Category Archives: Treatment

ADHD–Part II

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ADHD, as stated in my last post, is one of the most common chronic health conditions for children.  Those with this condition have difficulty regulating their behaviors, attention, and/or impulsivity.  ADHD presents itself in school, home, and the community and can present challenges in each environment.

ASSESSMENT

A comprehensive assessment involving multiple methods conducted by multiple professionals within different settings is important for arriving at a diagnosis of this disorder. Too often the diagnosis of ADHD is made too quickly or by observation alone.  The assessment should consist of communication with the child’s medical professional, and other sources, including a psychologist, educational personnel, and family. A direct assessment of the child is also recommended. The assessment should address the age of onset of the symptoms, the degree that it impairs the child, and any other features.

How do we obtain information from different sources?  First, I believe a good history is essential, one involving the child’s health, family background, and when the child’s developmental milestones were reached. A thorough history is also ascertained from information provided by school records, the child’s physician, and family members, as well as any others who might be familiar with the child.

Secondly, a physical evaluation is essential (and oftentimes, a neurological evaluation is also indicated) to rule out other causes of the disorder.

Next, information obtained from family should address different settings and include ADHD parent and child rating scales or checklists, including the assessment of inattention, hyperactivity, and impulsivity. The family assessment should also include structured and unstructured interviews.

School/classroom assessments are teacher-reported and can provide information including teacher rating scales and checklists of inattention, hyperactivity, and impulsivity, teacher narratives and reports, schoolwork, grades, and work samples, as well as specific data regarding the child’s behaviors in the classroom.

Finally, an assessment of coexisting conditions should take place that rule in or out other disorders that may include depression, learning disabilities, and anxiety, to name a few.

TREATMENT

There is no cure for ADHD at this time, but many treatments exist which are effective in the management of the disorder. When speaking of any treatment, most important is the education of the family and school staff about the nature of the disorder and its management for children. But among all of the treatments available, which ones are most effective?

The treatment that results in the greatest degree of improvement in the symptoms of ADHD is stimulant and nonstimulant medications.  Before medications are considered, though, academic and behavioral interventions and accommodations should be implemented for a reasonable time. Sometimes these interventions are effective alone.  According to the American Academy of Pediatrics (AAP), 80 percent of the children who use stimulant medications, either alone or with behavior therapy, show increased focus and decreased impulsivity. The most common stimulant medication, Ritalin, has been used for over 40 years in children and has shown to be safe. Strattera is a nonstimulant medication that is frequently used with children, as well. Antidepressants seem to be less effective, but are often used with those who have coexisting symptoms of mood disorders.  Some children may need a combination of medications depending on if they have other disorders along with their ADHD. There are side effects to these medications and they should be discussed with the physician who is in charge of prescribing them.

The decision to use medications can be a difficult one for parents, and rightly so!  If you do decide to try medication for your child’s ADHD, there must be close monitoring and frequent reassessment to decide if the treatment is working. Each decision about whether to try or not try medication should be based on what is best for the child as an individual.  There is a great deal of information available on the pros and cons of starting your child on ADHD medications.

Psychological treatments, such as behavior modification in school, social skills training, and parent training in child behavior management techniques have shown to have short- term effects.  Some studies suggest that once treatments end, so do the gains obtained (as with medication treatment, as well). Therefore, ADHD should be seen as a chronic condition that requires ongoing treatment for good, long-term management of the symptoms. Counseling can help parents and children understand the disorder, improve social skills, assist with behavioral interventions, and help those who are having difficulty coping.

Some children with ADHD may be eligible for special education services in the public schools under the Individual with Disabilities in Education Act – IDEA- and/or Section 504 of the Rehabilitation Act of 1973. To qualify for these services, the symptoms of the ADHD must be interfering with the child’s ability to learn in school. Thus, the comprehensive evaluation is important to ascertain whether the school services are warranted.

In summary, the treatment of ADHD requires a comprehensive behavioral, psychological, educational, and sometimes medical evaluation, along with the education of family members as to what this disorder is and the methods proven to assist with its management. Once the ADHD condition is managed, those with this disorder can usually lead adjusted and productive lives.

Please feel free to comment about this topic.  I welcome your feedback!

Can I Advocate for My Child’s Mental Health Needs? (*Of course, you can!!)

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Since 1949, May has been declared National Mental Health Awareness Month to draw attention to mental health issues that affect many Americans. As part of this effort, the first week in May is National Children’s Mental Health Week, which raises awareness about the importance of children’s mental health to their overall healthy development.  Today’s blog will focus on advocacy for your child regarding their mental health.

According to the U.S. Surgeon General, 1 child in 5 experiences significant problems with a psychiatric disorder. Sadly, only less than 1 in 3 is receiving the treatment that they need. This issue has come to the forefront due to several recent tragedies and the realization that mental health treatment is so often not available for those children who need it. Early detection and screening of children is also hotly debated around the country as to its effectiveness in the prevention of violence.

NAMI (National Alliance on Mental Illness) recently shared an article on tips for parents to advocate for their child regarding their child’s mental health. As written by Dr. David Fassler, Child and Adolescent Psychiatrist, I found these tips to be quite informative and helpful for individual advocacy. I hope many of you will find these tips useful, as well:

  • Get a comprehensive evaluation for your child to address your concerns. This may include several visits to a mental health professional. A careful and accurate diagnosis will yield effective treatment.
  • Look for the best clinician in your area pertaining to your child’s condition.  Check their credentials carefully: Are they appropriately licensed or certified in your state? If he/she is a physician, are they board certified? Push schools, insurance companies and state agencies to provide the most appropriate and best possible services, not merely those that are deemed adequate or sufficient.
  • Ask lots of questions about any diagnosis or proposed treatment, and enlist your child’s questions, as well. Child disorders may be very complex and simple solutions usually don’t exist. Most, if not all treatments have both risks and benefits.
  • Seek family centered treatment that builds on your child’s strengths. Ask about goals and objectives of treatment and how you will know if the treatment is helping. If treatment does not work, ask about options or alternatives.
  • Remember to keep all copies of consultations, treatment reports, and assessments in an organized place. Ask and insist on your own copies of all evaluations and maintain your own file on your child. This avoids unnecessary duplication of previous treatment efforts and future unnecessary testing.
  • Feel free to seek a second opinion. Any mental health professional should be happy to help with referrals and sharing information for the benefit of your child.  If you question a diagnosis or a treatment for your child, absolutely arrange an independent consultation with another clinician.
  • Help your child learn about their specific condition in an age appropriate fashion.  Use books, pamphlets, or the Internet to access information that your specific aged child can understand. Remember not to overload your child with more detail than they want or need.
  • Work with your child’s school. Be included in all school meetings held to discuss your child. Request school records and keep them at home in your organized file.  Make sure their educational program is meeting their specific needs.
  • Know the details about your insurance policy and how it affects your access to mental health care. Know their coverage of “specialists.”
  • Learn about your state’s reimbursement and funding systems. How does Medicaid work? Which services are covered and which are excluded? What other sources of funding is available for your child.
  • Seek out support from other parents by joining a local parent support group.  If none exists, think about starting one in your area.
  • Attend local and national conferences of parent and advocacy organizations where information is shared, ideas are offered, support is given and camaraderie is available.

Advocacy is hard work; there is no right or wrong way to be an advocate for your child.  It takes a lot of time and energy to advocate for better mental health access, but in the end you will help not only your own child, but also others who deserve access to appropriate and effective mental health treatment.

How do you advocate for your child or children in general?  I’d love to hear your stories and as always, thank you for sharing.