Final Thoughts on ADHD Medicines

My last post was how to start and titrate ADHD medicines. Today I’d like to discuss more of the fine-tuning issues, such as what happens if medicine isn’t taken every day, how to remember it, what to do if parents disagree about medicine, and even how to plan for travel.

Time Off ADHD Medicines

starting ADHD medicinesOnce a good dose is found, parents often ask if medicines need to be taken every day. 

Stimulants work when they work, but they don’t build up in the body or require consistent use. (This is not true for the non-stimulants, which are often not safe to suddenly start and stop.)

Some kids fail to gain weight adequately due to appetite suppression on stimulants, so parents will take drug holidays to allow better eating.

Days off the medicine also seems help to slow down the need for repeated increases in dosing for people who are rapid metabolizers.

Drug holidays off stimulants were once universally recommended to help kids eat better and grow on days off school. Studies ultimately did not show a benefit to this, so it is not necessary. Some kids suffer if they are not on medications. Behavior issues, including safety issues while playing (or driving for older kids) can be a significant problem when not medicated. Self esteem can also suffer when kids are not medicated. 

Despite the fact that some kids need daily medicine, others don’t. When kids can manage their safety and behavior adequately, it isn’t wrong to take days off. Many kids want to gain better weight, and taking a drug holiday can help with appetite.

Talk to your child’s doctor if you plan on not giving your child the medicine daily to be sure that is the right choice for your child.

Remembering the medicine

It’s difficult to get into the habit of giving medicine to a child every day.  Tomorrow’s post will be about how to remember medicines

My favorite tip is to put the pills in a weekly pill sorter at the beginning of each week. This allows you to see if you’re running low before you run out and allows you to see if it was given today or not. These medicines should not be kept where kids who are too young to understand the responsibility of taking the medicine have access.

Controlled substances

Controlled substances, such as stimulants, cannot be called in or faxed to a pharmacy. Many physicians now have the ability to e-prescribe these.

Controlled substance prescriptions cannot have refills, but a prescriber can write for either three 30 day prescriptions or one 90 day prescription when they feel a patient is stable on a dose.

Stimulants are not controlled substances because of increased risks and side effects. Some of the more significant side effects of ADHD medicines are seen in non-stimulant medicines. 

They are controlled substances because they have a street value. Teens often buy them from other teens as study drugs. This can be very dangerous since it isn’t supervised by a physician and the dose might not be safe for the purchaser. It is of course illegal to sell these medicines.

The DEA does monitor these prescriptions more closely than others. If the prescription is over 90 days old, many pharmacists cannot fill it (this will vary by state), so do not attempt to hold prescriptions to use at a later time.


Acids and Stimulants

It has been recommended that you shouldn’t take ascorbic acid or vitamin C (such as with a glass of orange juice) an hour before and after you take medication.

The theory is that ADHD stimulants are strongly alkaline and cannot be absorbed into the bloodstream if these organic acids are present at the same time.

High doses of vitamin C (1000 mg) in pill or juice form, can also accelerate the excretion of amphetamine in the urine and act like an “off” switch on the med.

In reality  have never seen this to be an issue.

If anyone has noticed a difference in onset of action or effectiveness of their medicine if they take it with ascorbic acid or vitamin C, please post your comment below.

When Mom and Dad disagree

It is not uncommon that one parent wants to start a medication for their child, but the other parent does not.

It’s important to agree on a plan, whatever the plan is.

Have a time frame for each step of the plan before a scheduled re-evaluation.

If the plan isn’t working, then change directions.

Be cautious of how you talk about this with your child. If kids know it is a disagreement, they might fear the medicine or think that needing it makes them inferior or bad.

Do not talk about the diagnosis as if it’s something the child can control. They can’t.

Don’t make the child feel guilty for having this disorder. It isn’t fair to the child and it only makes the situation worse.

Having the medicine when you need it

Refills 

There is nothing more frustrating for a parent and child than to realize that there’s a big test tomorrow and you have no medicine left and you’re out of refills.

Technically none of the stimulant medicines can have refills, but a prescription covering 90 days at a time can be given. This can be done with a 90 day prescription or three 30 day prescriptions.

The technicality of this is sometimes difficult. You cannot call your pharmacy to request a refill. You must ask to have the next prescription filled if your physician provided 3 prescriptions for 3 months.

Be sure to know the procedure for refills at your doctor’s office.

Travel

It’s very important to plan ahead prior to travel if your travel involves the timeframe of needing new medication.

You must plan ahead so that if a refill will be needed during the trip you will either be able to fill a prescription you have on vacation or you will need to fill the prescription in advance.

Most people can get a prescription 7 days prior to the 30 day supply running out but not sooner, so you might need to fill a couple prescriptions a few days earlier in the month each to have enough on hand to make it through your vacation. It takes planning!

Sometimes you can work with your physician and pharmacist to get medicines early prior to travel. Talk to your pharmacist to see if they can help arrange this.

If you are out of town and you realize you forgot your child’s non-stimulant, call your doctor to see if they can e-prescribe it. Many of the non-stimulants are not safe to suddenly stop, so they are likely to send in a prescription. Insurance is not likely to pay for these extra pills if it was recently filled.

International travel will require that you find the laws in the other country to find out if you can bring controlled substances into the country. If you will need additional medicine while you are in that country, you will need to find a way to get the medicine.

 

Mail order

Some insurance companies will allow mail order 90 day prescriptions.

There are insurance companies that not only allow, but require them on daily medicines.

Others do not allow it.

In general I advise against a 90 day prescription if the dose is not established or if there are any concerns that it might not be the perfect dose. If there is any concern that it might need to be changed, a 30 day prescription is a better option.

If you will need to do a mail order, be sure you schedule your appointment to get the prescription early enough to account for the lost time mailing.

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

ADHD Medications: Starting out and titrating

I have spent many days covering a lot about learning and behavioral problems. Topics covered include why and how to get these issues diagnosed, who is involved in the diagnostic process, and treatment options with diet, supplements, and alternative treatments. Yesterday I covered what prescription medications are typically used and side effects they may cause. Today I’ll discuss common ways to choose a medicine, how to titrate it to a proper dose, and when to change to something else.

Tomorrow will discuss final thoughts on how to remember medicines, if it’s okay to take days off, and what to do if parents disagree about the treatment plan.

Getting Started


starting ADHD medicinesThe first step in treating ADHD is getting a proper diagnosis. This should be done with input from parents and teachers since symptoms should be present in at least two settings. ADHD symptoms overlap with many other conditions, and if the diagnosis is not correct, medications are more likely to cause side effects without benefit.

Do not jump into medication until the symptoms have been fully evaluated and a proper diagnosis is made according to DSM criteria.

Stimulant medicines

Stimulant medicines are considered first line treatment for ADHD in kids over 5 years of age.

There are short acting and long acting formulations available for each type of stimulant. There are advantages and disadvantages to each.

Short acting medications tend to last about 4 hours, so can be given at breakfast, lunch, and after school, allowing for hunger to return as each wears off to help kids maintain weight. Short acting stimulants are often used later in the day after a long acting stimulant wears off for teens who need longer coverage.

Long acting medicines tend to last between 6 and 12 hours, depending on the medicine and the person’s metabolism. The benefit is that people don’t need a mid-day dosing, which for school kids means avoiding a daily trip to the school nurse. This can be socially unacceptable for older children. It is also easier to remember once/day medication versus multiple times/day dosing. The downside is that some children don’t eat well midday with long acting medicines.

Which stimulant medicine to choose?

Methylphenidate vs Amphetamine

While some children respond better to methylphenidates, others to amphetamines, some do equally well on either, and some cannot tolerate either.

It is not possible to predict which children will do best on any type, but if there is a family history of someone responding well (or not) to a medicine, that should be taken into consideration of which to start first.

Swallowing Pills

Another thing to consider is whether or not a child can swallow a pill.

Some of the medicines must be swallowed whole.

If you aren’t sure if your child can swallow a pill, have them try swallowing a tic tac. Use a cup with a straw, since the throat is narrowed when you tilt your head back to drink from an open cup.

