ADD/ADHD has had it's fair share of controversy and everyone seems to have an opinion on how best to deal with the symptoms - see the ADD/ADHD expert's FAQs for some sound advice.
Q: Adult ADHD
While looking for help on the internet (reading up) for my 8-year-old girl who I am sure is ADD and not ADHD - I came to the realization that I have been ADD my whole life. I truly don't know how I got through school university etc. (mostly by clever tricks).
Today I'm self-employed and if I trick anyone then I'm the one that suffers from it. My daughter is very bright and still copes well in school,but I have tested her concentration and at 8 years she can't look me in the eye for one minute while I'm talking and directly afterwards she will talk about something else. She also forgets what she's done within 30 min. When I ask her about it she will tell me "it's just blank, I can't remember what I did 30 min ago"! This sounds like me at age 40.
She is with Tina Cowly reading school and is doing very well, and her reading is improving. My worry is next year is her first year with exams - being bright is not going to help her. Ritalin is something that I thought I will never allow in MY HOUSE, but at this stage I think we can both do with it. If I go to my GP will they be able to prescribe it if they think it will help (both of us), and do you get a low dose slow release in SA? I'm still very scared of the product. We have been using plenty of omega 3 etc products IQ omega etc.
A: The switch from natural supplements to prescribed medication can be a difficult one. You seem to be doing a large amount of research which is the best first step you can take. The long-acting Ritalin is available in SA; the dosage is dependent on the severity of the symptoms, however, weight and general health factors will also play a role. I'm sure in your research you have come across Strattera and Concerta as well; although the side effects tend to be similar across ADD medications, some people prefer one over the others - this tends to be a trial and error process unfortunately. If you are still unsure of medication there are cognitive behavioural specialists who can assist with coping skills to deal with ADD.
Before deciding on a treatment route, it is advisable to get a professional diagnosis. It may be worth taking your daughter to an educational psychologist who deals with ADD for a complete evaluation; you can contact www.adhasa.co.za for a professional in your area. Likewise, you may benefit from an evaluation.
Q: naughty or ADHD?
Just curious to know, my 10-year-old son is on Ritalin for the last year. He takes 1 tab 10mg Monday to Friday in the mornings. I don't want to give him anything when he gets home as I don't see the need for it. What I need to know is: there are times when he becomes so naughty, like not listening and doing silly things that he knows he shouldn't do or annoying his sister, or having such a tantrum when its homework time.
My husband wants to discipline him, which we do to keep it under control, but where or how would one distinguish whether he is simply being naughty, or whether this behavior is because of ADD. I feel he does these things because of ADD, my husband feels that naughty is naughty and treats it as such. Am I just being a softy and using that as an excuse for his behaviour? Can you please give me some advice as how to address or treat his behaviour please?
A: It can be difficult to distinguish between just plain naughty and ADD behaviours. The simplest way is to determine if the behaviours are present everyday (including weekends), or on certain days such as non-extra mural days or at particular types of homework etc. If you can determine a pattern to his behaviours, it may due to boredom or avoidance of a subject. If it is almost a daily occurence, it is likely to be due to ADD.
In conjunction with your doctor, it may be worth trying an afternoon dosage for a time to see if the unfavourable behaviours decrease. If you do not want to increase your son's dosage, perhaps splitting his dose of 5mg in the morning and 5mg when he gets home would be beneficial; again this needs to be discussed with your prescribing professional beforehand.
Q: ADD diagnosis
The teacher suspects my daughter age 6 has ADD and would like us to do further tests. I am a little hesitant though. We have had her at an OT who said that she is "a late bloomer", and the Psychologist that did the school readiness test said she was fine to go to Gr1. She is a daydreamer in class and the teacher says she doesn't complete her class work on time. She is in a private school. I have put her on Eye Q to see if anything changes. Should I get the tests done?
A: It is understandable that you are wary of putting your daughter through another assessment; it is also understandable that your daughter's teacher bring her concerns to your attention. Have you provided the teacher with the reports of the OT and the Psychologist? From your post I do not know how long you have been trying EyeQ, it can take up to 3 months for the effects to become visible so it may be advisable to wait for that period to lapse before having the assessment. A diagnosis of ADD requires that her symptoms be present in two or more situations; you can begin monitoring her at home, on play dates, in a restaurant etc. Whatever your decision, keep the teacher updated on your intended plans to assure her you are aware of her concerns and that they are being tackled.
Q: ADD and discipline
My daughter of 10 has been diagnosed with ADD with inattention and anxiety. She has been on Strattera for 6 months. The star charts with R5 per day as a reward works brilliantly so mornings are much easier.
My main concerns at present are:
a) her table manners. I have been trying to get her to eat with her mouth closed for 2 years. She zones out and forgets to close her mouth. Mealtimes are a nightmare as this causes such tension.
b) her feeling like she does not so anything right. I think this is more relevant when she is tired. If I tell her off (i.e. for putting wet fishtank lid on top of her laptop, for leaving wet towels on floor), she cries and says she does not do anything right. I do not want to moan at her all the time, but I need to show her the right way which upsets her. I repeat a lot of things which also annoys her off. She hates being told what to do. I do always try to pick up on what she does right and praise her. But it does not help her to remember to do the repetitive things i.e. to put the lid down on the toilet, turn off lights. I try and not make too many rules and there aren't many.
