ERIC ED368136: Medical Management of Children with Attention Deficit Disorders: Commonly Asked Questions.

4 Pages·1991·0.14 MB·English

by  ERIC

DOCUMENT RESUME
ED 368 136
EC 302 892
AUTHOR
Parker, Harvey C.
And Others
TITLE
Medical Management of Children with Attention Deficit
Disorders: Commonly Asked Questions.
INSTITUTION
American Academy of Child and Adolescent Psychiatry,
Washington, DC.; Children with Attention Deficit
Disorders, Plantation, FL.
PUB DATE
91
NOTE
4p.
PUB TYPE
Inforaation Analyses (070)
Journal Articles (080)
JOURNAL CIT
CHArDER; p17-19 Fall-Win 1991
EDRS PRICE
MF01/PC01 Plus Postage.
DESCRIPTORS
*Attention Deficit Disorders; Clinical Diagnosis;
*Drug Therapy; *Medical Services; *Stiaulants;
Student Characteristics; Teacher Role
IDENTIFIERS
*Antidepressants
ABSTRACT
This brief article uses a question and answer format
to review basic information about medical management of children with
attention deficit disorders (ADD). Questions address:'characteristics
of ADD; how parents and teachers can tell if a child might have ADD;
types of services and programs which help these children and their
families; medications prescribed for ADD children; how
psychostimulants appear to help ADD children; common side effects of
psychostimulant medications; the use of tricyclic antidepressants in
treating ADD; side effects of tricyclic antidepressant medications;
ADD children who do not respond well to medication; dispensing of
medications at school to an ADD child; monitoring of effectiveness of
medications and other treatments; the role of the ADD child's
teacher; and refutations of common myths associated with ADD
medications.
(DB)
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Reproductions supplied by EDRS are the best that can be made
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Medical Management of Children with Attention Deficit Disorders
Commonly Asked Questions
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EDUCATIONAL RI SOURCES INFORMATION
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Children with Attention Deficit Disorders (CH.A.D.D.)
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American Academy of Child and Adolescent Psychiatry (AACAP)
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Harvey C. Parker, Ph.D.
spent Par n,s1 neSeSSaols represent
0. DOPPOo OP POnC,
CH.A.D.D., Executive Director
George Storm, M.D.
CH.A.D.D., Professional Advisory Board
Committee of Community Psychiatry and Consultation to Agencies of AACAP
Theodore A. Petti, M.D., M.P.H., Chairperson
Virginia Q. Anthony, AACAP, Executive Director
This article may be reproduced and distributed without written permission. Tear out for easy use.
3. What kinds of services and pro-
1. What is an Attention Deficit Dis-
However, you don't have to be hyperac-
grams help children with ADD and their
order.
tive to have an attention deficit disorder. In
families?
fact, up to 30% of children with ADD are
deficit disorder (ADD), also
Attention
not hyperacVve at all, but still have a lot of
known as attention
hyperactivity
deficit
trouble focusing attention.
disorder (ADHD), is a treatable disorder
2. How can we tell if a child has ADD?
which affects approximately three to five
per cent of the population. Inattentiveness,
Many factors can cause children to have
impulsivity, and oftentimes, hyperactivity,
problems paying attention besides an at-
are common cha:acteristics of the disorder.
tention deficit disorder. Family problems,
Boys with ADD tend to odtnumber girls by
stress, discouragement, drugs, physical ill-
three to one, although ADD in
girls
is
ness, and learning difficulties can all cause
underidentified.
problems that look like ADD, but really
Some common symptoms of ADD are:
arent To accurately identify whether a child
Help for the ADD child and the family is
1. Excessively fidgets or squirms
has ADD, a comprehensive evaluation
best provided through multi-modal treat-
2. Difficulty remaining seated
needs to be performed by professionals
ment delivered by a team of professionals
3. Easily distracted
who are familiar with characteristics of the
who look after the medical, emotional,
4. Difficulty awaiting turn in games
disorder.
behavioral, and educational needs of the
5. Blurts out answers to questions
STRESS
6. Difficulty following instructions
child. Parents play an essential role as coor-
DISCOURAGEMENT
dinators of services and programs design-
7. Difficulty sustaining attention
PHYSICAL ILLNESS
ed to help their child. Such services and
LEARNING DIFFICULTIES
programs may include:
FAMILY PROBLEMS
The process of evaluating whether a
Medication to help improve attention,
child has ADD usually involves a variety of
and reduce impulsivity and hyperactiv-
professionals which can include the family
ity, as well as to treat other emotional or
physician, pediatrician, child and adoles-
adjustment problems which sometimes
psychiatrist
psychologist,
cent
or
accompany ADD.
neurologist, family counselor and teacher.