Another option is to put it in a spoonful of yogurt or applesauce and have your child swallow without chewing.

If your child cannot swallow a tic tac, you can choose a medicine that doesn’t need to be swallowed.

Some come in liquid or chewable formulations. Some capsules can be opened and sprinkled onto food, such as applesauce or yogurt. There is a patch (placed on the skin) available for the methylphenidate group.

Genetic testing

I’ve met many parents who request “the lab to say which medicine will work best.”

There is no lab that does this.

Many companies promote that their genetic test can predict which medicine will be best tolerated, but in truth they do not predict which will work best to maximize treatment and minimize side effects.

There are pharmacogenetic tests that will help to identify if a person has an issue with metabolism that would require a higher or lower than typical dose, but it does not tell which medicine will work best. It also doesn’t verify the diagnosis, so if the diagnosis is incorrect, no medicine is the right one.

Pharmacogenetic testing for ADHD (and other conditions) is still relatively new. It has the potential to significantly change the medication treatment process, a term called Personalized Medicine. Personalized medicine needs to be further validated and its precision improved before it becomes mainstream.

Insurance

I would love to say that cost shouldn’t matter, that we pick the medicine based purely on medical benefit, but cost does matter. Insurance often dictates which medicine we choose. 

Before you go to the doctor to discuss starting medicine look at the formulary from your insurance company. All other things being equal, if one medicine is not covered at all (or is very expensive) and another is covered at a lower tier, it is recommended to try the least expensive option first.

Of course, if the least expensive medicine fails, then a more expensive one might be the right choice. 

Not knowing which will work best in any individual, choosing the least expensive makes sense. Sometimes all approved medications for ADHD are expensive. If that’s the case, see Affording Medications for tips on finding the best price.

Generics historically have been the least expensive, but that isn’t always the case. You must know your insurance formulary to know the cost.

The ADHD Medication Guide is a great resource to look for generics (marked with a “G”), which must be swallowed whole or can be opened or chewed (see the key on page 2).

Age indications

The age indications listed on page 2 of the ADHD Medication Guide are those that have FDA approval at the ages listed, but there are many times that physicians use medicines outside the age range listed.

Some do not even have an age indication listed. These ages are due to testing results, and can be limited because one age group might not have been tested for a specific medicine.

Note that the 17 year and adult medicines are different. Is there really a difference between a 17 and an 18 year old? Not likely.

start low and titrate to best effect

In general it is recommended to pick one of the stimulant medicines and start low and titrate to best effect without significant side effects.

Feedback on how the child is able to focus and stay on task, and reports of other behavioral issues that were symptoms in the first place should be received from teachers and parents, as well as the child if he is able.

There are many things to consider that affect focus and behavior that are not due to the medicine: sleep, hunger, pain, illness, etc. It takes at least a few days to identify if the medicine is working or not or if other issues are contributing to the focus and behaviors.

The younger the child is the longer I usually advise staying on a dose so a parent has a chance to hear from the teacher how things are going. I usually don’t increase faster than once/week in younger kids.

I rely more on the student’s report in middle and high school, since those students can be more insightful and they have so many teachers throughout the day that most teachers are not as helpful. Older students who are in tune with their problems and how they are responding to the medicine might be able to increase every few days, as long as there are no confounding factors that could influence symptoms, such as change in sleep pattern, big test or other stressor, or illness.

Finding the right dose

It is recommended to start with one of the two main classes of stimulants with a low dose, and slowly increase to find the best dose.

Continue to increase until either symptoms are well controlled without significant side effects or side effects won’t allow another increase.

If that stimulant doesn’t work well or has side effects that are not tolerated, then change to the other class of stimulant.

If that one does not work, you can try a different medicine from the class of stimulant that worked best.

If the third medicine doesn’t work, then a non-stimulant can be tried.

I recommend re-evaluating the original diagnosis if the third medicine doesn’t work, since ADHD might not be the cause of the issues and finding the right cause can lead to a better treatment.

Titrating the medicine goes something like this:
  • If symptoms are well controlled and there are no significant side effects, the medicine should be continued at the current dose.
  • If symptoms are not well controlled and there are no side effects that prohibit increasing, the dose should be increased as tolerated.
  • If symptoms are not well controlled (i.e. room for improvement) but there are side effects that prohibit increasing the medicine, consider a longer period of watching on this dose versus changing to a new medicine.

 

Before your visit:

Before you meet with your physician to discuss a new ADHD diagnosis or a possible change in treatment plan, be sure to get the following information and have it available at the visit or the visit will not be as productive as you desire:

  • Insurance formulary
  • Standardized testing from teachers, parents, and other significant adults
  • Verify if your child can swallow a tic tac or pill
  • Any contributing family history (family member responses to medications, family history of heart issues, etc)
Tomorrow there will be more on fine tuning ADHD medications.

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

ADHD Medications: Types and side effects

I have spent several days on the diagnosis of learning and behavioral problems and non-medical, dietary and supplemental treatments that can be used for these issues. Today I will focus on the types of prescription medications used primarily for ADHD as well as their side effects. Tomorrow will cover how to get started on a medication for ADHD.

Approved vs not approved medicines

There are many treatments out there that are not approved for the purpose they are used. This sounds scary, but if done properly might be a good consideration.

Physicians sometimes use treatments that have not been approved for the purpose or an age group because they know from general experience that it works or they are at a loss from approved treatments failing and they need to try something else.

One example is using a shorter acting form of guanfacine (Tenex) that has not been approved to treat ADHD, but it has some advantages over the longer acting form (Intuniv) that is approved for ADHD. The short acting form can be broken, allowing slower titration of dose changes. The long acting form cannot be broken.

Another common example is the use of albuterol, a medicine that helps breathing with conditions that cause wheezing. It is not approved for use under 2 years of age, but it is commonly used for younger children with difficulty breathing — and it helps them breathe, which might keep them out of the hospital and off of supplemental oxygen.

I do not think that all non-approved medicines are good or bad. It is a very individual decision of what medicines to use. Discuss with your doctor if a treatment is approved or if they are using something that is not. Although this is relatively common among people who treat children because many drugs have not been tested in children and have been “grandfathered” into use through experiences that show benefit, be sure the provider is not picking something that has no basis or supporting evidence, especially if he or she profits from the treatment.

Be very wary of anyone who promises a cure – if one really existed everyone would use it.

Medications approved to treat ADHD


When a medication is needed to control symptoms of ADHD, the first line medications are the stimulants unless there are contraindications. Non-stimulant medications are not found to be as effective as stimulants in the majority of children, but they do have a place in the treatment plan for some children. They are sometimes used in addition to stimulants for optimal results.

For information on these medicines, see A Guide to ADHD Medications. It reviews how stimulants act on dopamine and norepinephrine and various time release patterns of different medicines.

ADHD medication guide
ADHD Medication Guide

I love the ADHD Medication Guide (different from the similarly named post above) because it lists the medicines approved to treat ADHD in a colorful chart that groups the medicines in an easy-to-read format.

Categories of Medicines used for ADHD:

Stimulants
  • Methylphenidates (Aptensio©. Ritalin©, Focalin©, Concerta©, Daytrana©, Metadate©, Quillivant©)
  • Amphetamines (Adderall©, Vyvanse©, dexedrine)
Non-stimulants
  • Atomoxetine (Strattera©)
  • Guanfacine (Intuniv©)
  • Clonidine (Kapvay©)
  • Others are used off-label (no FDA approval for the purpose of ADHD treatment): Tenex, Catapres patch, antidepressants, and antipsychotics

Side Effects

Parents usually worry about medication side effects. This is a very legitimate concern, but must be balanced with the risks of not treating. Overall the medicines listed above are very well tolerated.

If a child has side effects to one stimulant, they can usually do well on a different class (methylphenidate vs amphetamine). When neither type is tolerated, a trial of a non-stimulant is indicated. If this isn’t tolerated, reconsider the ADHD diagnosis.

I often hear concerns that parents don’t want their kids changing their personalities or becoming “zombies”. If the right medicine is used at the appropriate dose, this is usually not a problem.

