ADHD Policy

Attention Deficit/Hyperactivity Disorder or ADHD

If you are concerned that your child may have ADHD, read the information below to get more information about ADHD. Make an appointment with your pediatrician at Pediatric Healthcare to discuss your child’s behavior.

Every patient with ADHD needs to be seen every 3 months for an ADHD check-up. These visits are to help monitor your child’s progress on treatment and to determine if changes are needed in your child’s medication regimen. An update from your child’s teachers on his/her progress is helpful.

Medications for ADHD are regulated drugs and need to be prescribed every month. The pharmacy has to have a hard copy of the prescription. These medications cannot be called in to the pharmacy by phone. You can call for the prescription to be sent to your home or picked up at the office by you every month. Because of the strict coverage policies of insurance companies, your child’s prescription cannot be written until at least one month after his/her last prescription.

What is ADHD?

All children have times when they have difficulty controlling their behavior. They may have difficulty waiting their turn. They may run around the room full of pent up energy or drift off into a daydream and not pay attention to your requests to finish their homework. Some children have trouble with these behaviors in the setting of a recent stress, such as parental divorce or death of a loved one.

Children with ADHD have problems with these types of behavior frequently enough that it interferes with their ability to do well in school or get along with their siblings and peers. ADHD is a characteristic of the child which has always been notable and not simply brought on by a stressor. Attention problems in children with ADHD occur everywhere, not just in one setting like school, but also at home and when playing with friends.

What behaviors should make me concerned that my child might have ADHD?

Some behaviors which may suggest ADHD are:

• Difficulty paying attention or following directions, daydreaming
• Difficulty organizing tasks or activities (such as homework or chores)
• Fidgeting or difficulty sitting still
• Acting on impulses without thinking through the consequences
• Poor school performance
• Frequently losing and forgetting things
• Problems with poor conduct
• Difficulty getting along with siblings or peers

What are the different types of ADHD?

Hyperactive children have difficulty staying still, squirm and fidget, talk too much and have difficulty playing quietly. They speak out of turn and cannot wait. These children are more likely to be noticed by teachers because they are disruptive to the classroom.

Inattentive children tend to be described as daydreamers. They have difficulty paying attention, organizing tasks, and make careless mistakes. They lose and forget things. These children are more likely to be missed by teachers, because they don’t attract attention. Girls are more likely to have this type of ADHD.

Most children with ADHD have both inattentive and hyperactive symptoms.

How can my pediatrician diagnose ADHD?

ADHD can be diagnosed by talking with you, your child and your child’s teacher about your child’s behavior. Some pediatricians at Pediatric Healthcare use rating scales which the parent and teacher fill out to determine the severity of symptoms.

To diagnose ADHD, your child must be at least 5 years old. Younger children frequently have behaviors similar to ADHD which are simply a part of normal child development. Most children of this age will outgrow these behaviors.

Your child’s problematic behaviors must be present in more than one setting. A child who has difficulty paying attention in school, but has no problem engaging in activities at home may just be bored or understimulated in school.

The ADHD behaviors must have been present since the child started school. In an older child who was previously doing well, other problems such as depression, psychiatric illness or drug abuse must be excluded.

Finally, ADHD behaviors must interfere with your child’s school performance or ability to get along with others in social situations.

What other problems can be confused with ADHD?

Sometimes other problems can exhibit similar symptoms to ADHD. Some of these are listed below. If you think these may be issues for your child, let your doctor know. This way your child be treated appropriately.

Learning disabilities such as dyslexia may make it difficult for children to learn specific skills such as reading or math. Special neurological testing can detect these problems so that the best learning strategies for your child can be found.

Hearing or vision problems – Children with hearing and vision problems may have problems paying attention because they cannot hear or see well enough. A hearing or vision test easily detects these problems and allows for correction with glasses or hearing aides.

Depression/Bipolar disorder – Children with mood problems may fly into fits of rage or have trouble paying attention. Counseling or specific medications for mood disorders may be needed.

Anxiety – Some children are so absorbed in their own worries that they cannot pay attention. Counseling or specific medications for anxiety disorders may be needed.

Recent Stress – Stresses such as a divorce, a recent move, a parent losing a job, death of a loved one or violence in the home can cause children’s behavior to change and make it difficult for them to pay attention if they are preoccupied with other concerns. Let your doctor know if there have been any recent stressors in your child’s life.

Drug Use – The effects of drugs (either drugs prescribed by your doctor or illegal drugs) may make it difficult for a child to pay attention.

What causes ADHD?

The cause of ADHD is not entirely clear. What we do know is that children with ADHD appear to have a problem with the chemicals that send messages in their brain. ADHD tends to run in families. Parents and siblings of a child with ADHD may also have ADHD. In rare cases, chemicals in the environment such as lead can cause ADHD.

What does treatment for ADHD include?

At the beginning of treatment, you and your pediatrician should identify goals for treatment of your child’s ADHD. For example, if your child completes only half of his homework right now, you could set a goal for your child to complete all of his homework on time. If your child gets in trouble for talking out of turn in class, you could set a goal to decrease this. It is good to have at least three goals and report on your child’s progress in each area at your follow-up visits.

You, your child’s teacher, and your pediatrician need to work as a team and communicate information about what works for your child and what does not.

