Ask Dr. Silver
The following are past questions and answers from Dr. Larry Silver on this topic.
Why would a child diagnosed with ADHD have trouble retaining letter sounds?
My 7-year-old son has ADHD and an IEP in class at his school. He is very good in math, but when it comes too letter sounds, he cannot retain them so he can't read or write. How do I, as his mom, help him too remember from one day to the next? And why is it he can retain all the things to do with math and not reading? I am confused?
Vickie
About 50 percent of children with ADHD also have Learning Disabilities. Your son sounds like this might be true for him. If not yet done, a comprehensive psycho-educational evaluation will clarify why he is having difficulties and clarify how best to help him.
(May 2008)
I'm fifteen and think I have ADD. What are your ideas?
Hello! My name is Rebecca Phipps, and I'm 14 years old, almost 15. I recently got accepted into this awesome new high school, West Florida. It's a difficult new school, and most people would just die to go there. I've always had a little bit of ADD, but because of the new stresses and other components, it's gotten worse. It's really embarrassing when I am talking to the teacher and I randomly forget what I was talking about.
My mom knows about this, and my brother has ADHD. I talked to my older sister about it and I tell her a lot of things I don't tell mom. The other day we were talking about my situation, and I want to talk to my doctor about getting the medicine for it. I figured there's not very much to lose. I was wondering if you had any suggestions about opening up a conversation with my mom about really considering talking to my pediatrician. Could you please help?
Thank you for trying to understand yourself. Yes, please talk to your mother. Explain what you describe above. Ask her to set up a consultation with your family doctor. When you have this appointment, list your observations and your concerns. Best of success.
(November 2007)
How does the doctor figure out medication dosage?
My question is in regards to my son's ADHD med, Adderall XR. He seemed to be doing really well with it for the past four months. However, he has been having trouble lately focusing. Our physician suggested raising it to 15MG, which didn't seem to help. He then suggested 20MG. I don't feel really comfortable raising it that high, as our son is only six years old.
Is it possible another medication may work better, even in the same stimulant family, like Focalin that can be sprinkled? Is it unusual for a child to do really well on a medication for four months and then have difficulties again? Thank you!!
The dose of any of the stimulant medications used for ADHD (Ritalin, Adderall, Focalin, etc.) is not based on age or body weight. Thus, the only way to know is to start at a low dose, usually 5 mg. Then, about every 5 – 7 days, the dose is increased to 10 mg, then 15 mg, then 20 mg until the best dose is found. (Be aware that Adderall XR __ is an eight hour release form. Thus, Adderall XR 20 means that it releases about 10 mg initially and about 10 mg four hours later for a total of 20 mg).
(November 2007)
What is the relationship between ADHD and sleep apnea?
Recently my seven-year-old son has been diagnosed with ADD and dysgraphia. He also has enlarged addenoids that have to come out. He only has 1 mm airway when he should have 10 mm. He has notable sleep apnea and is an aggressive snorer. Could his sleep apnea be playing into some of his focus and attention issues?
Sleep apnea can cause the child to be tired during school hours. If tired, he might be inattentive. I suggest that the sleep apnea be treated first. If, after he no longer has sleep apnea you still find him to be inattentive, it would be helpful to speak to his family physician about further evaluations.
(October 2007)
How can a parent help their teenager with ADHD (and/or LD) who has trouble staying organized?
My 15-year-old son was diagnosed approximately three years ago with the inattentive form of ADHD. He is also a gifted honor student in a very competitive public high school. We should have addressed this issue much sooner, but he was always able to overcome his difficulties so I never gave a thought that he had any learning disability.
His main difficulties are that he constantly forgets things, has difficulty staying on task, misplaces things including homework on a regular basis, and is easily distracted. We have never tried medication, nor have we sought special accommodations in the school.
Ever since he was in the second grade and required to turn in homework, we have received notes home from teachers each quarter of every year about my son failing to turn in work that we know he did. He also forgets to write down assignments and sometimes even forgets that he has a test or quiz in a given class. We have purchased planners but he inevitably loses them or doesn't use them effectively. Although never diagnosed, I too have many of these same symptoms, so it is difficult for me to assist as I would like.