Finding that right medicine and right dose might take some trial and error. Work with your prescriber to get to the right one for your child.

Most commonly observed side effects of stimulants:

Decreased appetite

Appetite is often low in the middle of the day and more normal by supper time if kids take a long acting stimulant.

Good nutrition is a priority. Encourage kids to eat the healthy “main course” first and leave the dessert out of the lunchbox. They should have healthy snacks (think of mini-meals) after school when they get hungry.

Short acting meds improve mid day appetite since they wear off around lunch time. The downside is the child needs to take a dose around lunch time at school.

Kids are often very hungry in the evenings when medicines wear off, so encourage healthy foods at that time.

I have seen some kids who have a really hard time off medicine sitting down to eat. These kids actually gain weight better on medicine because they can finish the meal.

Some kids can improve their appetite with an appetite stimulant. I often use cyproheptadine if weight drops too much in a child. It works best if it is not used every day. I will have kids skip their cyproheptadine at least a couple days each week.

Insomnia

Trouble sleeping is common with ADHD — with or without medicines.

If it is due to the stimulant medicine still being active, trouble sleeping may be relieved by taking it earlier in the day.

If the child’s brain is too active in the evenings because the medicine wears off, learning relaxation exercises can help. Check out the Winding Down section of Sleep Tips for more details.

Increased irritability

Moodiness is especially common as the medication wears off in the afternoon or evening and in younger children.

It makes sense if you consider that all day they are able to focus and think before acting and speaking, but then suddenly their brain can’t focus and they act impulsively.

Typically kids learn to adjust to the medicine wearing off as they mature.

Sometimes just giving kids 30 minutes to themselves and offering a healthy snack can help.

Cognitive behavioral therapy can help.

Anxiety

Anxiety does occur with ADHD and might be under-appreciated before the ADHD symptoms are treated.

Symptoms of anxiety are often missed. They can include avoidance, irritability, moodiness, somatic complaints (headache, stomach ache), and more. HeySigmund has a great list of subtle anxiety symptoms.

When kids can focus better, they might focus more on things that bother them, increasing anxiety and making it more apparent.

It is also possible that anxiety is misdiagnosed as ADHD, which is one reason for stimulant medication failure.

If you notice signs of anxiety, talk to your child’s doctor and/or therapist.

Mild stomach aches or headaches

Stomach aches and headaches are occasionally noted with stimulant medications. It is my experience that they are most common with a new medication or a change in dose.

Because these have many causes, it can be hard to determine if they are really from the medicine or another cause.

If they persist with the medicine, changing to another medication might help.

Tics

Tics are related to treated and untreated ADHD.

People with ADHD are more likely to have tics than the general population.

It was once thought that tics were caused by the stimulant medicines, but it is now thought that they happen independent of the medicine, and medicines might even help treat the tics.

Growth

Weight gain can be difficult for some kids on stimulant medications due to the appetite suppression on the medicine.

Studies have shown a decreased final adult height of about 1-2 cm (1/2 – 1 inch). For most people this small height difference is not significant compared to the benefits in self esteem, academics and behavior children gain on stimulants.

 

Rare side effects of stimulants

Hallucinations

I have only seen two children who could not tolerate stimulants due to hallucinations, but it is very scary for the family when it happens.

Unless there is a significant family history of them, I don’t know a way to predict which child is at risk.

These are a contraindication for continuing that medication, but another type of stimulant or medication can be considered.

Heart issues

Cardiac (heart) problems are overall a rare complication of stimulants and often times are not a contraindication to continuing the stimulant medicine.

There is a small increase in blood pressure and heart rate, both of which should be monitored regularly while on treatment and if the treatment is stopped.

A cardiologist should be considered to further evaluate a patient prior to starting a stimulant if there is any of the following:

  • Shortness of breath with exercise not due to a known non-cardiac cause, such as asthma
  • Poor exercise tolerance compared to children of the same age and conditioning
  • Excessively rapid heart rate, dizziness, or fainting with exercise
  • Family history of sudden cardiac death or unexplained death (such as SIDS)
  • Family or personal history of prolonged QT syndrome, heart arrythmias, cardiomyopathy, pulmonary hypertension, implantable defibrillator or pacemaker

side effects for the non-stimulants:

Atomoxetine

Atomoxetine can cause initial gastroesophageal complaints (abdominal pain, decreased appetite), especially if the dose is started too high or if it is increased too rapidly.

It can also cause tiredness and fatigue when it is first started or if the dose is increased too quickly.

It can increase the blood pressure and heart rate, both of which should be monitored regularly during treatment with atomoxetine.

There is an increased incidence in suicidal thoughts, though uncommon, so children should be monitored for mood issues on this medication.

A rare complication of atomoxetine is hepatitis (inflammation of the liver with yellow jaundice and abnormal liver function labs). The hepatitis resolves with stopping the atomoxetine.

Guanfacine and clonidine

Guanfacine and clonidine both cause fatigue and tiredness, especially when first starting the medication or with increases in dose.

Both of these medications can lower the blood pressure and heart rate, and these should be monitored closely while on guanfacine or clonidine, especially when first starting and increasing dose.

Handouts for medicines

I absolutely love the handouts that Dr. Nerissa Bauer has made for ADHD medications. Click on the image’s caption to go to her website’s page for that handout. The two stimulant classes are first, followed by the non-stimulants.

amphetamine adderall vyvanse
Amphetamines

Amphetamines (Adderall, Adderall XR, Vyvanse, amphetamine mixed salts, Dexidrine, Zenzedi)

 

 

 

ritalin concerta apetnsio metadate
Methylphenidate

Methylphenidate (ritalin, Aptensio XR, Concerta, Metadate CD or ER, Focalin, Daytrana)

 

 

 

strattera, atomoxetine
Atomoxetine

Atomoxetine (Strattera)

 

 

 

clonidine
Clonidine

Clonidine (Catapres, Kapvay)

 

 

 

guanfacine intuniv tenex
Guanfacine

Guanfacine (Intuniv, tenex)

 

 

 

Next up:

Tomorrow’s blog will be about how to choose a medicine to start and how to titrate it to find the best dose.

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

Alternative Treatments for ADHD

I’ve covered why you should get your child evaluated for learning and behavior issues, who does the evaluations, and what the evaluation process involves in my previous posts. I’ve also covered specific diets and supplements. Today I want to talk about alternative treatments for ADHD. If parents aren’t ready to use medicines yet or if they want to supplement medications with additional treatments, there are many alternatives.

Natural treatments, psychological and occupational therapies, and complementary alternative therapy for the treatment of ADHD are available. Some of these are more effective than others.

Alternative Treatments

Nutritionalternative treatments for ADHD

Nutrition is very important for learning and behavior in all kids, not just those with a diagnosis of some sort. My next blog will be dedicated to more on components of nutrition and elimination diets, then the following blog will cover vitamins and supplements.

Behavioral Therapy

Behavioral therapy can be very effective to help manage the symptoms of ADHD. It is beneficial even for children who are medicated to help them learn to control behaviors over time.

Parent skills training provides parents with tools and techniques for managing their child’s behavior. Behavior therapy rewards appropriate behavior and discourages destructive behavior. This training has been shown to improve ADHD symptoms among children, but studies show it does not change academic performance when used alone.

Parent training teaches parents to interact differently with children to encourage desirable behavior. This is done by reinforcing good behavior and having set consequences for bad behavior.

There are several kinds of parent training that have been shown to be effective. These include Parent-Child Interaction Therapy (PCIT), Parent Management Training (PMT), Positive Parenting Program (Triple P).

Cognitive Behavioral Therapy (CBT) is a way to change thinking from negative to positive and focuses on finding solutions to current problems. It has been proven to be effective in the treatment of ADHD and other common issues, such as anxiety. CBT can help children learn techniques to control behaviors, screen thoughts before speaking, organize things, and more.

Initial treatment for ADHD in children under 5 years of age is behavioral therapy. Studies show that the best benefits for ADHD are a combination of medication and behavioral therapy for those over 5 years of age.

 

social skills group

Many kids with ADHD struggle socially. They tend to lag behind peers by a few years developmentally. Their impulsivity and inattention leads to poor behavior and trouble making good friends. They may also have trouble managing their emotions.

