Treating ADD and ADHD: a Pediatrician’s Perspective – Part II
Last updated on March 12th, 2018 at 09:43 am
After the appropriate diagnosis is made and the correct testing and observation has been performed (see Diagnosing ADD or ADHD: a Pediatrician’s Perspective), a more secure diagnosis can now be entertained and we can move on to treatment.
At first, parents might very well take the stand of further observation as their children change classes and friends. This is not at all unreasonable, especially if medications are discussed, but medication for ADD or ADHD should be the last resort on the list of possible treatment options to help your child use all of his/her resources to reach the best goal. The first and the “easiest” intervention should be educational. Teachers should receive the results and suggestions deriving from those results that are directly related to the organizational aspects of the classroom. Many educational institutions are fully capable of employing the suggested techniques regarding the special nature of teaching children with such problems. Many schools are limited by space or funding for such programs but every effort should be made to involve the school first.
As I alluded to in part one of this series of posts, there are many conditions that mimic ADD or ADHD in presentation and actions. If any of these are found, the appropriate psychological help and input should be sought. Even in the absence of such specific emotional or psychological problems, I feel that counseling should be obtained for the entire family, as it can be a struggle for family members to deal with such a child. Counseling can help family members to handle certain situations in an appropriate and non- traumatic way to them and the children.
Finally, when all treatment options are brought to bear in an effort to ameliorate the issue and the problems still exist, medication should be discussed and considered. There are several ADD and ADHD medications available on the market right now. Generally they are broadly divided into stimulant and non-stimulant medications, and there are several medications within each division.
- Of the stimulant medications there are derivatives of methylphenidate and amphetamines: different forms of these medications allow for various routes of administration, side effects and overall effects on the child. Side effects of all of these medications are very similar but are not very common. The most common of these side effects can be decreased appetite and even slow weight gain as a result. Others include poor sleeping, increased activity and heart rate and a period of downtime as the medications wear off. All of these are usually short lived and can be altered by changing the type and/or dosage of these medicines.
- The second broad category of medicines are the non-stimulant variety. Although these are “non-stimulant” in chemical nature, the end effects of both types of medications can be the same, with the same side effects.
Having said all that, if the appropriate medications are used for the correct diagnosis in the proper dosage and form, the results can be astounding and lead to a much more stable and enjoyable family situation. There is much written about these medications (see recommendation below) and certainly no medicine should ever be used for an inappropriate reason.
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Dr. Joe Recommends:
- Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill by Lawrence Diller, M.D.
Editor’s Note:
- A terrific example of using a psychological approach to help manage some of the symptoms of ADHD can be seen in a post called ADHD and “Menditation” by pediatric psychologist Dr. Lynne Kenney.
Restoring Parental Joy to Support Happy, Healthy Kids
Last updated on August 31st, 2015 at 01:47 am
Parenthood is supposed to be a joy-filled journey – or so the ads and Facebook memes tell us. So why does it seem as though our days are largely about nagging, supervising homework, changing diapers and shuttling kids to and from their activities? What’s wrong with this picture?
“Today’s mothers are stressed out, overworked and pulled in so many directions that it can be hard to find the pleasure in parenting,” says Barbara Siergiewicz, a certified parent coach and child development specialist based in Rockport, Mass. “But if you remember how happy you were when you got pregnant and what you appreciate about your children, instead of the challenges of parenting, you’re making a choice to be joyful.” And happy parents create a happier, healthier environment for kids.
Follow this roadmap to restore the pleasure of parenting:
Make a Heart Connection
Set aside time every day to have a meaningful conversation with your child – one that’s focused on feelings, not homework or chores. “Ask open-ended questions to find out what’s going on in your child’s life,” advises Siergiewicz. “For example, ‘What was the best thing that happened today?’ or ‘What was the funniest thing that happened?’” No matter where the conversation takes place – whether over dinner or in the car – stay in the moment by listening intently. This will create a more relaxed, closer parent-child relationship and will foster what Siergiewicz calls the “heart connection.”
Stop the Gripe Sessions
Sure, it feels good to vent to your BFFs about your kids’ picky eating or to send a Twitter feed about your mom meltdown. But making it a habit is a big mistake – and becomes a self-fulfilling prophecy. “If you concentrate on the negative of parenting, it’s like pouring kerosene on the fire,” says Siergiewicz. “Negativity begets negativity — and that will keep you from rediscovering the joy of being a parent.” Try sharing the good things – photos of your child playing in the snow or news of a school concert – and you’ll be rewarded with a glow of pride.
