Posted by: BMJ | 2008/07/24

Mirror and other q

Hi Doc

I am posing the questions to you because the ADHD expert has a problem payng attention to his questions :)

Just some background:
My 7 year old son was diagnosed 7m ago as suffering from ADHD. (He was diagnosed by a pediatrician and his preprimary teacher and the evaluating psychologist agreed). After trying a few natural approaches and noticing no changes, we put him on Ritalin and well within 30 minutes we had a miracle. At the time we were also told by the psychologist that he was 7.7m behind developmentally. He had been receiving OT for visual perceptual intergration problems for a year already. He went to a private school specialising in kids with ADD/ADHD and learning problems and he is doing great. he had caught up his delay completely.

My questions:
1. When he writes (usually if he does homework later in the afternoon, not so much early in the day), he will mirror his letters. It is completely correct, except it is upside down and wrong way round. He also will start reading or writing from right to left. (He is left handed, dont know if it has anything to do with it). Can you explain why he does this? Is it realted to ADHD or just a common thing for children learning ro read/write? Will he ' outgrow'  this.

2. We have noticed that the effect of the Ritalin is lessening. It seem to take longer to work and work for a shorter duration. I have asked his teacher if she noticed any change and she said he is more active and talkative but she thinks it might be just excitement about his pending birthday party. I have certainly noticed a difference in the last 4 weeks at least. He weighs 25.5kgs and is on 10mg am and 5mg at noon. We know when the tablets have worn off as the sillyness (to the extreme) and jumping around starts. At which point do you increase the dosage ? Must the original improvement be completely gone or when you start to see a change like now?

His inability to concentrate seem to be directly linked to his activity levels. As he grows older and his activity lessens (we pray) will it mean that he will no longer need Ritalin?

Thank you for your opninion.

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Our expert says:
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OK< I don't specilaize in, nor have much experience with ADHD and childhood developmental disorders --- that would be in the province of a paediatrician or child psychiatrist. However, here are some thoughts.
At an earlier age, mirror writing is quite common, as it takes a while for a child to develop a reliable sense of "sidedness" --- Left/Right. And it does seem more common in Left-Handed children. It may persist into adulthood as a skill ( some people can do it easily, by choice, as did leonardo Da Vinci, who chose to write his diaries in mirror. Its less common by 6 or 7. and may then be related to forms of Dyslexia, and then a psychologist specializing in learning disabilities may be best able to assess this.
As for question 2, I really don't know. As the techer says, excitement at an approaching birthday party could be relevant, but this really needs the opinion of the ADHD expert ( remind him to take his tablets !) or your paediatrician. As I understand it quite often the ADHD features may indeed lessen and fade as a child grows older.

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