Joining a professionally run social skills group can help kids learn and practice important skills for interacting with others. Some school counselors can do this during school hours and many therapists offer groups outside of school.

School resources

Schools have various abilities in helping kids with unique needs. They can offer special seating (or standing desks), extra time for tests, fidget items, and other accommodations. To learn more about school resources, Understood.org has much needed information about what is available and what you can do to legally get accommodations with IEPs or 504Plans.

Exercise

Getting kids outside and moving has many benefits for all kids – including those with ADHD.

First, they are off all screens, which have been shown to increase aggressiveness and impulsivity.

Second, they are getting exercise. Studies show that when kids play outside their focus, attention, and behavior improve.

Exercise helps to elevate the same neurotransmitters that are increased with stimulant medications, which helps with executive functioning skills (sequencing, working memory, prioritizing, inhibiting, and sustaining attention).

Any exercise helps, but studies show the best are martial arts, ballet, ice skating, gymnastics, yoga, rock climbing, mountain biking, skateboarding, and whitewater paddling (I know not all of these are practical on a regular basis, but most are). These activities require sustaining attention, balance, timing, fine motor adjustments, sequencing, evaluating consequences, error correction, and inhibition.

Sleep

Sleep problems are common in many children, especially those with ADHD. Fixing the sleep cycle can have extreme benefits in learning and behavior.

Sometimes it’s as easy as getting a routine for sleep to ensure the proper number of hours for a child, but often they suffer from insomnia, nightmares, sleep apnea, restless leg, or other medical conditions that impair sleep time and/or quality.

Symptoms of chronic sleep deprivation in kids are hyperactivity, poor focus, and irritability. There are many kids who can have all of their ADHD symptoms relieved when they simply get better sleep. I see this in many teens who suddenly “develop ADHD”- only it’s really not ADHD at all. They are running on 4-5 hours of sleep a night. If your child has sleep troubles not improved with these Sleep Tips, talk to your child’s doctor.

Occupational Therapy and Sensory Training

There are many kids with ADHD who benefit from using techniques that occupational therapists use with sensory processing disorder (SPD). In some kids, SPD might be the real diagnosis causing symptoms of ADHD, but in others they may co-exist.

Treating SPD is usually fun for the kids, and there is no harm in doing their techniques even if a child doesn’t have the disorder.

Schools have started integrating these ideas into their classrooms as needed, such as having kids sit on stability balls or using tactile objects at their desks.

Therapy for SPD involves playing in ways that use sensory input (such as with sand or play doh, rolling down a hill, manipulating tactile objects, and more).

For a great list of ideas visit Sensory Integration Activities, but working with an occupational therapist is recommended.

Biofeedback and Neurofeedback

Biofeedback and neurofeedback are often not covered by insurance due to inconclusive evidence that they work. Children and adults with ADHD often have abnormal patterns of brain electrical activity on electroencephalographic (EEG) testing. EEG biofeedback is aimed at normalizing EEG activity by correcting the brain’s state of relative under-arousal and optimizing cognitive and behavioral functioning.

Neurofeedback trains kids to become more aware of their physiological responses and improve their executive functioning. Each neurofeedback session lasts 30-60 min and children usually need 10-20 sessions. Patients wear a cap that measures their brain activities, and it helps them train their brain to maintain focus during video games specific to this purpose.

The significance of most findings on neurofeedback and EEG biofeedback is limited by study design flaws that include small study sizes, heterogeneous populations, absence of a control group, inconsistent outcome measures, self-selection bias, and limited or no long-term follow-up. While this doesn’t mean they don’t work, I would like to see more studies showing their benefit. You might invest a lot of time and money only to find out it doesn’t work.

Working memory training

Working memory training has been shown in studies to help with symptoms of ADHD, though there are some conflicting studies out there.

Cogmed is the company that has studies showing benefit. It’s a computer program that kids play like a video game, but it reportedly trains their brain to remember things. Cogmed is intensive: 1 hour a day, 5 days a week for 5 weeks, but can be done at home. It can be expensive and is often not covered by insurance. About 70-80% of children show improvement immediately after the training, and of those who improved, 80% maintained the benefit over a 6 – 12 month window. Cogmed is designed to be used with medication, such as stimulants.

Herbs and other supplements

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective. I will cover these in a separate blog.

ADHD Coaching

Just like anyone who needs help improving a skill, working with a coach with experience helping others in that area can be a big help.

Working with an ADHD coach can help many with certain aspects of their life. ADHD coaches can help with organization, motivate a person with ADHD to finish tasks, or help them learn techniques that makes them more effective at life skills.

Coaches do not do psychotherapy or counseling. This can be beneficial for people who are against therapy but need help to improve their skills.

It does not work if the parent makes the child go. The child must be motivated to make changes in his or her life and be willing to work on things, then coaching can be great.

Tips on finding an ADHD coach can be found on PsychCentral.

Mindfulness

I recommend mindfulness for many issues, especially anxiety (which often co-exists with ADHD). Mindfulness is thought to help with ADHD as well. It is a process of being focused on the present moment and is more fully explained on Understood.org’s Mindfulness page.

There are many free apps that can help kids (and adults) learn mindfulness.

No evidence exists for these treatments

There are many alternative treatments out there that do not have scientific proof that they help. Many parents try these treatment programs in hope that their child’s symptoms will go away.

In general, if it sounds too good to be true, it probably is.

Don’t be fooled into thinking “alternative” or “natural” treatments are without risk. There are always risks, including the lost time not being on a proven therapy, leading to a child falling further behind academically and suffering emotionally from symptoms related to ADHD.

“Train the brain” games 

There are claims that games designed to train the brain can improve memory, attention and other skills, but there is no research that supports this claim. Kids may get good at playing the game and seem to learn, but studies have found no improvements that generalize to their daily life or learning. For more, see what experts say about “train the brain games” for kids with ADHD.

Brain Balance has a center in our city, and I’ve seen more than a few parents who waste time and money on their program. I don’t know of any that noted significant and continued benefit. Although their website might look like there’s impressive evidence to use it, there really isn’t. Please see Science Based Medicine: Brain Balance for more information.

Caffeine

Caffeine is a stimulant but since it is available from grocery stores instead of pharmacies some parents feel more comfortable using it instead of a medication.

If you’re using it as a drug, it is a drug.

Whether it comes in a beverage or a pill, it is a chemical with properties that act like other drugs in our bodies.

Unfortunately studies don’t really support its use. It’s difficult to dose since it comes in so many forms, and most people develop a tolerance for it, requiring more and more, which can increase side effects.

For details, see Science Based Medicine: Caffeine for ADHD.

chiropractic medicine, Vision therapy, and Applied kinesiology

I have not been able to find any valid scientific studies for chiropractic medicine, vision training, and applied kinesiology for the treatment of ADHD.

Insurance usually does not cover these and they can be quite expensive. I do not recommend them.

Essential oils and aromatherapy

Essential oils are all the rage now. It seems they can cure everything if you do a quick online search. The problem is that research hasn’t shown that to be true. Dr. Chad Hayes does a good job of discussing what they are and why they aren’t recommended.

Remember…

There is no alternative medicine. There is only medicine that works and medicine that doesn’t work. ~ Richard Dawkins

If it stays alternative, that must say something. Once an alternative treatment is shown to work, it becomes a preferred treatment, no longer an alternative…

Things to consider when choosing treatment plans:

  • First, be sure your child is properly assessed to make the best diagnosis on which to base the treatment plan.
  • Natural isn’t necessarily safe. Evaluate all the risks and benefits known before making a decision. Even exercise (which is always recommended) comes with risks, such as injury and at times sleep problems due to scheduled activity times.
  • Talk with your doctor about any treatments you are doing with your child. Don’t forget to mention vitamins, supplements, herbs, brain training, therapies, etc.
  • Choosing one treatment doesn’t mean you are married to it. If response doesn’t prove to be beneficial, re-think your approach.
  • There is no cure for ADHD known at this time. If someone claims that they can cure your child, don’t buy into it.
  • Learn your costs. Does insurance cover it? Insurance companies often prefer certain treatments due to their cost and other factors. They also do not cover many treatments. Sometimes this is again due to cost, but other times it is because there is no evidence to show the treatment is effective. (Hint: This is a good clue to look at other treatments!)
  • Is the treatment something your child can do and is your family willing to put in the time? CBT is proven to help, but it doesn’t work if the child and parents don’t work on the techniques at home. Neurofeedback and Cogmed take many hours of treatment over weeks of time and are not guaranteed to work in all children.  Medications must be titrated to find the most effective dose that limits side effects. This requires frequent follow up with your doctor until the best dose is found.

