The Diagnostic Puzzle, Part 2
Making the most of medication
According to the American Academy of Pediatrics, "at least 80 percent of children will respond to one of the stimulant medications if they are tried in a systematic way." What if your child happens to be in the other 20 percent?
You must work with a doctor who knows a thing or two about ADHD and related disorders. The doctor should have significant experience with trying out various ADHD medications and dosages, including some that are nontraditional, or “off-label” — that is, those that lack specific approval for treating ADHD. The blood pressure drugs clonidine (Catapres) and guanfacine (Tenex), for example, are often highly effective against impulsivity, hyperactivity, and sleep disturbances.
Assembling a team
"Don't hesitate to consult a specialist if traditional treatment isn't working, or if you suspect your child has a complex form of ADHD," says Brock Eide, M.D., of Edmonds, Washington, co-author of The Mislabeled Child (Hyperion). "Your pediatrician or family doctor may not be up-to-date on the latest and greatest cutting-edge diagnostic and treatment approaches."
Dr. Eide says that an ADHD child who is also affected by bipolar disorder, depression, or obsessive-compulsive disorder (OCD) should be seen by a child psychiatrist. If a child is experiencing social or emotional difficulties, a psychologist can be helpful. And if a child develops tics or has chronic headaches, it’s a good idea to consult a pediatric neurologist.
How can parents keep track of it all? John F. Taylor, Ph.D., the Monmouth, Oregon-based author of The Survival Guide for Kids with ADD or ADHD (Free Spirit Press), urges parents to keep a written log detailing their child’s symptoms and difficulties, as well as the steps taken to address them. "Write down all your concerns, your child's symptoms, abnormalities, and anything else that marks your kid as different from other kids. Pay particular attention to what changes as a result of medication or behavioral interventions, and what doesn't."
Dr. Taylor knows from personal experience how valuable a treatment journal can be: Three of his eight children have ADHD.
What about misdiagnosis?
Some children diagnosed with ADHD, in fact, don't have the disorder. Ask Shelly Niemeyer, a 38-year-old mother of two, living in Chesterfield, Missouri. "When my son, Luke, was in third grade, the teacher found out that both his older brother and I have ADHD," she says. "Immediately, it became Luke's problem, too. Our doctor read the teacher's report and put Luke on medication.
"My older son had improved when he started taking medication, but my younger son didn't. So I decided, after two months, to stop Luke’s meds." As it turned out, Luke doesn’t have ADHD — or any other psychological problem. "He's merely an active, creative-minded nine-year-old," says Shelly.
"When you start a child on ADHD medication, you should see substantial improvement very quickly, even with the first dose,” says Dr. Eide. If the improvement in behavior is marginal, despite trying several medications at various doses, it's a clear signal to start looking for conditions other than ADHD.
"Another factor to consider," says Fernette Eide, M.D., Brock Eide's wife and collaborator, "is the possibility of a 'look-alike.'" By that she means a disease or disorder whose symptoms resemble those of ADHD.
By the time Adam Colbert, of Westford, Massachusetts, was in preschool, everyone had noticed his speech problem and his inability to pay attention. "We were concerned," says his father, Jim. Thinking that Adam might have ADHD or a learning disability, Jim and his wife had Adam assessed — and were surprised to learn that Adam has a significant hearing loss. Now wearing a hearing aid, Adam is doing great.