Training parents to understand ADD
psychological and
interview,
Psychiatric
and to be more effective behavior
educational testing, and/or a neurological
managers as well as advocates for their
provide
examination
information
can
child.
leading to a proper diagnosis and treat-
ment planning. An accurate evaluation is
Counseling or training ADD children in
necessary before proper treatment can
methods of self-control, attention focus-
Complex cases
ing, learning strategies, organizational
which
begin.
the
in
8. Shifts from one activity to another
diagnosis is unclear or is complicated by
skills, or social skill development.
9. Difficulty playing quietly
other medical and psychiatric, conditions
Psychotherapy to help the demoralized
10. Often talks excessively
should be seen by a phys'.cian.
b40
or even depressed ADD child.
11. Often interrupts
Parents and teachers, being the primary
at home and at
12. Often doesn't listen to what is said
sources of information about the child's
Other interventions
13. Often loses things
ability to attend and focus at he -1
and in
designed
enhance
school
to
sell-
14. Often engages in dangerous activ-
esteem and foster acceptance, ap-
school, play an integral part in the evalua-
ities
tion process.
proval, and a sense of belonging.
2
Fall/Winter 1991
17
CHADDER
8. What are the side effects of tricyclic
4. What medications are prescribed for
with stimulants may become irritable and
antidepressant medications?
more sensitive to criticism or rejection.
ADD children?
Sadness and a tendency to cry are occa-
Medications can dramatically improve
Side effects include constipation and dry
sionally seen.
mouth. Symptomatic treatment with stool
attention span and reduce hyperactive and
The unmasking or worsening of a tic
softeners and sugar free gum or candy are
impulsive behavior. Psychostimulants have
infrequent
of
effect
disorder
an
is
usually effective in alleviating the discom-
been used to treat attentional deficits in
In some cases this involves
stimulants.
fort; Confusion, elevated blood pressure,
children since the 1940's. Antidepressants,
Tourette's Disorder. Generally, except in
precipitation
manic-like
possible
of
while used less frequently to treat ADD,
Tourette's, the tics decrease or disappear
behavior and inducement of seizures are
have been shown to be quite effective for
with the discontinuation of the stimulant.
uncommon side effects. The latter three oc-
the management of this disorder in some
Caution must be employed in medicating
individuals who can
vulnerable
cur
children.
in
there are
adolescents with stimulants
if
generally be identified during the assess-
e.g. depression,
coexisting disorders,
ment phase.
substance abuse, conduct, tic or mood
9. What about ADD children who do
Likewise, caution should be
disorders.
not respond well to medication?
employed when a family history of a tic
disorder exists.
Some ADD children or adolescents will
Some side effects, e.g. decreased spon-
either the
not respond
to
satisfactorily
taneity, are felt to be dose-related and can
psychostimulant or tricyclic antidepressant
be alleviated by reduction of dosage or
medications. Non-responders may have
switching to another stimulant. Similarly,
severe symptoms of ADD, may have other
height and weight gain
of
of
slowing
problems in addition to ADD, or may not be
children on stimulants has been docu-
able to tolerate certain medications due to
mented, with a return to normal for both oc-
adverse side effects as noted above. In
curring upon discontinuation of the medica-
such cases consultation with a child and
tion. Other less common side effects have
adolescent psychiatrist may be helpful.
been described but they may occur as fre-
5. How do psychostimulants such as
quently with a placebo as with active
10. How often should medications be
Dexedrine (dextroamphetamine), Rita lin
medication. Pemoline may cause impaired
dispensed at school to an ADD child?
(methylphenidate) and Cyiert (pemoiine)
liver functioning in 3% of children, and this
help?