Sources:

The ADDitude Guide to Alternative ADHD Treatment

WebMD: Attention Deficit and Hyperactivity Disorder: Alternative Treatments 

American Psychological Association: Easing ADHD Without Meds
Psych Central: Neurofeedback Therapy an Effective, Non-Drug Treatment for ADHD

Psychiatric Times: Integrative Management of ADHD: What the Evidence Suggests

Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.

 

Supplements for ADHD: Do Vitamins, Herbs, and Fatty Acids Work?

Parents often ask if they can treat their child’s ADHD without prescription medication. There are many alternative treatments in addition to prescription medications – some of which are more effective than others.  I will cover ADHD treatment with supplements today.

Supplements for ADHD – general

If you’re giving your kids supplements for any reason, be sure to tell their physician and pharmacist to avoid any known complications or interactions with other treatments.

Supplement use in general is gaining popularity. All you have to do is visit a pharmacy or specialty store and you will see various products marketed to treat ADHD.

There are some studies that show people with ADHD have low levels of certain vitamins and minerals. More studies are being done to determine if supplementing helps symptoms. There is growing evidence for vitamin supplementation, but there are no standard recommendations yet.

Should you use high dose vitamins?

Clinical trials using various combinations of high dose vitamins such as vitamin C, pantothenic acid, and pyridoxine show no effect on ADHD.

I don’t recommend high dose vitamin supplements unless a specific deficiency is identified. I don’t routinely screen for deficiencies at this time because there are no standard recommendations for this. We still have a long way to go before we know enough to make recommendations.

For children without a known vitamin deficiency, a standard pediatric multivitamin can be used, but effectiveness is not proven. I have no problems with anyone taking a multivitamin daily. However, I cannot recommend any specific brand since none of them are regulated by the FDA and there are many reports that show the label often misrepresents levels of what is really in the bottle. There have been instances of higher or lower than listed amounts of ingredients as well as unlisted ingredients in supplements.

My advice is to buy a brand that allows independent lab testing of their products if you choose to buy any vitamin or supplement.

Vitamins & minerals

The following is adapted from the University of Maryland Medical Center with the help of ADDitude Magazine and Natural Medicines Comprehensive Database.

Magnesium

Symptoms of magnesium deficiency include irritability, decreased attention span, and mental confusion.

Some experts believe that children with ADHD may be showing the effects of mild magnesium deficiency. In one preliminary study of 75 magnesium-deficient children with ADHD, those who received magnesium supplements showed an improvement in behavior compared to those who did not receive the supplements.

Too much magnesium can be dangerous and magnesium can interfere with certain medications, including antibiotics and blood pressure medications.

Talk to your doctor before supplementing with magnesium.

Vitamin B6

Adequate levels of vitamin B6 are needed for the body to make and use brain chemicals called neurotransmitters. These include serotonin, dopamine, and norepinephrine, the chemicals affected in children with ADHD.

One preliminary study found that B6 pyridoxine was slightly more effective than Ritalin in improving behavior among hyperactive children – but other studies failed to show a benefit. The study that did show benefit used a high dose of B6, which could cause nerve damage, so more studies need to be done to confirm that it helps.

If B6 is found to help, we need to learn how to monitor levels and dose the vitamin before this can be used safely.

Because high doses can be dangerous, do not give your child B6 without your doctor’s supervision.

Vitamin C

Vitamin C can help modulate the dopamine levels in the brain. Dopamine is a neurotransmitter that helps control the reward and pleasure centers in the brain.

Vitamin C can affect the way your body absorbs medications (especially stimulants for ADHD) so it is suggested to avoid vitamin C supplements and citrus fruits that are high in vitamin C within the hour of taking medicines.

Preliminary evidence suggests that a low dose of vitamin C in combination with flaxseed oil twice per day might improve some measures of attention, impulsivity, restlessness, and self-control in some children with ADHD. More evidence is needed before this combination can be recommended.

Vitamin D

Vitamin D is the one vitamin that is recommended to take as a supplement by many experts.

As we have gotten smarter about sun exposure, our vitamin D levels have decreased. Vitamin D deficiency has been linked to many problems, including ADHD.

Zinc

Zinc regulates the activity of brain chemicals, fatty acids, and melatonin. All of these are related to behavior.

Several studies show that zinc may help improve behavior.

Higher doses of zinc can be dangerous, so talk to your doctor before giving zinc to a child or taking it yourself.

Iron

Iron deficiencies commonly occur in children due to inadequate dietary sources since kids are so picky. Other causes include blood loss or excessive milk intake.

Iron is needed for the synthesis of dopamine, norepinephrine, and serotonin- all neurotransmitters in the brain.

Low iron has been linked to learning and behavior problems.

Too much iron can be dangerous, so talk with your doctor if you want to start high dose supplements. (Regular multivitamins with iron should not cause overdose if used according to package directions.)

If you’re using high doses of iron, it is important to follow labs to be sure the iron dose is not too high.

Essential fatty acids

Fatty acids, such as those found in fish, fish oil, flax seed (omega-3 fatty acids) and evening primrose oil (omega-6 fatty acids) are “good fats” that play a key role in normal brain function.

In a large review, Omega-3/6 supplementation made no difference in ADHD symptoms, but there are other benefits to this supplement and it carries little risk.

If you want to try fish oil to see if it reduces ADHD symptoms, talk to your doctor about the best dose. Some experts recommend that young school aged kids take 1,000-1,500 mg a day, and kids over 8 years get 2,000-2,500 mg daily.

For ADHD symptom control it is often recommended to get twice the amount of EPA to DHA.

L-carnitine

L-carnitine is formed from an amino acid and helps cells in the body produce energy.

One study found that 54% of a group of boys with ADHD showed improvement in behavior when taking L-carnitine. More research is needed to confirm any benefit.

Because L-carnitine has not been studied for safety in children, talk to your doctor before giving a child L-carnitine.

L-carnitine may make symptoms of hypothyroid worse and may increase the risk of seizures in people who have had seizures before. It can also interact with some medications. L-carnitine should not be given until you talk to your child’s doctor.

 

Proteins

Proteins are great for maintaining a healthy blood sugar and for keeping the brain focused.

They are best eaten as foods: lean meats, eggs, dairy, nuts and seeds, legumes, and fish are high protein foods. Most people in our country eat more protein than is needed.

If your child does not eat these foods in good quantity, there are supplements available. Talk with your doctor to see if they are appropriate for your child. Many of the supplements are high in sugar and other additives. Some have too much protein for children to safely eat on a regular basis.

Herbs

There are some studies supporting nutritional supplements or herbal medicines for ADHD, but many reported treatments have not been found effective.

Pinus marinus (French maritime pine bark), and a Chinese herbal formula (Ningdong) showed some support.

Current data suggest that Ginkgo biloba (ginkgo) and Hypercium perforatum (St. John’s wort) are ineffective in treating ADHD.

Summary

In general I think we all should eat a healthy diet that is made up primarily of fruits, vegetables, lean proteins, and complex carbohydrates.

If children are on a restricted diet due to allergy or sensitivities to foods or additives (or extreme pickiness), discuss their diet with your doctor. Consider working with a nutritionist to be sure your child is getting all the nutrition needed for proper growth.

If supplements are being considered, they should be discussed with your doctor. Talking about risks and benefits can help decide which are right for your child.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


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Special Diets for ADHD

Most of us have heard of the claims of cures for all sorts of ills, including behavioral problems (especially ADHD and autism) with simple dietary changes (with and without supplements). This post covers some diets for ADHD that have been recommended as treatments. Supplements will be covered tomorrow.

