Drug Therapy for Child with ADD?

October 26, 2004 8:19 AM

It has been recommended that my 6 y.o. see a psychiatrist for possible ADD. Has anyone else had experience with someone so young being administered drugs for this? I'm having fears that he'll turn into a zombie. Minus the flesh eating.
posted by adampsyche to health & fitness (29 comments total)

Psychiatrist does not necessarily equal drugs. Down our way, psychiatrist just means talking. Have the drugs been recommended as well? If so, what drugs?
posted by humuhumu at 8:26 AM on October 26, 2004

Well, he saw a psychologist, who recommended seeing someone who practices psychiatry.
posted by adampsyche at 8:36 AM on October 26, 2004

You're right to be concerned about this. ADD is way overdiagnosed and overmedicated. My mother is a teacher of 47 years of experience - she just retired last June - and she says there is one in about every other class she has. That is, about one kid out of every 50-60 kids will be ADD.

I don't have the information at my fingertips and I can't ask her right now, but I do remember that if a kid can listen to a television program and understand and remember it, and if he has enough concentration that he can play video games, then he isn't ADD.
posted by orange swan at 8:54 AM on October 26, 2004

Adampsyche - just as a heads up, there's been a ton of research into how diet affects ADD, and studies on how ADD symptoms have been greatly improved by reducing or eliminating certain things from the diet. I might do some Googling and start implementing some dietary changes while waiting to see the psychiatrist - if you notice an improvement, then you can mention it and maybe stave off immediate drugging.
posted by annathea at 8:55 AM on October 26, 2004

We went through this with my son, and we tried absolutely everything short of putting him on medication because we didn't want him to be a zombie. I went to school with him almost the entire first grade year to help control him, we did anger management, psychiatry, group therapy, we did meditation, we did positive and negative reinforcement; none of it worked. When we finally decided to try medication (he was 7,) we talked to his doctor and told her we *didn't* want him to be zorked out, and we wanted him to be on the lowest dose possible to help him concentrate without altering his personality.

She prescribed Concerta, which is basically effective for 12 hours a day, so he has the max dose at school, and at night, he's still got a minimal level of the drug in his system, but he pretty much reverts back to his wild, hellion ways. Even when it's at full efficacy, his personality is exactly the same, he can just focus more effectively and he's lot less frustrated because of that (gets in a lot less trouble, too!) The only side effect he's had from it is that sometimes, he has a hard time getting to sleep, but that's rare and we can counteract that with a teaspoon of Benadryl.

We've been extremely vigilant about explaining his medication to him, telling him what it is, and telling him that all it will do is help him concentrate better- he will still have to put forth the effort to concentrate and work hard. I'd still recommend trying other things before going straight to medication, but ADD medication has come a long way since creating the initial wave of Ritalin Zombies. Good luck!
posted by headspace at 9:03 AM on October 26, 2004

Do you think he's out of control, or is this a case of other people (e.g., people at school) deciding he has problems? I would leave drugs for the point where nothing else works and your and his lives have become hell—not before then.

Way back in the eighties, I was actually thrown out of a school (or "asked not to return," in private-school-ese) because my mother refused to drug me up. She thought it was a question of teachers wanting things easier rather than my having a psychological problem. Turns out she was right: I was bored (with poor self-control) not attention deficit, and a better school with better teachers (coupled with clear consequences for not controlling myself) was the appropriate solution.

Meanwhile, friends of mine spent their childhoods taking pills they hated and looking forward to "medication vacations." The pills fucked with their appetites, their sleep, and their self-esteem. None of them take anything anymore and they are plenty functional adults, some more so because they learned to get organized early.

So, I would say see if other forms of behavior modification are suitable first. For everyone's sake.

(I'm sure medication has improved since the eighties and early nineties, but it still can't be good.)
posted by dame at 9:03 AM on October 26, 2004

Adam, I emailed you.
posted by konolia at 9:07 AM on October 26, 2004

he has enough concentration that he can play video games, then he isn't ADD.

