How to Stop ADHD Medications for the Summer

How to Stop ADHD Medications for the Summer

How can I stop my son’s or daughter’s medications for ADHD without causing problems?

This is one of the most frequently asked questions from parents of children with ADHD during the early part of the summer.  Many parents feel their ADHD child or teen should be taken off of their ADHD drugs during the summer.

Here are a few of their arguments about stopping ADHD drugs:

  • When I was little, my doctor told my parents to stop my ADHD medications to give me a rest over the summer
  • I’m afraid he’s been on them too long without a break and they will damage his brain
  • I’d like to see if her behavior gets better over the summer without those drugs
  • School is out now and since we only started the ADHD medications to improve his grades, he doesn’t need them while he’s out of school
  • I don’t feel like fighting him (or her) to get him (or her) to take the drug while we’re on vacation
  • It’s not like he (or she) is going to be reading or studying over the summer, so I want to give him (or her) a break.

There are probably many more similar questions and concerns about continuing ADHD medications when a child is out of school for the summer. And, I can understand why a parent would like to give their child a break from taking pills when absolutely not necessary. When I first started practicing family medicine in the 70’s, we referred to these “pill breaks” as drug vacations.

ADHD medications were usually the only drugs we would consider for a drug vacation. For example, other medications for things like diabetes mellitus, heart disease and asthma are just too essential to normal life to be considered for drug vacations. ADHD experts and other doctors who treat ADHD would often argue the fact that a child or teen couldn’t focus, concentrate or control their impulsivity wasn’t life threatening so therefore the drugs could be stopped for a month or two without causing problems.

Unfortunately, I know a bunch of people including parents of children without ADHD as well as parents of ADHD children and ADHD teenagers who would disagree. Here are a few of their reasons:

  • The mom of 5 year old Joshua still misses her son. He’s not there at breakfast, or for her to play with at bath time, or to celebrate birthdays. Joshua was playing in the front yard when a 16 year-old lost control of his car, running over him, killing him instantly. The 16 year-old was driving too fast and texting at the same time. He had stopped his ADHD drugs two weeks earlier.
  • Jeff and Laura had planned a summer vacation to Disney world, but instead had to spend all of their vacation money (and much more) to pay lawyers when their daughter Kayleigh was caught shoplifting a DVD at the local mall. She had been off of her ADHD medications for over a month. Of course, Kayleigh’s brother and sister didn’t make it to Disney world either.
  • Debra and Stephen spent a year helping their 6 year-old son get his life back to normal after he ran out into traffic on a 4 lane highway while chasing a baseball. His impulsivity went out of control about 3 weeks after they stopped his methylphenidate for the summer.
  • Miguel’s mom decided to stop his guanfacine the last day of school. She reasoned since it wasn’t a controlled substance, it wouldn’t matter. Five days later, Miguel was in the hospital with very high blood pressure, blurry vision, and a really had headache.  He was experiencing what is called rebound hypertension as a result of stopping the drug abruptly.

These are just a few examples of the many “bad things” that can happen when ADHD drugs or therapy are abruptly discontinued. As you can see, stopping ADHD medications isn’t simple. Doing so without first consulting a doctor, may affect not only the ADHD child or teen, but other family members and even perfect strangers. In all of the above cases, these kid’s ADHD medications were stopped-cold-without consulting a doctor.

To avoid a similar catastrophe, I advise my ADHD parents:

  • Don’t stop your child’s-especially teenager’s-ADHD medications or therapy without first discussing it with me
  • It can be dangerous to abruptly stop any medication for ADHD, depression, or anxiety. In some cases, your child’s blood pressure could go very high. In others, ADHD behavior-impulsivity, inattentiveness, hyperactivity-may return with a passion-much worse than before.
  • Stopping an antidepressant or medication for anxiety or depression can lead to suicidal thoughts and self-harm behavior.
  • In all cases, weaning medications slowly over a 3-4 week period is acceptable as long as we agree to look for symptoms of withdrawal.