Why talk about diets for ADHD?

ADHD elimination diet, vitaminsFears of side effects from long-term medication or a history of medication failures cause families to look for alternative treatment options for child behavior issues. Diet modification and restriction is intriguing for parents since it fits into the ideal of a healthy lifestyle without added medicines and their potential side effects. However, there is a lot of controversy as to whether these restrictions help except in a small subset of children who have true allergy to the substance.

In general if a simple solution through diet was found, everyone would be doing it.

That just isn’t happening.

I do think that we all benefit from eating real foods — the ones that look like they did when they were grown, not processed and packaged. Fruits, vegetables, protein sources, whole grains, and complex carbohydrates should be the basis for everyone’s diet. It’s just good nutrition. But the direct effect of special diets on learning, behavior, and conditions such as ADHD is limited.

Natural does not equal safe.

When my kids were young and picky eaters I never would have considered stimulating their appetite with organically grown marijuana. While it is all natural (even organic!) and it might increase their appetites, it would have risks, right? In this case I don’t think the risks would outweigh the benefits. But so often parents think that if it’s natural, it’s healthier than something made by man.

Drugs have been tested. They have risks too, but those risks are a known. Some natural therapies have not been as thoroughly tested and they are not regulated, so the label might not correctly identify the contents. For this reason, I think that healthy foods are a great option for everyone, but I hesitate to recommend a lot of supplements, especially by brand.

Elimination diets

Over the years there have been many foods or additives that have been blamed for causing learning and behavioral problems. Some of the proposed problematic foods:

  • food dyes
  • refined sugars
  • gluten
  • salicylate and additives
  • dairy products
  • wheat
  • corn
  • yeast
  • soy
  • citrus
  • eggs
  • chocolate
  • nuts

I’m sure the list goes on, but I’ve got to move on. I’ll discuss some of the specific elimination diets and what evidence about each says.

Food additives

Food additives have been blamed for learning and behavior problems for many years. In 1975, Dr. Ben Feingold hypothesized that food additives (artificial flavors and colors, and naturally occurring salicylates) were associated with learning disabilities and hyperactive behavior in some children.

Since then many case reports of similar claims have continued to surface, but those do not have the same weight as a double-blinded control study. Most studies done in a scientific manner have failed to show a benefit.

It never hurts to eliminate artificial dyes and additives in your child’s diet. If it helps, continue to avoid them. But if no change is noted, don’t continue to rely on dye avoidance as a treatment plan.

GAPS Diet

Another elimination diet is the GAPS (Gut and Psychology Syndrome) diet, designed by Dr. Natasha Campbell-McBride.

She asserts that a wide variety of health problems  (autism, ADHD, schizophrenia, depression, and more) are from an imbalance of gut microbes. Not only has it not been proven to work, I worry that it restricts healthy foods, such as fruits, and kids will develop other problems on this diet.

I cannot go into details in this space, but for more information visit Science Based Medicine: GAPS diet.

Gluten

Gluten is in the news to be the base of many problems. It seems to be recommended to go gluten free for just about any ailment you can think of.

There are a subset of people who are really sensitive to gluten, and they benefit greatly from a gluten free diet.

But the large majority of people gain no direct benefit from this expensive and restrictive diet. One indirect benefit of the diet previously was that it was nearly impossible to eat pre-packaged and processed foods, which leaves real fruits, vegetables, and other high quality foods. As more people are going gluten free there are more pre-package products made gluten free. I wonder if the benefits people have noticed previously will wane when they eat these foods.

Talk with your doctor before deciding if going gluten free will work for your child.

Sugar

Sugar is often blamed on hyperactivity. By all means, no child needs extra sugar, so cut out what you can.

Well controlled studies did not find a behavioral difference in kids after refined sugars.

Interestingly, parents still perceived a change (despite researchers finding none) in at least one study by Wolraich, Wilson, and White. 1995.

Food allergies

Food allergies are now commonly thought to be related to behavior and learning problems.

In some children with true allergies, foods can affect behavior. However, most children do not have food allergies and avoiding foods does not alter behavior. It can be challenging to determine if there is a food allergy since some of the tests offered are not reliable.

Elimination Diets Final Thoughts

In a small subset of kids food avoidance helps, but in the large majority studies do not support avoidance of foods.

If you think your child benefits from avoiding one or two foods, it probably isn’t a big deal to restrict those foods.

But if you suspect your child is allergic to everything under the sun, you will need to work with your doctor and possibly an allergist and a nutritionist to determine exactly what your child must avoid and how they can get all the nutrients they need to grow and develop normally.

Next up: Supplements for ADHD

Stay tuned for a summary of supplements on ADHD – what’s been proven to work and what hasn’t!

Evaluation Process to Diagnose Learning & Behavioral Issues

I have talked about why kids should be evaluated if they have learning or behavioral issues and who is involved in this evaluation in the past few posts. Today I want to talk about what to expect during an evaluation. Not all kids need every test available. It depends on what their specific concerns are as to what will be tested, but a proper diagnosis can’t be made without standardized testing and a complete evaluation.

What types of things are evaluated?

Evaluation Process to Diagnose Learning & Behavioral IssuesThe evaluation includes several types of assessments because there are many things that can cause learning or behavioral issues.

There are no specific laboratory or imaging tests available to determine a diagnosis on a routine basis. It’s important to do a thorough standardized evaluation to get the right diagnosis.

Contributing issues include but are not limited to: ADHD, anemia, anxiety, bullying or abuse, chronic illness, depression, hearing or vision problems, learning disabilities, malnutrition, oppositional defiant disorder, sensory integration disorder, and sleep deprivation.

Symptom overlap

Having one diagnosis does not mean you can’t have a second. Actually many of these issues go hand-in-hand and co-exist.

ADHD, anxiety, neurodiversity, learning disorders
There is a lot of overlap of symptoms of many similar conditions.

Standardized questions

A big part of the diagnosis lays in the symptoms noted at home and school, so there are a lot of questions about how your child fares at each.

Both parents and teachers and any other significant adults should fill out standardized questionnaires as recommended by the clinician doing the evaluation for many behavioral issues. Older kids (and adults) can do self assessments.

It’s important to answer each question as honestly as possible to avoid misrepresentation of symptoms, which can lead to an improper diagnosis.

History

Reviewing the child’s story can give clues. This includes the current concerns of parents and teachers in addition to historical facts and events.

If there were developmental delays in motor skills or language development, further evaluation in those areas might be insightful.

It’s important to review the family history, since many of these issues run in families.

Sleep patterns are often insightful since sleep deprivation can decrease executive functioning and mimic many conditions.

Other issues, like a history of anemia or elevated lead levels should be discussed.

Exam findings

A physical exam should be done to help identify any physical symptoms that can contribute to learning or behavioral problems, such as large tonsils leading to sleep apnea.

Behavior evaluation

Some clinicians will go to your child’s classroom to observe behaviors. This is sometimes provided through the school district but might also involve a private therapist.

Neuropsychological testing

Neuropsychological testing might be recommended. It can assess learning disorders and attention issues, identify strengths and weaknesses, and help determine what interventions will work best for your student. Understood.org has information about neuropsychological testing.

Vision and Hearing

If your child has not had a vision and hearing screen done previously or there are concerns, it is recommended to do those screens. When a child cannot see the white board or hear the instructions, learning and behavior are both impacted.

Evaluation Process

As you can see, there are many things to consider when evaluating learning and behavioral concerns. A proper diagnosis usually takes more than one visit. More than one person should be involved in the screenings in many cases. Do not attempt to shortchange this process. Without a proper assessment, the wrong treatment might be advised, leading to poor outcome.

The next few blogs will discuss treatment options for ADHD, including dietary changes, supplements, alternative and additional treatments and medications.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


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Who’s Who In Learning & Behavior Evaluation & Management?

I tried to convey why it’s so important to get a proper diagnosis of learning and behavioral problems in my last blog, Labels – Why should my child be diagnosed? Today I’d like to explain what is done during the evaluation and who’s involved in testing and treatment. Primary care physicians are a great place to start with questions about how to evaluate and treat various concerns. After that where should you go?