Catch Them Being Good
“Many parents expect adult-level performance from their kids, and they’re not capable of delivering it,” says Siergiewicz. This sets up a lose-lose situation, with the child falling short and the parents feeling perpetually disappointed. Rather than focusing on what your 10-year-old does wrong and nagging him about it (which isn’t very joyful), accept that he’ll make mistakes and praise him for what he does right. Saying “Thanks for putting away your toys” or “Thanks for clearing your plate without being asked” reinforces good behavior. As Siergiewicz notes, “Positive feedback will boost your child’s self esteem and lead to more of the positive behavior you want to see.” And the better the behavior, the less nagging you’ll need to do.
Clear the Calendar
Jam-packed schedules are a recipe for cranky kids and exhausted parents. Limit your child to just two extracurricular activities each week – say, basketball and guitar lessons – so everyone will have a chance to relax, recharge and reconnect. The less time you spend racing from one activity to another, the more time you’ll have to be in the moment with your children and simply enjoy their company.
Create Family Rituals
Families need regular fun time, whether it’s watching a movie together on Friday night or going out for breakfast on Saturday morning. Having something that everyone can look forward to helps increase the joy. “Family rituals that are positive, loving and nurturing – where parents and children are focused on each other – create lasting memories that sustain us through hard times,” says Siergiewicz. (Like those days when you’re busy carpooling!)
Tips to Help Raise an Independent and Confident Child
Last updated on April 23rd, 2014 at 11:58 am
Next time you’re about take over your child’s science project or even make their bed, put down the poster board and leave the sheets where they lie. While we may want to do everything we can to make our kid’s lives easier. we shouldn’t.
There’s a fine line between being supportive and doing too much for our children. Here, two child development experts offer five ways to gently sway you away from becoming a helicopter parent.
Bonus: these parenting tips will help your children become more independent and confident, boosting their mental strength and health.
1. Create Little Helpers
If your kids are young, it’s easier to get the idea of doing chores ingrained in their heads. For a preschooler it’s as easy as saying something like “When you finish playing with those blocks, the next part of play is putting them away,” suggests Margaret Owen, PhD, director of the Center for Children and Families at the University of Texas in Dallas.
2. Direct over Do
If your school-age child hasn’t gotten in the habit of doing chores, don’t despair. Just be patient. It’s tempting to get frustrated when your child doesn’t clean up his room or put his clothes back in the closet – but maybe he doesn’t know how. “Did you talk about where his backpack should go after school?” Dr. Owen says. “Or does he know where the knives and forks go when setting the table? You have to patiently demonstrate those tasks.”
3. Give Her a Say
The best way you can prompt independence in your child is to make sure he or she is participating in the running of the household. “Say things like ‘How about you help me plan the menu for dinner’ or ‘how about you help me fold these clothes,’” says Vicki Hoefle, a parenting expert in Seattle and author of Duct Tape Parenting (Workman, 2012). “Life is about helping out. Kids don’t need coaxing, elaborate systems or rewards so long as the chore is a job they can handle.”
4. Have Faith
By doing things for your children instead of letting them try, you’ll ultimately make your kids question their ability to do anything for themselves. “Our children determine their self-identity based on how we as parents see them,” says Hoefle. “Think about the message you’re sending to your child by saying ‘Let me help you,’ ‘This looks too hard’ or ‘It’ll be easier if you do it this way,’” she says. “After all, these benign statements affect a child’s sense of herself.” When your kids do make the effort, avoid hovering over them or criticizing the quality of their work. “Think about how you would feel if someone did this to you,” Hoefle says. “The answer is always that you’d feel lousy.” The laundry may not be folded perfectly and there may be a missed math problem or two, but with practice and encouragement, your children will improve.
5. Be the Support
If you think of your child as a building and that your job is to be the scaffold, you’ll be parenting in a way that sets up your child for life. “As her scaffold, your job is to prop her up when she needs you,” Dr. Owen says. “Ultimately, your job is to then take away some of the layers of the scaffold as she gets stronger.”
Are You a Drama Mama? Know When to Back Off
Last updated on March 3rd, 2014 at 10:57 pm
Your child has a fight with a friend. She’s in tears; you’re furious and ready to defend her. But should you? In this age of helicopter parenting, it’s hard not to step in when you see your child in a social dilemma. But that’s not always the answer.
“In recent years, I’ve seen a trend of mothers confronting other mothers – by phone or email, or in person – to resolve their kids’ social issues; I call it ‘Mama Drama,’” says Joyce Marter, a psychotherapist and the owner of Urban Balance LLC in Chicago. “It’s problematic on several levels: It not only crosses boundaries, but also prevents kids from developing coping skills and learning that it’s not a perfect world where everybody always gets along and gets included.”
