Any tips for helping a teen with ADHD that is basically well managed begin to set long-term goals?
Long-term goal setting for teens is difficult, regardless of whether or not they have ADHD. As always, noting positives and building on those can help kids with ADHD (and all of us) begin to set realistic goals. Sometimes it helps to break these down into personal, academic, career, etc. Helping this teen become excited about possibilities is key.
What is the neurochemistry pathway associated with ADHD?
We think that the circuits that go from the striatum (the part of the brain that gets input from the outside, reacts emotionally, and sends messages on their way) connects to the frontal lobes (the part that thinks, plans, and organizes). It is the chemicals (dopamine, norepinephrine primarily) that work in this system that we think aren't firing efficiently enough.
What are some common symptoms of ADHD in a toddler?
Toddlers are really active and get into everything. Here are some good tips, whether you have a youngster that is just energetic or may have ADHD. Routines can help, like fun, energetic play followed by quieting times. Toddlers love to help, and having them do things with you can help them learn cooperation, social skills, and improve self-esteem.
The psychologist says my daughter should get an evaluation for ADHD—but she is not hyperactive. What is ADHD without hyperactivity?
There are 3 types of ADHD including the type with inattention and little hyperactivity. Those with inattentive ADHD just seem to be a daydreamer or "lazy," which is more common in girls and is often not identified because the child isn't disruptive. It is important to identify, as a bright child may be at risk of being retained in school and not learning because of the inability to pay attention.
Are there any accommodations or tips for my child about to take their college entrance exams?
If your child has had testing that qualified for extra time, that can be very helpful. If not, preparation, a good night's sleep, taking medication as prescribed, and learning to "pace" themselves can be very helpful.
What are the best ways to control anxiety associated with ADHD?
Learning coping skills to deal with anxiety (relaxation, taking a break, deep breaths, etc) can help. There are ADHD medications that can help with anxiety, as well. For example, the non-stimulant medication atomoxetine is sometimes used instead of a stimulant medication.
Is it possible to become ADHD as a late teenager?
According to the criteria for diagnosis, the symptoms must be present before the age of 12. With that said, many bright youth compensate really well for ADHD symptoms until they hit college, when the academic demands become much more intense. In addition, anxiety and depression can decrease concentration and the ability to focus, so the child should be sure that they are getting expert hep to sort it all out.
Are all generic forms of Adderall the same?
Adderall comes in XR (extended release) and fast acting. Generic forms should be equivalent. In some cases, individuals do notice a difference, and the doctor can specifically request the brand name medication.
Are any medication-free treatments effective? What are some alternative approaches would you suggest?
In school, having a seat near the teacher, extra time for tests, and modifying homework can be helpful. There is some emerging data that brains can be trained with cognitive training, like a five-year old may benefit from a system of positive rewards for sitting and paying attention. Anything that helps the child gain skills at increasing focus and attention is good.
How do you get a kid in college to consistently take ADHD meds when they discover they can make money selling them during mid-terms and finals?
Seems that a chat about appropriate use of medication and having the prescriber discuss this as well may be helpful. I know that it may be very tempting, but the student may be arrested or expelled from college for this. Best to be sure they understand the consequences.
Can you explain what executive function is?
Executive function is a term that refers to the ability to think ahead, regulate behavior, and is the "higher order" part of mental functions. We think that executive functioning is mostly related to how well our frontal lobes are functioning and how well they integrate with the rest of the brain. Poor organizational skills, impulsive behavior, and poor ability to think of how actions will affect others are all related to executive functioning.
How does that relate to ADHD?
Kids with ADHD struggle with executive functioning, and often have to find ways to stay organized and plan ahead to make up for this difficulty. Although executive functioning and ADHD are different, it is really common for kids (and adults) with ADHD to have difficulties with executive functioning.
My child's school is suggestion that I get him a medical evaluation for ADHD and potentially medication. What does this mean?
Getting a child evaluated is different than having them take medication. An evaluation can let you know if your child is having difficulties with learning, attention and focus, and any other issues that may make it difficult to pay attention in class. Remember, there are non-medication options (behavioral plans, sitting near the teacher, resource room help, etc) that can help your child learn and focus.
What does a medical evaluation mean for my child?
Medications may be recommended, but as the parent, you consider what is right for your child. As with all decisions we make for ourselves and our kids, we must weigh the pros and cons. Also, if a child does start a medication, it does not need to be long-term. Also, what is right when they are 5 may be different when they are 8, 10, 12 and 14.