That's not strictly true. ADD can also include hyperfocus on certain things, usually things the person finds interesting. This can sometimes be problematic as when you do just the interesting things to the detriment of the other less interesting things that also need doing [like school, homework, bill paying, whatever]. I'd recommend some time getting familiar with the CHADD group and web site. They are a fairly balanced group that can give you some straight talk about medication issues without being really polemic on either side. I live with a guy with ADD who hasn't ever been medicated and we have a pretty thorough strategic plan for dealing with the ups and downs that ADD tosses our way. Granted he's an adult, but one of the things that we found is that a half hour of really vigorous exercise can help minimize ADD symptoms for hours and hours. He's become a regular cyclist and it's improved his concentration and his mood considerably.
posted by jessamyn at 9:10 AM on October 26, 2004

I've seen drugs used a kid that young and it gave him a zen kind of calm rather than a doped-up kind of calm. He was seriously affected by ADHD before that, and the difference is miraculous. He's relaxed, happy, and enjoying the ability to get engrossed in a book instead of feeling like he's got ants in his pants all the time. If it's not too severe a problem for your kid, then your psychiatrist will probably recommend some dietary and/or behavioral changes to try first.
posted by stefanie at 9:11 AM on October 26, 2004

I was diagnosed as "hyperactive" (this was the mid-70's, ADD didn't exist yet) when i was about childpsyche's age and put on ritalin (and a diet that eliminated all food aditives and refined sugar). The diet lasted about 2 weeks, the ritalin for a year. There were side effects of lost sleep and appettite. After it was done, I went back to being a spazzy kid with poor social skills, spotty academics, and behavior problems.

Oddly a few years ago, my mom suggested I go back on Ritalin (I was 31) at a family dinner. A couple months earlier when I mentioned that had been experiencing anxiety, both my mom and one sister whipped out vials of Xanax to give me.

But then again I've enjoyed recreational pharmaceuticals on occassion and for some people maybe these pills can do some good. I guess you could say I'm conflicted. But, I'd say get a second opinion from someone outside the school system.
posted by jonmc at 10:10 AM on October 26, 2004

if he has enough concentration that he can play video games, then he isn't ADD.

I, too, disagree with this. But no matter...

The important thing to be learned from that, though, is that there are myriad different opinions about childhood ADD. I have a kinda-sorta-stepson who's seen dozens of doctors and therapists over the years. Literally every one had a different opinion about what was wrong. Never hesitate to get a second, third, fourth or fifth opinion. And if a doctor or therapist is telling you something that contradicts what you've seen in your child, don't be afraid to call bullshit.

Adam, I've emailed you about this.
posted by jpoulos at 11:13 AM on October 26, 2004

We haven't crossed the med bridge yet, but as someone with a five-year-old boy who's got something along those lines, we've been wrestling with this a lot.

Here's what we've learned so far:

1) "ADD" is a very, very broad term, and is rarely any kind of a clinical diagnosis. There are a really wide range of conditions that can contribute to a kid's inability to focus.

2) I would recommend that you definitely talk to as many experts as possible before you commit to a specific route. I know it's a cliche to say "When you have a hammer, everything looks like a nail", but it's true. You talk to a nutritionist, they're very likely to recommend dietary changes. You talk to an occupational therapist, and they're going to likely focus on sensory integration issues. Talk to a psychiatrist, and you're very likely to get prescribed something, even if it's not necessary Ritalin.

3) For our boy, the issues definitely go beyond just attention--while he's certainly got problems focusing, and he's very, very bright, he's also got behavioral and social issues that we're focusing on.
I make that point to suggest that very often, attention issues are really symptoms of broader underlying problems. Whether it's boredom, metabolism, something psychological or genetic, medicating too early can potentially address a symptom without helping him address the deeper underlying cause.

4) We are told, over and over, that almost no drug has been tested and tracked in children as extensively as Ritalin. Ignoring the frightening social implications of that fact, it does give some level of comfort that you won't be probably be putting your child at physical risk.

5) This is a big point for us, and fits into our overall thinking--all the data is for kids "6 and up". People are definitely more leery of meds for kids who are five. Our basic take on that is that it gives us a window to keep focusing on all the _other_ issues that might be at play, and if, a year from now, he's still got real attention issues, then we'll look more seriously at something like Concerta or Stratera.