I do not want to "let things go" and I want to be consistent, but at the same time I do not want her to feel defeated as much as she does.
A: It is wonderful to hear of the strategies you're successfully using. Your two remaining concerns are very valid and I am pleased you are aiming for consistency.
With regards to the table manners, could you not include this into her star chart? If this reward system has worked well perhaps including a new item to the list will be enough of a reminder.
Your daughter's feeling of not being able to do anything is right is a common perception among children with ADD; it may be exacerbated by her anxiety. I am not certain how you remind her of the right way to do things, perhaps using a lighter tone or making a joke of 'oh dear, you did it again' or tickling her instead of saying anything may be less stressful for her.
For the routine things she forgets, perhaps little notes stuck around the house to serve as reminders 'for everyone' would help. You can remove the notes in a few weeks once the tasks become routine.
Q: ADD with oppositional defiance syndrome
My daughter of ten has ADHD with oppositional defiant syndrome, she is on Concerta 36mg. I am finding that the defiant syndrome is still very apparent and tiring for me. She used to be on Ritalin and we changed to Concerta as it lasts longer. Please advise as to what I can do to manage?
A: ODD is possibly one of the most difficult disorders to live with and the pressure it is placing on you and your family is very understandable. You can enroll in a parent management course which will provide you with strategies to cope with your daughter's behaviour.
It may also be beneficial for your daughter to undergo cognitive behavioural therapy, however, by the very nature of ODD she will likely resist this suggestion. Developing coping skills for you first will better enable you to deal with the next steps. Please contact The South African Depression and Anxiety Group (SADAG) on 011 262 6396 or 0800 20 50 26 for details of a specialist in your area who can provide such a course.
Q: ADD and concentration
My 9-year-old daughter's teacher is complaining that my child is day dreaming? What can I do to help my daughter?
A: The first avenue is to ensure your daughter is 'merely' day dreaming and is not worrying about something; stress can manifest in different ways, and day dreaming can be a form of escape. Once you have confirmed there are no major stress factors, boredom needs to be eliminated. If her daydreaming is limited to one or two subjects, she may be bored and then a pep talk about trying her best, even when things are not that interesting, should suffice.
Ensuring your daughter has a healthy, balanced diet, limiting sugars and preservatives can go a long way to improving concentration. Omega 3 and 6 capsules are a very good supplement which can provide a boost.
No one knows your daughter better than you, and if you are still concerned you can contact ADHASA on 011 888 7655 or www.adhasa.co.za for an educational psychologist in your area who can provide an assessment to ascertain the reason for your daughter's day dreaming.
Q: Dazed ADHD
My son, aged 7, has been on Concerta for almost 2 months. He started responding really well, but now he seems to be in a bit of daze at times. At school he is still battling to concentrate, but at home at night he looks at me when I tell him to do something as if he just can't do it - he hears me but ends up crying. I feel bad about continually shouting and end up smacking him.
Mornings he takes over an hour to get ready for school - just takes his time. I've tried incentives too - nothing is working. He is very loving when he wants to be, but I can see he feels worthless. I feel like it's my fault he can't cope as I've tried so much already. He is going for speech therapy, remedial therapy and play therapy – I can only get him into remedial school from next year - please can someone help?
A: The dazed reaction in the evening can be due to an incorrect dosage, or as a result of the medication having worn off. However, if the school is not noticing any improvement, it seems the former situation is more likely.
There is also the possibility that Concerta is not the ideal medication for him. Poor self esteem is very common among children with AD/HD as they become accustomed to failure. Self esteem courses are available and it may be worthwhile sending him on one, once the medication side has been dealt with.
It is important to be gentle but firm with him during the beginning stags of medication; children of his age may well be feeling 'different' but unable to express it. Please remember the being firm part as well - the last thing you need is a child unwilling to do anything because he knows you feel sorry for him. It is a trial process, but results should be evident soon.
Q: ADHD son sleeping badly
My 7 year old son has ADD & has been sleeping very badly recently. I have made no significant changes to his diet or routine, only those recommended by the school nutritionist last year January as he has several hereditary allergies.
He has also been misbehaving at school lately, having shouting matches with his teachers and bullying other kids. He attends a private school for children with ADD / ADHD and other learning difficulties. The school has several experts such as a nutritional expert, a psychologist, an educational psychologist, etc. He also has a lot of individual and group sessions with the psychologist when ever he misbehaves at school, which seems to be more frequently as of late.
A friend of mine suggested I try melatonin. Will this be beneficial? The omegas are not really aiding his concentration and I'm also worried that this will lead to weight gain. He is also constantly agitated, moody and depressed. The fact that he's not sleeping may be adding to his ADD. There are no psychological factors like abuse or alcoholism that could play a role in his recent behaviour, so my best guess is that it might be dietary. Please help, I'm at my wits end!
A: You are correct in saying that his moodiness and concentration are likely to be affected if he is not sleeping well. Melatonin can be used to help regulate sleep cycles; however, as you have mentioned your child has a number of allergies, please check with your GP before starting anything.
It seems the school is covering all angles with his numerous therapies. However, if with improved sleep patterns there is no change in his current behaviour it may be worth while taking him for a medical checkup and/or a referral to another educational psychologist or play therapist who is not involved in his day to day activities.
What are the symptoms of ADHD?
ADHD and diet
(Joanne Hart, Health24, March 2011)