I encourage individuals and families to start getting oriented to the concept of being affected by ADHD by getting good information on the condition. There are many resources to get current information on ADHD. Familiarize yourselves through these resources: NIMH, Mayo Clinic, The Hallowell Centers, CHADD, The National Resource Center on ADHD and AACAP are very good places to learn. If you think you or your child may be living with ADHD based on your reading, have a conversation with your physician, pediatrician or a mental health professional about your concerns. Getting a comprehensive assessment that looks at you and your life or at the whole child, his/her school and family life, medical concerns, family history, stressors and the child’s strengths and resilience is essential.
With children, teachers and parents are each in unique positions to make observations to inform the evaluation. If your child’s teacher has suggested an evaluation of your child based on observations, then those observations can be one key piece of the diagnostic puzzle. There are standardized parent and teacher rating scales to place these observations in a more structured way. Examples of these tools are the Child Behavior Checklist or the Connors Rating Scale. Your child’s pediatrician or a mental health professional should be able to make recommendations on the best tool for you.
This diagnostic evaluation conducted by an experienced clinician is the current standard for making an accurate diagnosis. For children who also receive neuropsychological testing to evaluate their learning style (sometimes an issue in kids living with ADHD) there are certain subtests that assess attention—these can corroborate the clinical diagnosis, but should not be used the make the diagnosis per se. There is no one single test for a diagnosis of ADHD. Learn more about ADHD symptoms, causes and diagnosis.
To assist the diagnostic process, it is also important to share any family history of ADHD or symptoms. ADHD has a strong genetic element and runs in families. Many parents I have met identify with the same symptoms as their child’s, but were never evaluated or assessed. Some parents note the same traits in themselves as they describe in their child, and that can create an opportunity for more formal assessment if desired.
Familiarizing yourself with parenting strategies that support your child, such as tips for organization, structure, limits, aerobic exercise and behavioral strategies, will also serve you well. In addition, you can also work to develop an understanding of how the educational system can help your child once the diagnosis is made; this could be as simple as sitting in front of the class and having extra time for a test, but could require more accommodation depending on your child’s specific learning needs and style. Learn more about options for the education accommodations you can seek. Also, review the ADHD and parenting section for tips and suggestions.
All medications have two important areas to be concerned about—the common side effects and the serious ones. In stimulants, the most common side effects are reduced appetite (which over time can limit growth) and difficulty sleeping. The development of tics (involuntary movements) is less common, but important.
The FDA voted to label stimulants with a “black box” warning, which I explain to my patients is the most serious “stop sign” the FDA has for prescribers and patients to consider before starting any medication. The FDA warning is as follows.
[TRADEMARK]*should be given cautiously to patients with a history of drug dependence or alcoholism. Chronic abuse can lead to marked tolerance and physiological dependence with varying degrees of abnormal behavior. Frank psychotic episodes can occur, especially with parenteral abuse. Careful supervision is required during withdrawal from abusive use since severe depression may occur. Withdrawal following chronic therapeutic use may unmask symptoms of the underlying disorder that may require follow-up.
*Name of drug goes here
Recently there have been concerns over a possible connecion between stimulants and heart concerns including sudden cardiac death. At this time there is no black box warning for this concern for stimulants. Ask your preseciber their take on this issue and be sure to tell your doctor if you have a family history of cardiac concerns before taking any medication. See also the FDA black box warning regarding Strattera and suicidality.
FDA-approved medicines have been shown to meet their standards for clinical usefulness and safety. Selecting the right medication is a process between the prescriber, the individual and the family and is benefited by the use of rating scales to make clear what is and is not working to help inform the medication trial. Often the individual will report his or her experience—good or bad—on the compound.
In regard to children, finding the right medication and dose has always been a challenge, but with the publishing of the follow up of NIMH’s Multimodal Treatment of Children with ADHD study (MTA) (Jensen cite, Molina, et al., Journal of Developmental and Behavioral Pediatrics: Feb. 2001, Volume 22, Issue 1, pp 60-73), practitioners and researchers are also now working to better understand the best developmental window and amount of time for a child’s medication usage. Learn more by visiting the NIMH Q and A on MTA. This study helps us to stay humble about how much we do not yet know and also to see the profound challenge that is ADHD and that we as an advocacy community have to support the effort to find treatments that can make a difference for a child’s outcomes in the long term as well as the shorter term. The many challenges in finding the best long-term interventions for kids living with ADHD makes me reflect on the importance of how children are viewed in the family, how their strengths are maximized and how they are loved while living with ADHD.
These types of interventions typically do not have clear scientific studies to draw definitive conclusions regarding their use, but also typically have few risks. Examples of complementary approaches are dietary changes, (both restrictions and supplements like Omega-3 fatty acids), cerebellar (motor skills) training and biofeedback. My reading of the evidence for a contribution from additive and food colors is mixed; I think the best strategy based on this is to reduce these when possible and to select a healthy diet. Omega-3 fatty acids are clearly good for your heart and brain, so I like them in the diet. For more on health and wellness for people living with mental illness, visit the NAMI Hearts & Minds online program.
I also often recommend interventions like martial arts and aerobic exercise, as the former is about self control and mastery of one’s body and the latter has shown effectiveness for anxiety and depression, which we know sometimes co-occurs with ADHD. There are a variety of stress management strategies in this complementary field—meditation, yoga and acupuncture to name a few. Learning more from research and trying what works best for you, provided it has minimal downsides, is a good approach in general.
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In the workplace, Living with ADHD in the workplace can present challenges, and playing to one’s strengths is a balancing act. Many people living with ADHD are entrepreneurs and find they like working for themselves, although structure can be an issue at times for people who do not have regularity in their lives. Others are drawn to high stimulation tasks like teaching, coaching or theatre. Many can succeed in traditional office jobs, but will likely benefit from strategies that can help, such as a quiet space to reduce additional stimuli or staying with one task at a time. Adults with ADHD should implement as many strategies as they can on their own. But there are also laws in place that provide for accommodations under certain conditions. Learn more about ADHD at work.
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