It is hard to resist the overall pressure, sometimes. Even at his school, which has been understanding enough to give him a full-time aide in his kindergarten class, his teacher's been dropping hints like "You wouldn't deny your kid insulin if he was a diabetic, would you?" She said it in a really supportive way, and has been very supportive overall, but as former teachers ourselves, we can't help but identify with the part of her that's thinking "Class would be so much easier if he would just calm down every once in a while." (He was literally trying to climb out a window last week--they had firefighters come in and teach them to know two exits out of every room, so he took the lesson to heart.)

We have found a couple of things that have worked. Focusing on his diet, especially on refined sugars, has helped a lot. We had someone recommend the "Feingold" diet, which we tried for a while, but it is just _so_ strict that when it didn't make a noticeable difference after a couple of months, we scaled it way back.

One thing that's also helped a lot is finding a karate class that specifically focuses on kids with this sort of problem. One of the instructors is a child psychiatrist and a black belt, and the other sensei has a lot of experience dealing with kids. They'll take him one-on-one into a separate room, and start with really basic exercises like bouncing a ball against a wall and catching it, 10 times in a row. On a good day there, he can stand in one spot and focus on various exercises for 5-10 minutes in a row (which is usually something he can only do with videogames).

Hope this helps...good luck.
posted by LairBob at 11:17 AM on October 26, 2004

"Seeing a psychiatrist" does not mean a) that the psychiatrist is going to recommend medication, or b) that you have to accept the psychiatrist's recommendation for medication.

I have known people (adults and children) who have resented being medicated for ADHD, and I have known people (adults and children) who welcomed it and felt that it saved their lives. I know one couple whose eight-year-old son literally begged them to let him go on medication, to which they had been staunchly opposed.

You need all the information before you (and your son) can make a decision about how to proceed, after all. LairBob, as always, has great wisdom to offer. If you can find a support group (real-world or virtual) of parents whose children are experiencing similar issues, my guess is that you might find some more wisdom from those who have been there.

And a lot of crackpots, of course. But that is the way of all things. Good luck to you and your son. It sounds like he has the most important thing already--caring, thoughtful parents.
posted by Sidhedevil at 11:45 AM on October 26, 2004

Wow, what great advice so far.

As far as picking a psychiatrist, you might get reccomendations for one that publicly beleives that medicating is a last resort. My parents did that with me ... I was diagnosed with a number of things, including processing disorders, that all eventually came under the umbrella of aspergers syndrome. The psychs at the school hadn't heard of it at the time (mid 90's) and would never have figured it out, and were just reccomending that I get all drugged up ... which wouldn't have helped, because it was a social and auditory processing disorder that kept me from being 'normal', and caused me to be bored and act out.

The reccomended diets (no milk, no wheat) didn't work for me ... indeed, I work better when I've got significant amounts of both in my diet. Through all of this, keep in mind that your son is uniquely your son and it's a process of exploration into what works for him, not what's worked for every other child.
posted by SpecialK at 12:29 PM on October 26, 2004

There's more than enough written here, so I'll keep this short. Be prepared for speeches from well meaning people regarding the over use of drugs for add and it's overdiagnosis. You'll also find people who don't even think it exists.

While it's smart to be careful and get second and third opinions, and we all know no one thing works for everyone, I work at a children's hopsital, and the difference drugs can make on a child with add is amazing.

My wife also has add, and if you want to see a zombie take her off her medicine. The drugs allow her true personality to shine through, without the frustration of having to deal with add.

Good luck.
posted by justgary at 12:45 PM on October 26, 2004

Another recommendation to consider diet if you already haven't done so. One of my sisters is ADHD but for her it's like an allergic reaction to artificial colourings with red being the worst. A couple hours after a red peppermint candy will make her unlivable. We ate alot of plain cereal and fruit for about six months growing up until my parents figured out her trigger.

Not everyone will be helped by a specific diet but at least it is fairly cheap to try.
posted by Mitheral at 1:57 PM on October 26, 2004

Thanks for all the responses. You've all been rather helpful.