Start with the pediatrician

learning and behavior evaluation and managementParents are sometimes surprised to learn that I treat ADHD, anxiety, and many other behavioral disorders. I see many kids every day with these issues. I enjoy watching as they learn to manage their behaviors and improve their executive functioning over the years. Even kids who really struggle in the early years can grow into confident and accomplished adults.

I often say that kids with ADHD are talented, smart and can do wonderful things. They have unique gifts.

There are some pediatricians who don’t treat these issues, but I find there’s a huge need. In many cases since I’ve followed a child for years, I know them well and can help better than a specialist who doesn’t have that history.

Despite plenty of experience, I do use specialists often.

Many learning and behavior problems have similar symptoms, so it might take several professionals to help evaluate the situation.

Of course the professionals at school are imperative to being part of the team. And there are times when the diagnosis isn’t clear or a child doesn’t respond to the treatment well, other specialists are very helpful to assess the issues.

Cautions…

There are of course many tests and treatments available that have not been proven to help. Future blogs will cover testing and treatments, but until then, just a few cautions.

There are tests available, such as EEG for ADHD, that are not shown to be beneficial and can increase cost without adding to the diagnostic evaluation.

There are many treatments that haven’t been shown to be effective but still advertise good results for a fee.

If it sounds too good to be true, it probably is. Discuss tests you are considering with your child’s doctor, especially if there is a large price tag attached.

 


Who’s who?

The alphabet soup of credentials confuses many parents. I’ve tried to compile a list of experts in various fields who might need to be involved in your child’s assessment and care as well as explain what types of things they can do to help in the process of evaluating and treating learning and behavior issues.

Parents

Parents (or primary caregivers) are critical to giving insight into how children learn and behave. They should be interviewed and fill out standardized questionnaires to help with the diagnosis. Their feedback on how each treatment is working is helpful in fine tuning treatment plans.

Teachers & Other School Professionals

Teachers are imperative in helping assess the issues and concerns since they can compare any one child to a room of their peers and they know how your child handles various situations and what their typical behaviors are.

Many schools will have a school counselor or psychologist evaluate and help treat students.

Teachers with advanced background in learning disabilities are used to help address specific concerns.

It’s recommended that each teacher fill out standardized questionnaires to help with the initial evaluation of focus and behavior disorders and again to assess responses to treatments.

Schools may put students on IEP or 504 Plans to help with their education. For more on these see IEP & 504 Plan. 

Therapists (not mental health)

Physical Therapists, Occupational Therapists, Audiologists, and Speech Therapists can be school based or private, but they are helpful in addressing specific motor skills, sensory issues, hearing issues, or speech/language concerns.

They do not prescribe medication, but work within their area to improve certain skills that affect learning and behavior.

Check with your insurance to see what is covered in your plan. Ask the school if they offer any of these services.

Mental health specialists

Psychologists (clinical psychologists, cognitive psychologists, educational psychologists and neuropsychologists) and clinical social workers offer testing as well as therapy for many disorders.

Some therapists specialize in testing, others in treating. Some do both. You will have to ask what their qualifications are and what role they play in diagnosis and management.

Clinical therapists can do parent training to help parents manage behaviors at home, especially for younger children.

Therapists cannot prescribe medications, but some people find that the therapy provides enough benefit that medication is not needed or that the therapy in addition to medicine helps better than either treatment alone.

Cognitive behavioral therapy is the preferred first line treatment for certain disorders, such as ADHD in young children and anxiety.

Therapists often provide social skills training, which is needed for many children with behavioral and learning issues who don’t learn social skills as easily as their peers.

You should check your insurance list of providers to see who is covered. It also might be worth pricing some who do not take your insurance but will give you a bill to submit yourself. If a person is out of network your cost might be about the same as a person who is harder to get in to see but on your plan.

Physicians

Physicians (pediatrician, family physician, developmental pediatrician, neurologist, and psychiatrist) can make a diagnosis and prescribe medications for treatment of certain diagnoses, such as ADHD or anxiety.

Not all have experience with each of these issues so you must ask what their experience is.

It can take quite a while to get into specialists and they can be expensive, so starting with your primary care physician often is easier and very helpful to rule out medical issues and to do the evaluation and treatment if they are comfortable.

Many psychiatrists do not accept insurance and they are typically difficult to get in to see.

Physicians (including psychiatrists) generally do not do therapy. They focus on the medication benefits and side effects. Therapy along with medication often improves outcome, so multiple specialists working together can be beneficial.

Physician-extenders

Nurse practitioners and physician assistants can work with physicians to diagnose disorders and prescribe medications to treat them. In some states they can work independently.

They do not offer psychotherapy, so it is often beneficial to work with more than one person to get the best outcome.

Benefits include that they are generally easier to get in to see and they are relatively inexpensive compared to physicians. Not all are comfortable with treating these issues. Ask about training and experience.

Working as a team

The types of professionals who work with any given child to assist in diagnosis and treatment vary depending on the issues at hand. The most important thing is that they work as a team and communicate with one another.

This communication is often done through parents and written reports. It’s important that all members of the team have access to what the others are doing.


Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

 

Labels – Why should my child be diagnosed?

This is the first in a series of posts about learning and behavior I will do over the next several weeks. Parents are often afraid of labels when it comes to getting an appropriate assessment of learning  or behavior issues.

I see a lot of children with various behavioral and learning issues. Teachers and parents often first think of ADHD with any problem, but that isn’t always the problem, or at least the primary one. It’s simply one of the most common diagnoses. Since it’s so common, I will focus on this topic often, but it can mimic other problems and it often coexists with other issues.

I firmly believe that kids with learning and behavioral problems cannot just “work harder” to fix the problem.

We would never ask a child in a wheelchair to “just try harder” to walk up stairs. We shouldn’t expect someone who has trouble focusing to be able to “just try harder” either.

When I’m sleep deprived, I cannot focus as well. I cannot read and comprehend what would typically be easily understood and retained. I lose track of things. I lose my temper more easily or get upset about the little things that usually wouldn’t phase me. I must put extra effort into everything, which is even more exhausting.

I liken this to how some people feel most of the time.

How can we possibly expect them to just try harder without professional assessment and treatment?

What about labeling?
ADHD kid messing around
Kids with ADHD get distracted easily and have trouble staying on task.

One reason parents don’t want to have their child diagnosed with ADHD or any other learning or behavioral problem is that they fear a label.

What’s a label?

It’s not a diagnosis, but the way we’re perceived. Think about how many judgements and labels you make in a day.

I try really hard to not judge because it’s not my place, but those thoughts sneak into my mind all the time:

  • That person is rude.
  • That’s my shy (hyper, loud, smart, active, loving, etc) child.
  • That outfit is inappropriate.
  • That group of giggling girls is too loud and out of control.

I don’t say anything with these thoughts most of the time because it’s not my place.

I often mentally rebuke myself for having them, but I still have the thoughts.

The truth is that we all make judgements all the time. And when a child acts out a lot, he is judged and labeled.

If a child never seems to be organized, she is judged and labeled.

If a child falls behind academically, he is judged and labeled.

If a child bothers other kids in class with movements or talking, he is judged and labeled.

It happens with or without a diagnosis. The label is there.

With proper management, your child might lose the negative labels and be able to succeed!

Aren’t behaviors and focus problems from bad parenting?

Probably in part due to this stigma, parents worry about how the diagnosis will reflect on the child and family. If a child has an infectious disease or  a chronic condition such as asthma, there is much less hesitation to assess, diagnose, and treat the illness.

If this is just due to bad parenting, how does medicine help?

Diagnosing isn’t always easy.

One of the problems with diagnosing many learning and behavioral disorders is they’re difficult to test for since there is a continuum of symptoms of normal and atypical and there are so many variables (such as sleep) that can affect both learning and behavior.

There are diagnostic tools that should be used to assess the issues at hand. Your child shouldn’t be diagnosed without a standardized assessment. There are many available, depending on the concerns (ADHD, anxiety, dyslexia) and the age of the child, and sometimes kids need more than one type of assessment. Some of these can be done at your physician’s office. Others can be done with a professional who offers that type of assessment.

