October 17, 2009

Maybe Your Child Has ADD and Needs Ritalin

What You Should Do When Someone Tells You: "Maybe Your Child Has ADD and Needs Ritalin"

Perhaps you feel panic, anger or relief. Wait. All they're really telling you is that your child isn't meeting their expectations of behavior or performance. Attention Deficit Disorder (ADD or ADHD for hyperactivity) has become the all too inclusive umbrella term for a variety of childhood (and increasingly adult) problems.

However, given current views on behavior, if they're suggesting ADD they're implying that they think the problem is because of your child's brain - and that may be only be part of the problem or not be the case at all.

Before you pursue investigating a "chemical imbalance"consider the possibilities of a "living imbalance." Are the expectations for your child's behavior and performance too high or reasonable in all their settings? Is his/her performance all that much worse than the other children? These days to be considered "average" is almost pejorative. A vast group of children perform "below"average without being abnormal. These children may be good at certain tasks and less good at others. A living imbalance can also exist when supports for the child and the family are too low. Have there been more stresses (emotional, educational, financial) on the child or his/her family? Has there been less family time for positive attention or immediate and consistent discipline? Maybe changing classes or teachers, getting extra help from an aide or resource teacher is enough to restore the balance between performance, expectations and support.

If the problems are long standing (say more than three months) consider as a start speaking with your pediatrician or family doctor. He/she should be familiar with your child and should be able to offer initial opinions, advice and direction. Be cautious, however, when after a 15 or 20 minute interview Ritalin is offered. No evaluation that short could possibly address the myriad factors involved in a child's behavior. Ritalin improves the performance of both normal and ADD children so a positive response to Ritalin says nothing about the causes. A quick Ritalin-only approach may mask learning, emotional or relational problems and delay their being addressed.

Remember that there are no definitive biological or psychological tests for ADD. Despite attempts to standardize criteria for ADD it remains a diagnosis very much "in the eye of the beholder." Some people and doctors see ADD in virtually every problem situation; others, including some doctors, don't believe that ADD even exists! If you are referred to or find a professional who specializes in ADD (child psychiatrist, behavioral pediatrician, educational psychologist), ask about the doctor's ideas and beliefs on ADD and Ritalin. Find out how they arrive at their diagnosis, opinions and conclusions. If you're not comfortable with their approach, find someone else. If you're not sure ask other professionals in the area their opinions about the specialist you've picked.

A good ADD evaluation should address all the areas of a potential living imbalance. Both parents should give their versions of the problem to the evaluator. Some doctors prefer to use written symptom questionnaires. They are not a replacement for face to face talking between the parents and evaluator or calling the teacher on the telephone. An interview with your child should include an assessment of his/her emotional status, temperament and learning abilities. Someone should meet the child's entire family one time.

After the possible emotional, family or school problems have been evaluated and are being addressed, there may be a role for a medication intervention. Ritalin or similar drugs have been used safely in children for fifty years. No parent is immediately eager to start medicating their child but they should not feel guilty when after a thorough evaluation and multipartite treatment plan, they decide to try Ritalin for their child.

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