He isn't hyperactive, that's for sure. Normal six year old in that respect. Active, bright, and happy. But he has trouble with attention, staying on task, and even just flat out refuses to do any work. If a teacher is helping him, and coaxing him along, he can do the work and do it well, but the moment someone turns their back, he's doing whatever he wants to do. He seems to be caught up in a fantasy world, and if you ask him a question, he responds with something completely unrelated.

Which is not to say that I think his imagination is all that bad, in fact, I think it's quite good, given his creativity. But it interferes with his ability to get along in school. He often goes off by himself, and just doesn't listen. All the teachers love him, though, 'cause he's such a sweet kid. And he kinda gets by on his looks.

I'm not sure what we're going to do, but we will do so deliberately, and with all of the information we can get our hands on. We are certainly not ruling out medication, but want to make sure that we've done everything up until that point. Thanks again!
posted by adampsyche at 2:14 PM on October 26, 2004

I recommend looking at Thom Hartmann's work.
posted by Zed_Lopez at 2:22 PM on October 26, 2004

Adam - Ok, completely unprofessional diagnosis here and I'm not a doctor or a psych, just a guy with a chemically imbalanced brain -- but he doesn't sound like he's ADD, he sounds like he's autistic in some fashion (and there's a billion ways...) and has a phasic processing disorder. I guess the message is: Go get him tested with a good, competent neuropsych (not just a psychiatrist or a psychologist, someone who has a backround in neurology as well) and keep an open mind about what he could have.
posted by SpecialK at 2:45 PM on October 26, 2004

Adampsyche, my armchair psychologist mode says that those counterproductive behaviors sound like something that could be much better addressed by cognitive behavior therapy than by medication alone! I would strongly encourage you to consult a psychologist who specializes in cognitive behavior therapy as well as the psychiatrist.

(And, on preview, what SpecialK said about consulting a neuropsychiatrist also.)
posted by Sidhedevil at 2:47 PM on October 26, 2004

I have ADD, and I take psychostimulants to function better in my day-to-day life. They have helped me an enormous amount.

I wasn't diagnosed with ADD until I was 17. My intelligence and natural ability was obvious to my teachers (and to standardized tests), but my often mediocre performance did not translate into a winning academic record. Inattentive ADD is notoriously hard to detect. After I started the psychostimulants, my grades and performance noticably improved--but the damage was already done. I have horrible study and organizational skills, maladaptive habits, and so forth. I often wonder how my life could have been different if I was diagnosed earlier.

Before making any sort of decisions, or considering medication etc., you need to have a diagnosis made. Your son's teachers have noticed a problem--but the root of this problem is yet to be confirmed. In order for my diagnosis to be made, I went through a battery of psychological tests administered by a neuropsychologist. Testing will reveal the nature of your son's behavior.

But, from what you've wrote, Adam, it sounds like your son is Dually Exceptional--gifted, and has a learning disability. It's hard for someone with ADD to get focused, but it's even harder for someone with ADD to focus on something boring. If your son is not being challenged by his classwork, he's not going to pay too much attention to it.

I strongly suggest finding a psychologist/psychiatrist who specializes in educational assessment, and getting some definitive answers.

(on preview: Sidhedevil, CBT can be helpful, but it doesn't even come close to medication in many respects. Some of my problem is based in my behavior, but a large part of it is--well, my attention. If I get distracted by the sound of the student next to me tapping his pencil on the desk, it's going to adversely affect my performance. Medication helps control the attention span in ways that CBT simply cannot.)
posted by LimePi at 3:36 PM on October 26, 2004

Writing as a neurologist:

I share reservations about the existence of ADD in general, and if it does exist I believe it's overdiagnosed to explain behavioral issues.

I also share deep reservations about prescribing neuroactive drugs to young, plastic brains.

Many young children with proposed ADD are sent to neurologists (a few even to myself, though I am an adult neurologist), and every so often we do find something neurologically wrong with them. Although this is usually something worse than ADD, in my opinion is may be better not to be wrong.

So, "be sure that other things have been excluded before you settle into a course of medication for ADD" would be my advice.
posted by ikkyu2 at 3:49 PM on October 26, 2004

With all due respect to ikkyu2, researchers are starting to get a handle on the neurological basis of ADHD. There's a replicated link between ADHD symptoms and variations in the genes for dopamine transporter and dopamine D4 receptor.