The main problem at this juncture is that he is seeking a Navy ROTC Scholarship. Therefore, by the Navy's rules, in the year prior to his being medically evaluated for the scholarship, he cannot take medications to treat ADHD, nor can he receive accommodations that other children do not get, or he will be medically disqualified.
What suggestions do you have, without using medications or school accommodations, for us to help our son be successful? He desires to study Engineering, which is an extremely rigorous program. We are very worried that his disorganization and lack of focus will make things very difficult for him to succeed without using medication or accommodations. Thank you for any help you can provide.
Chris
May I first answer the question for all students and then for the specific issues related to your son. Organizational problems might result from ADHD, from a Learning Disability (LD), or from a combination of both. If the problems are secondary to the ADHD, stimulant medication can make a significant difference. If the problems are the result of LD, medication will not help but special education tutoring will help. If the problems are the result of both, medication and special education tutoring will be needed.
The easiest first step for most students is to try a stimulant medication. If successful, great. If not, a psycho-educational assessment will be needed to clarify the issues.
Now for your son. It might be best to get a psycho-educational evaluation first. If the problems relate to LD, a private special education tutor (without accommodations) might be all that is needed. ADHD medications or ADHD accommodations would not be on records.
(August 2007)
How can a teacher help a child with ADHD who has trouble reading and speaking?
I am a fifth grade teacher and I have a student who is medicated for ADHD with a patch. He shows an attention rate of about 85 percent throughout a school day. However, I have found that he experiences trouble in reading and in speaking at times. When called upon to orally read in class, he must stare at the text for approximately 20 seconds in order to verbalize his words. He also experiences this at times in beginning communication. Do you have any ideas of what the causes may be, or how I can assist him? Maybe games or skills practices that could help.
Thanks,
Donna
About 50 percent of students with ADHD will also have a learning, language, and/or motor disability. If your student is in fifth grade and struggling with reading, has he been evaluated by your school system for a possible learning disability? You also describe difficulties processing what he hears and what he must organize in his head before he can speak. Has he been evaluated for a language disability?
I think it is wonderful that you want to better understand and help. Start with getting psycho-educational and speech-language evaluations. These data will help guide your classroom efforts.
(July 2007)
How should ADHD be treated when there is also an anxiety disorder?
My eight-year-old son was diagnosed with inattentive ADHD and Central Auditory Processing Disorder (CAPD). He has always been a shy anxious child and uncomfortable socially. We have been trying different stimulant medications for him that have helped the inattentiveness, but have exacerbated the anxiety (separation anxiety and peeling his finger tips particularly).
We are now going to try Straterra. Should he get a formal diagnosis for anxiety disorder and be taking something more like Wellbutrin, or should we see how he responds to the Straterra? I have always been bothered by his anxiety issues and feel that the professionals I have seen seem to focus more on the ADD issues. Only now is the present doctor recommending he also has therapy for anxiety.
Thank you,
Judy
When someone has ADHD and also has an anxiety disorder, it is not uncommon for the medication used to treat the ADHD to exacerbate the anxiety disorder. It is best, therefore, to treat the anxiety disorder first.
Once this disorder is under good management, it should be possible to reintroduce a stimulant medication to treat the ADHD. The most frequent medications used to treat anxiety disorders are called “Selective Serotonin Reuptake Inhibitors.” Discuss this approach with the prescribing doctor.
(June 2007)
Can a really busy person get diagnosed without spending much time at it?
Is there a way I could be diagnosed without having to go to my general practitioner? During the week, I have college and have to work so I never have spare time to go to the doctors. But I want an official diagnosis that I have ADD or ADHD. It would help me get a little extra help in college
There is no easy or quick way to diagnose or treat ADHD. You need to be seen by a physician to establish the diagnosis and to receive treatment. Maybe you could find someone at your college's Health Services so that you do not have to travel. Again, if you have a problem that is impacting on your success, you must find the time to get the proper diagnosis and treatment.