The main types of treatment are medication and behavioral therapy. Stimulant medications for ADHD include Ritalin, Adderall, Concerta or Metadate. These work by increasing the chemicals in the brain which help your child to focus and concentrate. Medicine helps about 80% of children to improve their behavior significantly. Some children have to try different doses or different types of stimulants before they find one that helps. Many parents have concerns about whether their child can become addicted to or abuse the medicine. When taken as directed by your pediatrician, stimulants for ADHD are not addictive and help your child to focus and function better.

There are newer non-stimulant medications such as Clonidine, Tenex, and Strattera. It is still unclear if these medications are as effective as stimulants. They may be right for children who have had severe side effects on stimulants.

Behavior therapy teaches parents and teachers ways of setting up the home or classroom so that it is easier for the child with ADHD to function. It also teaches them to set up rules and enforce them in a way that improves the child’s problem behaviors. There should be rewards when your child behaves well and a consequence when he fails to meet a goal. These rewards and consequences need to be enforced consistently to work.

Which medication is best for my child?

It may take time to find the best medication, dosage, and schedule for your child.

Your child may need to try different types of stimulants. Some children respond to one type of stimulant, but not another. Your pediatrician will also need to adjust the amount of medication. Some children respond to smaller amounts than others. Usually, your pediatrician will start at a low dose and gradually increase until your child’s behavior improves significantly. Extended release forms of stimulants are relatively new. They have the advantage that your child usually only needs to take one pill a day. Ask your doctor about extended-release forms if your child is still taking pills more than once a day.

At Pediatric Healthcare, we ask that patients come in every week or two during the first month on stimulant medications. When the correct dose and medication has been decided, we have you come in every three months to make sure the medicine is still working and check for possible side effects.

Because stimulants are controlled-substances, a prescription needs to be written every month. To pick up your child’s monthly prescription, simply call the office and tell them you would like to pick up the prescription or that you would like them to mail the prescription to you.

What side effects should I look for when my child is on stimulants?

The most common side effects of stimulants are:

• Decreased appetite/weight loss
• Sleep problems
• Headaches
• Jitteriness
• Stomacheaches

Less common side effects are:

• Rebound effect (bad mood as the medication wears off)
• Transient tics (tics are repetitive motions or sounds that the child makes unintentionally)
• Increase in blood pressure or heart rate
• Growth delay

If your child begins having side effects, your doctor may suggest:

• Decreasing the medication dosage
• Adjusting the schedule of the medication
• Using a different medication

Does my child need to take his medication all of the time?

Some children can function well enough with ADHD to go about usual daily activities when they are not in school. These children may not need to take their medicine on weekends or during the summer months. Talk to your doctor about taking these “medication holidays.” These can be especially helpful if your child is losing weight on stimulants. The “medication holidays” may help him catch up on his weight.

How can I help my child control his behavior?

Children with ADHD need structure and organization most of all. Taking care of a child with ADHD can be stressful, so be sure that you seek support for yourself. CHADD (Children and Adults with ADHD) provides local parent training and support groups.

Here are some tips for helping your child:

• Keep your child on a daily schedule. Try to keep the time that you child wakes up, eats, bathes, leaves for school, and goes to sleep the same each day.
• Cut down on distractions. Loud music, computer games and television can be overstimulating. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Whenever possible, avoid taking your child to places that may be too stimulating, like busy shopping malls.
• Organize your house. If your child has specific and logical places to keep his schoolwork, toys, and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.
• Reward positive behavior. Offer kind words, hugs, or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child’s efforts to pay attention.
• Set small reachable goals. Aim for slow progress rather than instant results.
• Help your child stay “on task”. Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer frequent, friendly reminders.
• Limit choices. Help your child learn to make good decisions by giving your child only 2 or 3 options at a time.
• Find activities at which your child can succeed. All children need to experience success to feel good about themselves.
• Use calm discipline. Use consequences such as time-out, removing the child from the situation, or distraction. Sometimes it is best simply to ignore the behavior.

How can my child’s school help?

Your child’s school needs to use special behavioral techniques to help the medication work.

Here is a list of techniques the school should use:

• Seating the child at the front of the classroom to decrease distractions.
• Using a system of clear rewards and consequences, such as a point system or token economy.
• Sending daily or weekly report cards or progress reports. Link to get details on setting up a school-home daily report card.
• Using small groups for activities.
• Keeping assignments short or breaking them into sections.

How can the law help me in getting services for my child with ADHD?

The IDEA (Individuals with Disabilities Education Act) and Section 504 of the Rehabilitation Act of 1973 require public schools to cover the costs of evaluating the educational needs of children with special needs that interfere with their learning and to provide the needed services.

Will my child outgrow ADHD?

ADHD continues into adulthood. However, adults are better able to compensate for ADHD by developing their strengths, structuring their environments, and using medication when needed. Adults with ADHD can lead very productive lives and may even be more successful in some careers.

Are teenagers getting high on stimulant medication prescribed for ADHD?

There have been recent reports of teenagers selling and using ADHD medicines in ways other than prescribed by their doctor. If your child is on medication, it is always best to supervise the use of the medication closely. Certain formulations of stimulants such as Concerta are manufactured in a way that makes them difficult to abuse.

Are stimulant medications “gateway drugs” leading to illegal drug or alcohol abuse?

People with ADHD are naturally impulsive and tend to take risks. But those with ADHD who are taking stimulants are actually at lower risk of using other drugs, because they are being treated for their ADHD.

Resources

The Attention Deficit Information Network, Inc.

Children and Adults with ADHD (CHADD)

National Attention Deficit Disorder Association

Please feel free to call us if you have any questions regarding these policies.