That said, ADHD may be overdiagnosed and overmedicated, and looking for causes outside of neurochemistry is never a bad idea. Even if your son does have ADHD and you decide to use medication, all the avenues you'd use for a non-ADHD child will still be helpful.
posted by lbergstr at 5:23 PM on October 26, 2004

As someone who spends most of his days thinking about genetic epidemiology, I'm almost offended at the idea of a single-gene polymorphism explaining something as complex, not to mention ill-defined, as ADD or ADHD or whatever they're calling it these days.

Phenotype definition is the beginning and end of linkage studies, and the current working definition of ADHD doesn't meet any of my criteria for a meaningful phenotype. In fact, it's my favorite poster child/whipping boy for teaching people about phenotype definition and how not to do it.

Linkage studies are also not really the best way to get at complicated traits. They're really super, on the other hand, if you want to understand why your pea plants have white or pink flowers.
posted by ikkyu2 at 8:32 PM on October 26, 2004

As with other contributors I emphasise that I'm not in any way a healthcare professional. But I think what Dame says rings a lot of bells. SpecialK, Lairbob too... these are really interesting responses. And Adampsyche, the way you describe your kid could apply to so many amazing, interesting people. It reminds me of me when I was at school. Like another poster on this list I was described as "hyperactive" when that was the term to use.

The undertone to many of the comments on the subject of ADD is that we find a child who doesn't fit the norm, who can't be put neatly into the box, so we try and treat this condition with drugs. And often some pretty hard amphetamine-like substances at that.

In my opinion it is often the box which is wrong, at least for the child. For example, I found school a suffocating, bizarre institution ... and I sympathise with anyone who lives in a dream world of their own and refuses to do work. Why should they? To me (and I'm not diagnosing your child here, just speaking generally) that's not ADD... that's a perfectly reasonable response to some of the environments we find ourselves in.

On top of this - and again it's just personal opinion so don't be offended - I think it puts a parent in a difficult moral position if they give kids drugs like Ritalin. It's not an antiseptic you rub on a cut. It's not even insulin. It's a psychoactive substance. I think your reservations about your child possibly being prescribed drugs in this way are totally justified.
posted by skylar at 1:52 AM on October 27, 2004

IANAD.

I tend to agree with the "mild autism" assessments (FWIW, count me among the "ADHD is massively overdiagnosed" crew). If your child is as bright as you say, this plus his behavior lead me in that direction- autism and high intelligence often go hand-in-hand.

One thing you don't mention (or I missed among all the great responses here) is whether you've gotten a second opinion. If you haven't, your first stop should be another psychologist, not a specialist.

his teacher's been dropping hints like "You wouldn't deny your kid insulin if he was a diabetic, would you?"

Liarbob, I know you think your child's teacher is being supportive, but if someone said this to me, I'd have a hard time not bringing this up with the administration. It's a crassly manipulative comment that his teacher is completely overstepping her bounds in making. Your son's teacher (I'm assuming) professionally trained in child psychology and should never, ever be equating behavioral issues with true physical disorders. It's totally irresponsible.

/soapbox.
posted by mkultra at 2:13 AM on October 27, 2004

... "is not professionally trained"...
posted by mkultra at 4:19 AM on October 27, 2004

mkultra, I see where you're coming from, and I just wanted to clarify that this comment came up as part of a wider-ranging conversation, and really didn't come across as arm-twisting. There are definitely folks on both sides of our family who have found great help, as adults, from drugs like Lexapro/Prozac. We understand that for some people, mental/emotional challenges can be, in part, physiological. You genuinely wouldn't deny someone help on that front, if you were confident that were part of the equation.

As a broader point to folks who have suggested that the school environment is part of the cause (boredom, etc.), I'd just point out that for a child like mine, these challenges were clear well before he ever went to kindergarten, and they're present in every aspect of his life. Yes, a boring or unsupportive school environment would make things even worse, but this is definitely something deeper than an environmental problem.
posted by LairBob at 5:03 AM on October 27, 2004

Being intelligent does not rule out the diagnosis of ADD.
posted by LimePi at 2:10 PM on October 27, 2004