Category: ADHD

What you need to know before your child is started on ADHD Medications

Girl on ADHD Medications

Clinical evidence shows that treatment for ADHD is very effective in controlling the symptoms of ADHD.  It works even better in combination with behavioral strategies.  These days the several different types of ADHD medications.  After the confirmation of ADHD diagnosis, if parents want to try meds, I discuss various options. They broadly can be categorized into 2 groups  stimulant and non-stimulants.  Various ADHD medications act differently on the brain  and also have  different spectrum of side effects.

The choice of medication depends on desired goals as well as anticipated side effects.  For example if a child  already does not have a good appetite I would avoid stimulants because it can reduce appetite and sometimes can also cause weight loss. On the other hand a child whose weight is ahead of his height may benefit from stimulants as they depress appetite. I like to talk to family about any family history of heart disease, high blood pressure, or substance abuse with your doctor.

Stimulant medication usually start working within half an hour to 1 hour.  The onset of action actually depends on  the dose and  formulation.  Short acting stimulants have to be administered more than once daily usually 2-3 times.  Long-acting stimulants can be given on the  once a day.  Different formulations of ADHD medications with same ingredient can result in different effects as well as side effects. Non-stimulant medications may take up to 2 or 3 weeks before a beneficial effect is seen.

Administration of ADHD Medications:

Stimulant medications are given in the morning and if you miss a dose then you should never double up the dose. Some medications can be sprinkled on food and can be mixed in water or juice such as Biphentin and Vyvanse. These medications are tasteless. On the other hand you can not open capsule of Strattera (non stimulant) as it is very bitter. You also can not break tablet of Intuniv or Concerta as they are long acting and gradual release of medication mechanism is disrupted by breaking the capsule.

Side Effects of ADHD Medications:

Stimulant medication can cause several side effects including headaches, reduced appetite, difficulty in falling asleep, abdominal pain.  Some children may experience worsening of symptoms when medication is radiating off in the afternoon or evening.  Some children also experience emotional outbursts  and may  cry on and free lives with pending particularly for first few days.  Generally this emotional response.  Soft and stimulant medication do not change the personality of the child. Serious side effects are rare, that may include dizziness, fainting, severe irritability or serious behavioral changes.

Reference:

Patient education: Treatment of attention deficit hyperactivity disorder in children (Beyond the Basics)

ADHD Diagnosis-Is it Really ADHD?

ADHD Diagnosis

ADHD is diagnosed using standard guidelines.  The DSM-5 diagnostic guidelines are available specifically for children  between 4-18 years of age.   I generally withhold the diagnosis of ADHD  in children younger than 4 years of age.  It is often difficult to assess attention span  in a child younger than 4 years of age.  And  intervention is rarely necessarily at this age.

There is  no single test available for the diagnosis of ADHD.  The diagnostic process requires  collection of information from several different sources. I want to see if the child has similar spectrum of symptoms in different situations and locations. It is also important to ascertain whether the severity of symptoms are severe enough to impact his life.  The impact on life may occur because of poor academic performance, inability to make friends or if it  is impacting quality of life in any other way.

Children’s with ADHD have 3  clusters of symptoms  that include  inattention, hyperactivity and/or impulsivity.  It is important for us to look at the child’s behavior individually  and compare  to that of other children of similar age. It is also essential that information is provided by  primary caregiver as well as other individuals who spend significant time with the child  such as teachers, daycare workers, or his/her coaches.

ADHD Diagnostic Symptoms:

The following are the diagnostic criteria that are used to confirm a diagnosis of ADHD:

Symptoms of Inattention:

  • Easily distracted and avoids any task that require sustained attention
  • Forgetful and needs constant reminder and redirection
  • Loses and  misplaces both normal belongings such as gloves or pencils
  • Does not seem to respond when spoken directly
  • Often  fails to  pay attention to details and makes careless mistakes

Symptoms of hyperactivity & impulsivity:

  • Often fidgets and squirms often on the go and appears to be driven like to motor
  • Cannot participate in leisure activities quietly
  • Talks excessively
  • Cannot wait for  his/her turn
  • Blurts out answers  before question is completed
  • Interrupts and intrudes on others

ADHD Diagnostic Criteria:

In order for us to make a diagnosis confidently following criteria must be met:

  • The symptoms must occur in 2 or most settings such as home  school daycare or other social situations and must be causing  some impairment.
  • Children ranging between 4-17 years of age should have at least 6 or more symptoms while children 17 years and older must have 5 or more symptoms to qualify for the diagnosis of ADHD.
  • Symptoms  must have started before the child  reaches that 12 years of age however these symptoms may have not been recognized until the child is older.
  • Symptoms should have continued for more than 6 months  and  must impair the child’s ability to function at home or school.   It may affect schoolwork or relationship with friends or siblings.
  • In addition to looking at your child’s behavior, I do a physical and a thorough neurologic examination. A detailed medical history is necessary to understand the child’s behavior and rule out medical conditions that may affect his/her behavior.

I also like to screen children additionally for anxiety, depression, learning disorder,  developmental coordination disorder, aggression, sleep problems etc.