Since the duration for effective action for
may not be completely reversed when this
Ritalin and Dexedrine, the most commonly
Seventy to eighty per cent of ADD
medication is discontinued.
used psychostimulants, is only about four
Over-medication has been reported to
rhildren respond in a positive manner to
hours, a second dose during school is often
cause impairment in cognitive functioning
psychostimulant medication. Exactly how
required. Taking a second dose of medica-
and alertness. Some children on higher
these medicines work is not known. How-
tion at noon-time enables the ADD child to
doses of stimulants will experience what
ever, benefits for children can be quite
ap-
focus
utilize
effectively,
attention
has been described as a "rebound" effect,
significant and are most apparent when
propriate school behavior and maintain
consisting of changes in mood, irritability
concentration is required. In classroom set-
academic productivity. However, the noon-
and increases of the symptoms associated
tings, on-task behavior and completion of
time dose can sometimes be eliminated for
with their disorder. This occurs with variable
assigned tasks is increased, socialization
whose afternoon
academic
children
degrees of severity during the late after-
with peers and teacher is improved, and
schedule does not require high levels of at-
noon or evening, when the level of medi-
disruptive behaviors (talking out, demand-
tentiveness. Some psychostimulants,
i.e.
cine in the blood falls. Thus, an additional
ing attention, getting out of seat, noncom-
SR Ritalin (sustained release form) and
low chse of medicine in the late afternoon
pliance with requests, breaking rules) are
Cylert, work for longer periods of time (eight
or a decrease of the noontime dose might
reduced.
to ten hours) and may help avoid the need
be required.
The specific dose of medicine must be
Antidepressant
dose.
for noon-time
a
determined for each child. Generally, the
7. When are tricyclic antidepressants
medications used to treat ADD are usually
higher the dose, the greater the effect and
such as Tofranil (Imipramine), Nor-
taken in the morning, afternoon hours after
side effects. To ensure proper dosage,
pramin (deslpramine) and Elavli (amy-
school, or in the evening.
regular monitoring at different levels should
triptyline) used to treat ADD children?
In many cases the physician may recom-
be done
clear
are
there
no
Since
mend that medication be continued at non-
This group of medications is generally
guidelines as to how long a child should
school times such as weekday afternoons,
considered when contraindications to stim-
take medication, periodic trials off medica-
weekends or school vacations. During such
ulants exist, when stimulants have not been
tion should be done to determine continued
non-school times lower doses of medication
effective or have resulted in unacceptable
need. Behavioral rating scales, testing on
than those taken for school may be suffi-
side effects, or when the antidepressant
continuous performance tasks, and the
cient. It is important to remember that ADD
property is more critical to treatment than
child's self-reports provide helpful, but not
is more than a school problem
is a
it
the decrease of inattentiveness. They are
infallible measures of- progress.
problem which often interferes in the learn-
used much less frequenity than the stimu-
Despite myths to the contrary, a positive
ing of constructive social, peer, and sports
response to stimulants is often found in
lants, seem to have a different mechanism
activities.
of action, and may be somewhat less effec-
adolescents with ADD, therefore, medica-
tive than the psychostimulants in treating
tion need not be discontinued as the child
11. How should medication be dis-
ADD. Long-term use of the tricyclics has
it is still needed.
reaches adolescence if
pensed at school?
not been well studied. Children with ADD
6. What are common side effects of
who
regardless
important,
of
who are also experiencing anxiety or de-
Most
psychostimulant medications?
dispenses medication, since an ADD child
pression may do best with an initial trial of a
may already feel 'differenr from others,
tricyclic antidepressant followed, if needed,
Reduction in appetite, loss of weight, and
care should be taken to provide discreet
with a stimulant for the more classic ADD
falling asleep are the most
problems in
reminders to the child when it is time to take
symptoms.
common adverse effects. Children treated
3
Fall/Winter 1991
18
CHADDER
Myth: Positive response to medication is
medication. It is quite important that school
confirmation of a diagnosis of ADD
personnel treat the administration of medi-
shows
child
that
a
Fact: The
fact
manner, thereby
a sensitive
cation
in
improvement of attention span or a reduc-
safeguarding the privacy of the child or
tion of activity while taking ADD medication
adolescent and avoiding any unnecessary
does not substantiate the diagnosis of
embarrassment. Success in doing this will
ADD. Even some normal children will show
increase the student's compliance in taking
a marked improvement in attentiveness
medication.
when they take ADD medications
The location for dispensing medication at
Myth: Medication stunts growth
school may vary depending upon the
Fact: ADD medications may cause an in-
school's resources. In those schools with a
itial and mild slowing of growth. but Over
full-time nurse, the infirmary would be the
the growth suppression
effect
is
time
first choice. In those schools in which a
minimal if non-existent in most cases
nurse is not always available, other properly
Myth: Taking ADD medications as a
their
and manage ADD students
in
trained school personnel may take the
child makes you more reliant on drugs as
classroom.
responsibility of supervising and dispens-
an adult.
Here are some ideas that teachers told us
ing medication.