There is no proof that electroencephalography (EEG) or neuroimaging is helpful to establish the diagnosis of ADHD.

So many excuses to wait…

There are many reasons for parents to be hesitant to begin an evaluation when their kids are showing signs of a learning or behavioral problem.

  • Some think it’s just a phase.
  • Many wonder if another few months of maturity will help the child.
  • Some think the child is just misbehaving and stricter rules or harsher punishments will help.
  • Others think the child is just looking for attention and giving more praise will help.
  • Some parents think it is because of the other children around — you know, “Little Johnny is always messing around in class so my Angel Baby gets in trouble talking to him.”
  • We should try something else. (Linked blog is from a parent who shares her story.)
Why not wait?

While I’m all for looking for things on your own that can help a child’s behavior and optimize their learning (to be covered in a future post), I also think that avoiding the issue too long can lead to secondary problems:

  • academic failures
  • poor self-esteem
  • depression
  • drug/alcohol abuse
  • accidental injuries due to impulsivity and hyperactivity
  • strain on family life
  • social issues with peers

Working with the school and seeking professional help outside of school can help your child succeed.

If a parent is not wanting to start medication, there are other things that can be done that might help the child succeed once the specific issues are identified.

Not treating ADHD and learning differences has consequences.

The children suffer from poor self-esteem because they constantly are reminded that their behavior is bad or they fail to perform at their academic potential.

They have a harder time doing tasks at school because they lose focus. They get distracted and miss important information.

Children get in trouble for talking inappropriately, acting out or for invading other’s personal space.

Social skills lag behind those of peers and they often have a hard time interpreting how others react to their behaviors.

Their impulsivity can get them into dangerous situations, causing more injuries.

Older kids might suffer from depression and anxiety from years of “failures”.

Teens often try to self-medicate with drugs or alcohol.

Why are you hesitant?

If you still worry about labeling your child with a diagnosis, think about what the root of your worry really is.

Remember that the diagnosis is only a word. It doesn’t define the best treatments for your child, but it opens the doors to allow investigation of treatments that might help your child. In the end most parents want healthy, happy kids who will become productive members of society.

How can you best help them get there?

Looking for more?

Many parents benefit from support groups to learn from others who have gone through or are currently going through similar situations, fears, failures, and successes. Find one in your area that might help you go through the process with others who share your concerns. If you know of a support group that deserves mention, please share!

ADHD

CHADD is the nationwide support group that offers a lot online and has many local chapters, such as ADHDKC. I am a volunteer board member of ADHDKC and have been impressed with the impact they have made in our community in the short time they have existed (established in 2012). I encourage parents to attend their free informational meetings. The speakers have all been fantastic and there are many more great topics coming up!

Anxiety

Many parents are surprised to learn how much anxiety can affect behavior and learning. To look for local support groups, check out the tool on Psychology Today.

Autism

The Autism Society has an extensive list of resources.

Dyslexia 

Dyslexia Help is designed to help dyslexics, parents, and professionals find the resources they need, from scholarly articles and reviewed books to online forums and support groups.

Learning Disabilities 

Learning Disabilities Association of America offers support groups as well as information to help understand learning disabilities, negotiating the special education process, and helping your child and yourself.

Tourette’s Syndrome and Tic Disorders 

Tourette’s Syndrome Association is a great resource for people with tic disorders.

General Support Group List 

For a list of many support groups in Kansas: Support Groups in Kansas .

School information

Choosing schools for kids with ADHD and learning differences isn’t always possible, but look to the linked articles on ways to decide what might work best for your child. When choosing colleges, look specifically for programs they offer for students who learn differently and plan ahead to get your teen ready for this challenge.

Midwest ADHD Conference – April 2018

Check out the Midwest ADHD Conference coming to the KC area in April, 2018. I’m involved in the planning stages and it will be a FANTASTIC conference for parents, adults with ADHD, and educators/teachers.

Midwest ADHD Conference
The Midwest ADHD Conference will be held in April 2018, in Overland Park, Kansas.


Share Quest for Health

Cherish the Gifts of ADHD

Ok, so I know most parents of children with ADHD will read this title and think I’m crazy. Gifts of ADHD? Really?

Kids with ADHD have trouble with behavior, academics, and social skills.

Adults with untreated ADHD fail to meet their own expectations, as shared by Jessica McCabe, and have problems at work and home.

How in the world can we cherish ADHD?

ADHD involves impairments in executive functioning. How can anything causing a broken executive functioning system be cherished?

Because they also have many positive traits that can be cultivated.

  • People with ADHD tend to think outside the box so are great problem solvers.
  • They have lots of energy so can work tirelessly.
  • They are often very creative so are gifted in the arts.
  • They often have a great sense of humor.
  • We all think of their inattention and poor focus, but they also hyperfocus on things they love. If they become passionate about something, they can sustain attention and work on it for long periods of time. If they use this hyperfocus wisely (with setting time limits so they can do other daily activities) they can become an expert in that area. For young children the hyper focus tends to be on “kid” things, like trains or video games, but as they get older, allowing kids to experience activities that interest them will give the opportunity to find a life passion that could turn into a fantastic career.

gifts

First, we must realize that everyone has gifts.

ADHD has many variables in the way it shows up, so people with it also have many variations in gifts. But they do have gifts.

I want parents, spouses, siblings, grandparents, aunts, uncle, neighbors, teachers, and more to understand the value of these gifts and help children (and adults) recognize the benefits that people with ADHD can have.

“ADD people are high-energy and incredibly good brainstormers. They will often happily work 12 to 15 hours by choice. The business community should not fear ADD. Instead, they should see that they have a potential gold mine here.” – Dr. Kathleen Nadeau, psychologist

Despite those positive qualities, It’s easy to lose sight of them

Don’t forget to look for the gifts of ADHD despite the troubles.

I’m not saying life for them is easy.

It’s not.

They struggle with many things other people can easily manage. But they still have gifts. I want kids to grow up building their confidence by using their gifts, not by measuring their failures when they don’t conform to norms.

Kids can lose their drive and ambition if they are not supported along the way. Depression and anxiety can easily develop when kids continuously fail to meet their potentials.

School is not favorable to kids with ADHD.
It’s hard for kids with ADHD to stay on task and not rush through assignments.
  • Kids must sit in a chair for prolonged periods of time and keep quiet.
  • They need to color in the lines. They need to do all the steps in the order the teacher wants. Doing things someone else’s way is not easy for kids with ADHD.
  • They need to solve the math problem the way the teacher did it and show their work. They lose points if they get to the right answer but didn’t show their work or if they get there a different way. The teacher might assume they cheated to get the answer, but some kids just skip steps. To me that might just show brilliance. They can skip steps. Their brain just “gets” to the right answer. I never could figure math out without being told how to do it, but there are kids out there who can. What a gift! Unfortunately they feel dumb if they can’t show the steps just like the teacher taught. And it would be quite typical for a child with ADHD to have a brain that thinks this way if math is that child’s gift. What a shame that our schools tend to make these kids feel inferior because in the end they might resist working on math and will never reach their potential.

role models and resources

If your child struggles with the diagnosis, consider finding a mentor who is successful but has the same diagnosis.

Have them read Percy Jackson (link to a book review). He’s a fictional character with ADHD and dyslexia that kids can look up to.

Throughout history many successful people have had ADHD. Your child with ADHD can also become a leader, an inventor, an artist, or an otherwise excellent contributor to society. Let them see this list and see how many athletes, celebrities, and other leaders have ADHD.

Dr. Melissa Welby has compiled a list of her favorite books on ADHD.

cultivate the gifts!

We need to help these kids find their gifts and work on their challenges so that they can flourish.

Support them so they do not lose self-confidence.

Celebrate what they do right more than harping on what they do wrong.

Encourage them to develop their talents.

Help them find ways to accommodate for their struggles and to learn tools to help with some of the executive functioning problems they have.

Cherish them!

ADHD gifts
Yes. Cherish the gifts of ADHD.