Laurie Zelinger, a child psychologist and the author of Please Explain Anxiety to Me! Simple Biology and Solutions for Children and Parents, agrees. “Social slights occur and recur throughout life,” she says. “You lived through them, so your child deserves the opportunity to live through them too.”
Here are some common kid dramas your child may face, and how to help her survive them – without being a drama mama.
Drama: Your second-grader is hurt because she didn’t get invited to a classmate’s birthday party.
Solution: Don’t call the birthday child’s mom and demand an invite for your child. Not only is this rude, but it also puts the mom in an awkward position if she has limited space or money for the party.
Instead, help your child deal with her disappointment by sharing your own sadness about times when you were left out of parties or clubs. Remind her that she didn’t invite the entire class to her last birthday party, and, if the classmate isn’t a close friend of hers, point that out. Finally, suggest a get-together with her true pals. “The real problem might be that she needs more social interaction,” says Marter.
Drama: Your son complains that no one plays with him at recess.
Solution: Talk to your child about being excluded, and make supportive statements – “I bet you never expected that to happen” – to validate his feelings. “If you ask too many questions, you’ll sound like a detective and put him on the defensive,” cautions Fred Zelinger, a child and family psychologist in Cedarhurst, N.Y. “You’ll end up getting less information than you would in a normal parent-child conversation, where he tells you something and you respond with a comment.”
Call or email his teacher, explain the situation and ask if she’s noticed anything that might be causing the problem. Maybe your child is being left out because he doesn’t play fair or gloats too much when he wins. “You can’t force other kids to play with him at recess, but you can coach him on his behavior and how to engage a different group of kids,” says Marter. “Urge him to be assertive and say things like, ‘I want to play this game too.’”
Drama: Your 10-year-old is on the outs with her BFF — whose mom just happens to be a good friend of yours.
Solution: Since you’re close with the other mother, it’s OK for both of you to help the girls resolve their differences, according to Marter. First, ask your daughter what caused the rift, keeping in mind that she’s telling only one side of the story. Be supportive – “It hurts when your friend is mad at you, doesn’t it?” – and suggest she try a heart-to-heart to end the fight.
From there, discuss the issue with your friend – without placing blame on anyone: “It’s hard to watch our girls go through this. It’s probably just a misunderstanding. Let’s get them to sit down and work it out.” Says Marter: “Give your child the tools she needs to have an effective conversation with her friend, but don’t have the conversation for her.”
Pediatric Safety Announcement: Welcome Dr. Michele Borba!
Last updated on March 2nd, 2018 at 02:37 pm
Please join us in welcoming our new Child Psychology and Bullying Prevention Expert Dr. Michele Borba to the PedSafe Expert Team!
5 Digital Ways to Build Important Bonds with Grandparents
Last updated on March 2nd, 2018 at 02:43 pm
When we were kids, we likely spent time getting to know grandma by baking cookies with her. Or we went fishing with grandpa, or played a game of Monopoly after Sunday dinner. These bonds are important support for kids.
These days, though, extended families are more likely to be spread out, more than an afternoon’s drive from each other.
The good news is, today’s grands are also more tech-savvy than they were even five years ago. In 2012, 53 percent of American adults over the age of 65 used the Internet and email, according to the Pew Research Center. This is the first time in history that at least half of senior citizens are web fluent.
Those two trends make for the perfect opportunity to try out some of the new sites and apps that grandparents can use to stay close to their grandkids. If your parents live far away, you’re probably already using Skype to keep them in the loop on your kids’ daily lives. Here’s what else is worth a try:
Face Juggler: This new app lets you take photos of multiple people, swap the faces, then share the new portraits via email. It sounds silly, but makes for some addictive fun. My 10-year-old neighbor, Christopher Bein, has tried this out: “Grammy Lois said she hasn’t laughed so hard in a long time!”
Scoot & Doodle: This website is a shareable doodle pad. All you need are Gmail addresses and a mouse. It’s the new drawing-together-at-the-dining-room-table – and the perfect way for grandparents to interact with their grandkids online.
Grandparent Games: Set up a free account to connect your parents and your kids face to face to play interactive activities together. There’s also a mobile app.
Instagram: You and your tween or teen may be using it, yet you probably haven’t thought of encouraging your parents or in-laws to join. But why not? It’s a social network based solely on photo sharing, something most grandparents love. It’s really appealing to seniors who aren’t quite ready for the Facebook scene.
Ancestry app: Researching your family tree is more popular than ever with our parents’ generation. They, in turn, relish sharing their discoveries with their grandchildren. The Ancestry app lets grandparents and their favorite kids build their family tree together. They can learn the history of previous generations and record their findings at the same time.