Fact: There is no evidence of increased
have helped:
12. How should the effectiveness of
medication taking when medicated ADD
Build upon the child's strengths by of-
medication and other treatments for the
become adults,
there
nor
fering a great deal of encouragement and
is
children
ADD child be monitored?
evidence that ADD children become ad-
praise for the child's efforts, no matter how
dicted to their medications.
small.
Important information needed to judge
Myth: ADD children who take medica-
Learn to use behavior modification
effectiveness of medication
usually
the
tion attribute their success only to medica-
programs that motivate students to focus
comes from reports by the child's parents
attention, behave better, and complete
tion.
and teachers and should include informa-
Fact: When self-esteem is encouraged, a
work.
tion about the child's behavior and atten-
Talk with the child's parents and find child taking medication attributes his suc-
social
tiveness, academic performance,
cess not only to the medication but to him-
helpful strategies that have worked with the
and emotional adjustment and any medica-
child in the past.
self as well.
tion side-effects.
medication,
the child taking
is
If
Reporting from these sources may be in-
communicate frequently with the physician
formal through telephone, or more objec-
Summary of Important Points
(and parents) so that proper adjustments
tive via the completion of scales designed
ADD children make up 3-5% of the
can be made with respect to type or dose
for this purpose.
1
population, but many children who have
of medication. Behavior rating scales are
The commonly used teacher
rating
trouble paying attention may have prob-
good for this purpose.
scales are:
lems other than ADD. A thorough evalua-
Modify the classroom structure
to
Conners Teacher Rating Scales
tion can help determine whether attentional
accommodate the child's span of attention,
ADD-H Comprehensive Teacher
deficits are due to ADD or to other condi-
preferential
shorter
assignments,
i.e.
Rating Scale
seating in the classroom, appealing cur-
tions.
Child Behavior Checklist
2. Once identified, ADD children are
riculum material, animated presentation of
ADHD Rating Scale
best treated with a multi-modal approach.
rein-
frequent
and positive
lessons,
Child Attention Problems (CAP) Rating
Best results are obtained when behavioral
forcement.
Scal e
management programs, educational inter-
Determine whether the child can be
School Situations Questionnaire
ventions, parent training, counseling, and
educational
special
through
helped
Academic performance should be
medication, when needed, are used to-
resources within the schoc!.
monitored by comparing classroom grades
aether to help the ADD child. Parents of
Consult with other school personnel
prior to and after treatment.
children and adolescents with ADD play the
such as the guidance counselor, school
It is important to monitor changes in peer
key role of coordinating these services
psychologist, or school nurse to get their
functionho,
family
social
relationships,
3. Each ADD child responds in his or her
ideas as well.
skills, a capacity to enjoy leisure time, and
own unique way to medication depending
self-esteem.
14. What are common myths asso-
upon the child's physical make-up, severity
school nurse
The parents,
or other
ciated with ADD medications?
of ADD symptoms, and other possible
school personnel responsible for dispens-
problems accompanying the ADD. Re-
Myth: Medication should be stopped
or overseeing the medication
trial
ing
sponses to medication need to be moni-
when a child reaches teen years.
should have regular contact by phone with
tored and reported to the child's physician.
Fact: Research clearly shows that there
the prescribing physician. Physician office
4. Teachers play an essential role
in
is continued benefit to medication for those
visits of sufficient frequency to monitor treat-
helping the ADD child
feel comfortable
teens who meet criteria for diagnosis of
in the overall care of
ment are critical
within the classroom procedures and work
ADD.
children with ADD.
demands, sensitivity to self-esteem issues,
Myth: Children build up a tolerance to
13. What Is the role of the teacher in
and frequent parent-teacher contact can
medication.
the care of children with ADD?
help a great deal.
Fact: Although the cose of medication
5. ADD may be a life-long disorder re-
may need adjusting frorn time to time there
Teaching an ADD child can test the limits
quiring life-long assistance. Families, and
is no evidence that children build up a
of any educator's time and patience. As any
the children themselves, need our con-
tolerance to medication.
parent of an ADD child will tell you, being
tinued support and understanding
Myth: Taking medication for ADD leads
on the front lines helping these children to
6. Successful treatment of the medical
manage on a daily basis can be both
to greater likelihood of later drug addiction.
aspects of ADD is dependent upon ongo-
Fact: There is no evidence to indicate
challenging and exhausting.
helps
if
It
ing collaboration between the prescribing
that ADD medication leads to an increased
teachers know what to expect and if they
physician, teacher, therapist and parents.
likelihood of later drug addiction.
receive in-service training on how to teach
4
CHADDER
19
Fall/Winter 1991