Community Expert Q&A: ADHD Advice with Dr. Melvin Oatis

Dr. Melvin Oatis is an Assistant Professor of Clinical Psychiatry at the New York University School of Medicine's Child Study Center.

What are some signs of ADHD?

Q.We have the medical history of our adopted three-year-old son, but we don't know much about his birth mother's history except that she was labeled as ADHD. Are there signs to look for in our boy? —lauried2

A. Although ADHD tends to run in families or has a degree of inheritability, there is not a one-to-one correlation to having the disorder. So the chance that your son could develop symptoms consistent with ADHD is greater than that of a child without a family history, but it is not 100 percent. Young children with ADHD will be more physically active; unable to sit still for extended periods or at story time; and they may move more quickly between activities than children who do not have the disorder. Cardinal symptoms of inattention, difficulty focusing for extended time periods, and becoming easily distracted may not be readily apparent at this age based on the demands or expectations of a three year old. If you become more concerned with his behavior in the future, be sure to seek a professional evaluation.

Should I get a second opinion?

Q. My seven-year-old daughter goes to a speech therapist and has a hard time focusing, following directions, understanding, and so much more. She's a great kid but we are not sure if we are missing something greater. I've asked her pediatrician if she has ADHD and he said no, but her teacher seems to think so. —Michigan_mom

A. There are three cardinal areas of symptoms: inattention (daydreaming, easily distracted, not following instructions or directions, often losing things, making many careless errors, unable to maintain focus for extended periods of time), impulsivity (calling out, interrupting, difficulty waiting their turn), and hyperactivity (squirmy, fidgety, often on the go, restless, excessive talking). ADHD is a clinical diagnosis focused on symptoms that exist in more than one setting and have persisted for at least six months. There is no blood test.

A child with significant speech delays can look like an ADHD child because of poor communication skills and frustration, or may indeed have the ADHD disorder. To make a diagnosis, consult with a child psychologist or psychiatrist; the doctor will want information from your child's teachers about her performance in school, and her peer relationships.

Do schools deal with ADHD children differently?

Q. My daughter's first-grade teacher brought up the possibility of ADHD. Is there a class type that suits this type of child? —joanneok

A. A classroom with a smaller teacher-to-pupil ratio is best in order to have more individual time and instruction. Many teachers have experience with children with ADHD and make some adjustments, like putting them in the front of the classroom, or seating them away from a window to minimize distractions. But first, in order to establish the diagnosis, you should complete parent and teacher Conner's forms and submit them to a psychologist or psychiatrist; the doctor will perform a clinical interview to find out if the diagnosis is in order. Girls with the inattentive ADHD subtype are often missed and diagnosed later—their behavior doesn't attract an adult's attention until they start to fall behind academically. Patricia Quinn wrote an excellent book Understanding Girls with AHDH which you may find useful.

Are ADHD and watching too much television linked?

Q. I have seen reports lately that there could be a link between ADHD/ADD and the amount of television a young child watches. Is there any validity to these reports, or are the disorders purely biological? —mommytosophie

A. Studies that link TV and ADHD are very preliminary and do not account for numerous variables. Genetics plays a big role with the disorders, as do other influences. If you think your child watches too much television, daily active play will help her develop motor and language skills.

How young is too young for medication?

Q. My six-year-old son started taking the drug Concerta when he was three. I'm confused and scared about his starting medication so young, because I know that ADHD is fairly new and there is very little known about it. —glorielsa

A. Fear not about your child's care! Some developmental pediatricians as well as general pediatricians treat rather routine cases of ADHD when there are no other psychiatric illnesses involved. Continue your son's meds. Also, he should see a psychiatrist for evaluation; the psychiatrist should then confer with your pediatrician to decide together how often your son needs this kind of extra care. Therapy can help you to access other methods to assist you with your son's development, and it can eliminate some of his unwanted behaviors. Let the therapist know your concerns if you begin.

Can gifted children have ADHD?

Q. My twins' IQs are both above 132, and my son is currently on Zoloft. I know that some characteristics of gifted and ADHD children seem to be parallel, and recently my son has been displaying disruptive behavior in kindergarten. We are moving soon, and he will be in a new school. What can I do? —kathleenl

A. You can have ADHD and be gifted. Find a school that has a small teacher-to-student ratio and one that can academically challenge and stimulate your child. Zoloft is for anxiety and depression, not attention—unless you and the physician believe that your child's inattention is due to anxiety or mood.

How do I handle my child's meltdown between dosed of medication?

Q. My five-and-a-half-year-old son is on five milligrams of Ritalin twice a day. It is working wonderfully. However, about once a week or so, he has a meltdown—he is very emotional and will get very upset at minor things. Is this normal? Should we consider another medication? —cdstevens

A. This reaction does occur with some children as the meds wear off (and sometimes it is an effect seen when they first start the medication) and for some children, the behavior goes away over time. Since you say the medication works well, you may try giving your son an extended release Ritalin that will last longer instead of dosing twice a day. By the time that wears off, it may be a smoother transition for him. Having a routine at the end of the day also helps, where your son knows what is expected from him—like after dinner, we brush teeth, have story time, then bedtime.

How do I explain ADHD to my child?

Q. My six-year-old daughter has ADHD. How do I explain this to her? —jennns

A. You can list her behaviors in a child-friendly manner such as, "Remember when you did this behavior (name it for her)? It was not the correct thing to do. We (mommy, daddy, and the doctor) are going to help you to stop doing this behavior." You can explain that is the reason you go as a family to see the treating doctor, to help change the behaviors which are incorrect or bad. Emphasize that she is not a bad child.

Do all ADHD drugs cause tics in children?

Q. My seven-year old son developed coughing and sniffing tics when on Dexedrine. Now we're trying Metadate, to see if that does the same thing. But if all these drugs are basically the same, won't they all cause tics? —newshound

A. Children may exhibit a tic on one stimulant and not another even though they are in the same medication class. Before switching to a different class of medicines like a non-stimulant, often physicians will decrease the dose of the medication that the child is on, or stop it and try another stimulant if your child was responding well to the first. Before switching to a different class of medicines like a non-stimulant.

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