(April 2007)
What happens when family members have ADD and other disabilities such as depression, anger-control problems, and anxiety disorders?
My daughter, who is 11 years old, was diagnosed with ADD. She is on Focalin. For the most part she is doing pretty good but she has her occasional breakdowns. How do you help get a person out of a meltdown without a lot of screaming, yelling, crying from that person?
My wife suffers from depression and also is ADD. She is on medication which does not help when my daughter has one of her meltdowns. Then my wife starts to have a meltdown. Sometimes panic attacks arise from what my daughter is saying etc during a meltdown. Any suggestions would be grateful in dealing with my wife and daughter.
Thanks
Bruce
It is important that you learn about what is called comorbidity with ADHD, as I discussed in my book, The Misunderstood Child. Fifty percent of children with ADHD will have one or more of a pattern of emotional regulatory problems. These include anxiety disorder (with panic attacks), depression, anger control problems, and obsessive-compulsive disorder.
These comorbid conditions are neurologically-based as is the ADHD. Usually, each of these problems existed over many years and can occur in school as well as at home. The medication may have made each worse but may not be the cause. Often, there is a family history of similar problems. It sounds as if your daughter might have one or more of these regulatory problems. I recommend that you have her evaluated by a Child and Adolescent Psychiatrist. It is essential that you clarify all of her problems so that a comprehensive treatment plan can be done.
(March 2007)
What happens if medication does not seem to be working well?
My son was diagnosed with ADHD and learning disabilities at the end of third grade. He is now in ninth grade and gets very frustrated to the fact that he can't concentrate and do well in school. I feel frustrated myself because I don't know how to help him get out of his frustration.
He used to take Concerta until last year. He now refuses to take the medicine because it makes him feel a different person and he gets angry and aggressive when he takes it. I stopped giving it to him.
Please provide me with some feedback as to how I can help him succeed.
Lvonne
Let me focus first on the ADHD. Maybe he can't concentrate in school because his ADHD is no longer being treated. You should know that there are two consequences of being on too high a dose of Ritalin (Concerta). First, the individual may be more emotionally fragile - more angry or upset. Second, the individual may feel spacey - like someone flattened his personality. Perhaps if he saw someone who knew how to adjust the dose and monitor the medication, he would not resist. Discuss this with your physician.
Second, he has learning disabilities. And, now he is in high school. Does he have the compensatory strategies to handle high school work? Does he have the necessary accommodations in class? Could his frustration also be because he is no longer receiving adequate services?
(January 2007)
Where can an adult be formally diagnosed with ADHD?
I have been diagnosed with adult attention deficit. I am currently taking Concerta. Where can I take a diagnostic test? Is it a formal test in which I can take so I can seek professional help? I just retired from the military and I would like to be able to go to college and able to really learn and not only pass a test.
I am getting ready to go to college this fall and I am assuming they would like some type of formal evaluation, test type documentation. The more a read about ADHD the more I see myself back in my early age.
Thank you,
William
The formal criteria for diagnosing someone of any age with ADHD is in a diagnostic manual called the DSM-IV.
The first step is to confirm the presence of hyperactivity and/or inattention and/or impulsivity. Then, it is necessary to show that these behaviors have been present since childhood (chronic) and that they exist in many aspects of your life (pervasive).
Finally, it must be clear that there are no other disorders that might explain the problems. A physician makes the diagnosis. Check around to find out which physicians, often psychiatrist, are knowledgeable about ADHD.
(November 2006)
Do you have any tips for teenage drivers with ADHD and/or LD?
I am a 17-year-old girl who has been diagnosed with ADHD and a type of LD. I have had my license since August of 2005. Since then (not including the minor bumps against the garage), I've had two severe car accidents resulting in totaling both cars. The first one was inexperience, but the second one was failure to pay attention and my reaction time.
My parents are restricting my driving right now but they don't want to take it away because they don't want me to lose my freedom. Do you know of any tips or books for teenagers living with ADHD and driving?
Thanks
Ashley
You are wise to ask for help.
Start by learning what type of LD you have. Hopefully your parents or a school professional will know. You need to find out if this disability might be contributing to your problem. For example, if you have visual-spatial or visual-motor difficulties, you might have trouble judging distance, closeness.
Then, clarify in what ways you have ADHD. Are you hyperactive? Are you inattentive and easily distracted? Are you impulsive? If you are any or all of these, it would be important that you be on the proper medication when you drive. This medication would reduce or stop such behaviors.
Now, to be more practical. Ask your parents to check with the driving schools in your area. Ask if any program has a teacher that works well with students who have ADHD or Learning Disabilities. Even though you already have a license, it would be helpful to take more practice lessons with someone who understands and who can give you practical advice.
Good Luck.
(November 2006)
How can I get a good diagnosis for my child who might have a learning disability?
My 5-year-old son was recently referred for testing by teachers. We filled out forms and brought him to the pediatrician who promptly diagnosed my son as ADHD and prescribed Focalin.
I asked about other possibilities related to LD maybe being part of the problem as his skills are severely delayed (about 1.5 years behind other children). I was told it was possible he had an LD that caused him to lose interest and focus OR it could be ADHD that caused him to have problems learning. I asked how do we know which it is and was told the solution was to medicate and see if it works or not.
I described in detail his ability to learn and retain information verbally just not visually so much. I asked about testing for learning disabilities before we started medicating my child.
The pediatrician referred me to a developmental clinic who does not take private insurance, only Medicaid, and costs around $10,000 for a full screen for LDs. I need to have an alternative as I cannot afford this screen and am hesitant to make my child a guinea pig with medication that he may or may not need.
Please help - what do I do? What resources exist for us?
Thank you,
Jenni
You ask good questions. Your son's problems might be due to evolving Learning Disabilities or due to ADHD or due to both. It is important to clarify.
Did your pediatrician do a full assessment? Did he/she use the required criteria to diagnose ADHD? (Presence of hyperactivity and/or inattention and/or impulsivity that has been present for several years and that are noted at school, home, with friends.) If not, don't accept the diagnosis.
I would suggest you find a good educational diagnostician, experienced with early childhood. You will not have to guess. If there are developmental delays or LD, testing will clarify. This assessment should not cost more that $1,500 to $2,000, depending on what is done. (I have no idea what a developmental clinic would do that would cost $10,000).
(November 2006)
How do we help a child with ADHD and auditory processing deficit?
We are trying to decide which therapy would be better for our daughter who has been diagnosed with a mild case of ADHD and a possible auditory processing deficit. We are currently considering the NILD Discovery program or neurofeedback. We cannot find information comparing the two.
Thank you so much for replying.
Sincerely,
Lori
First, and most important is that the diagnoses are correct and that other possible causes for the problems have not been missed. Has she had formal psycho-educational testing? Has she been diagnosed with ADHD by a professional who uses the criteria required to make this diagnosis? Please do not jump into any type of treatment until you know what it is that you are treating.
For ADHD, medication is the treatment that works best. For auditory processing problems or learning disabilities, speech-language or special education therapy works best.
Don't spend your money and your daughter's time on NILD Discovery or neurofeedback as an initial step. Neither has been documented as being effective treatments for ADHD or for auditory processing problems.
If you want more information on evaluation, diagnosis, treatments, you might want to read the book, The Misunderstood Child.
(August 2006)
Should ADHD medication be given only when a child is at school?
My step-son is taking Concerta. Shouldn't he take it every day? His mom only gives it to him through the week, not on the weekends, or only when he's in school. When we have him, he says he feels weird on Monday at school. I want to know if it is harmful to him because he's on and off it so much.
Thanks,
Shaun
Medication for ADHD, such as Concerta, should be taken whenever the hyperactivity, inattention, and/or impulsivity could interfere with the child's ability to function and perform.
If weekends are casual and there are no sports activities or homework to do, he might be ok without medication. If you notice that his ADHD behaviors create behavioral, social, or academic difficulties when he is with you, it might be important for him to be on the medication.
(July 2006)
For more information on this topic, please visit the ADHD section in LD InDepth.