To sum it all up, stopping ADHD drugs abruptly can be very dangerous for your ADHD child’s or teen’s health and the health and well-being of others if done so without the guidance of the doctor responsible for prescribing the drug or therapy.

Parents should err on the safe side…discuss ADHD drug vacations with your child’s doctor before stopping any medications.

Frank Barnhill, MD

 

Here are a few previous posts that deal with ADHD drug vacations:

ADHD Teens-Impulsivity, Alcohol and Drugs during the holidays

http://www.mistakenforadhd.com/2011/12/adhd-teens-impulsivity-alcohol-and-drugs-during-the-holidays/

ADHD Drug Holiday: Should Kids Stop Therapy on Christmas Vacation?

http://www.mistakenforadhd.com/2011/12/adhd-drug-holiday-should-kids-stop-therapy-on-christmas-vacation/

ADHD Drug Vacations can cause Learning Problems

http://www.mistakenforadhd.com/2011/01/adhd-drug-vacations-can-cause-learning-problems/

Stopping ADHD Medications May Cause Social Behavior Problems

http://www.mistakenforadhd.com/2011/01/stopping-adhd-medications-may-cause-social-behavior-problems/

Stopping ADHD drugs for the holidays may make it worse

http://www.mistakenforadhd.com/2011/01/stopping-adhd-drugs-for-the-holidays-may-make-it-worse/

How to Diagnose and Treat Sleep Problems that cause ADHD Behavior

How to Diagnose and Treat Sleep Problems that cause ADHD Behavior

Problems sleeping have caused many kids and adults to be wrongfully labeled because of misdiagnosis of attention deficit hyperactivity disorder.

Recently, many news and research articles have popped up confirming what behavior specialists have “known” for years; children and adults who have problems sleeping are more likely to have behavior problems such as ADHD.

It just seems it took a long time for everyone else to come to grips with the association between a “good night’s sleep” and normal or appropriate behavior. I considered the quality and quantity of sleep to be such a big part of a child’s or adult’s ability to function the next day; I dedicated an entire chapter to the topic in Mistaken for ADHD.

In my last article; Problems sleeping cause ADHD Behavior in Children and Adults, we discussed how any “thing”; medical or otherwise, that caused a child or adult to have problems sleeping could also cause signs and symptoms of ADHD.

As you’re sure to remember, ten year-old Leslie was a perfect example of how a child could be misdiagnosed with ADHD-when in fact suffering from disordered sleep.

Disorders of sleep or disordered sleep are medical problems that may include both physical and emotional things as well as environmental-surrounding factors. Sleep experts estimate up to 25% of Americans suffer some type of sleep disorder or problem sleeping and at least 10% of those persons are children or teens.

As discussed in Mistaken for ADHD, Chapter 8-Sleep Disorders; in excess of twenty things can cause disordered sleep. In this article, you’re going to learn about the things that can mimic ADHD causing misdiagnosis that directly affect a child’s or adult’s breathing and can be definitively diagnosed by a “sleep study”.

These include:

  • Obstructive sleep apnea (OSA) is a condition characterized by episodes of snoring with periods of apnea or cessation of breathing caused by partial or complete obstruction of air flow. It is usually found in those who are overweight and have very thick necks or large abdomen, have something like a mass or tumor in their neck, or have very large adenoids, tonsils or nasal polyps. Technically, OSA can be caused by anything that restricts airflow through the mouth or nose.
  • Central Sleep Apnea (CSA) is a form of sleep apnea that is not caused by obstruction, but is associated with a defect the part of the brain responsible for controlling breathing while asleep.
  • Restless leg syndrome (RLS) causes a person to experience unpleasant feelings in their legs when lying down or asleep. Many describe the “pain” as cramps awakening them from a sound sleep and say that they can usually “walk it off”. As a result, we often refer to RLS as a voluntary leg movement disorder.
  • Periodic Leg Movement Disorder (PLMD) is associated with involuntary movement of a person’s legs while asleep. The movements can’t be controlled or walked off and may or may not awaken the person. However, once awake, most persons note their legs feel tired, but return rapidly to normal.
  • Narcolepsy is a form of uncontrollable-sudden onset of sleep. It is felt to occur as a result of some type of damage in the parts of the brain that control levels of consciousness.
  • Periodic insomnia simply means a person suffers from poor sleep that really doesn’t qualify as disordered sleep, but must be considered when trying to make the diagnosis. Sometimes, this sleep problem can be cured by altering room temperature, avoiding food and caffeine for six hours before going to bed and using good sleep hygiene.
  • Night-time seizures similar to petit mal seizures or mini-seizures can cause what is called partial arousal from sleep, thus interfering with the quality of sleep.
  • Cardiac arrhythmia or rapid-skipping heart beat can awaken a person multiple times during sleep periods by causing a pounding pulse, chest pain or shortness of breath. The most common arrhythmias are usually atrial fibrillation and paroxysmal supraventricular tachycardia (SVT).

As previously noted, each of these causes of disordered sleep can be diagnosed by using a sleep sudden or polysomnography. During the traditional sleep study these things are assessed:

  • Airflow at the mouth-nose level
  • Respiratory rate and depth
  • Oxygen levels
  • Brain wave patterns
  • Muscle movements-especially legs and arms
  • Heart rhythm.

By measuring each of these, a sleep expert can decide which type of breathing disorder exists if any and then, of course, recommend a course of treatment. Treatments for these types of sleep disorders may include:

  • Use of CPAP or continuous positive airway pressure
  • Weight loss
  • Tonsillectomy-adenoidectomy
  • Removal of any neck mass such as an enlarged thyroid or a tumor
  • Medications to control night-time seizures
  • Drugs that control heart rate and rhythm
  • Stimulants to reverse narcolepsy or daytime sleepiness
  • Improving sleep hygiene (no exercise, food, alcohol or caffeine in the six hours before bed)
  • Correcting low iron levels, vitamin B12 levels, vitamin D levels or thiamine levels.

Obviously, there are many more disorders of sleep that can be misdiagnosed as ADHD and cause inappropriate drug therapy for attention hyperactivity disorder in both kids and adults.

If you suspect a sleep problem might be causing your child’s or loved one’s ADHD like behavior, it’s really important you mention so to his or her doctor and ask for a sleep study as soon as possible. The consequences of the sleep apneas and narcolepsy can be quite serious and in some cases, life threatening.

In our next article, we’ll discuss more of the greater than 20 things that cause sleep problems that cause ADHD behavior.

Frank Barnhill, MD

Here are a few resources for you to take a look at:

ADHD Diagnosis: Sleep Problems Cause ADHD Misdiagnosis

http://www.mistakenforadhd.com/2011/09/adhd-diagnosis-sleep-problems-cause-adhd-misdiagnosis/

Sleep Problems in Children May cause ADHD Misdiagnosis

http://www.mistakenforadhd.com/2011/06/sleep-problems-in-children-may-cause-adhd-misdiagnosis/

Sleep Disorders in Children, Bullying and Aggressive Behavior

http://www.mistakenforadhd.com/2011/06/sleep-disorders-in-children-bullying-and-aggressive-behavior/

Barnhill, Frank MD. Mistaken for ADHD. How you can prevent mislabeling your child as a failure in life…Chapter 8, pp. 105-140. Published March 2010.

Problems sleeping cause ADHD Behavior in Children and Adults

Problems sleeping cause ADHD Behavior in Children and Adults

Any “thing” that causes a problem sleeping can also cause a child or an adult to have signs and symptoms of ADHD.

If you take a moment to think about it, it only makes sense that sleep disorders-regardless of the cause-can cause behavior often misdiagnosed as attention deficit hyperactivity disorder.

Ten year-old Leslie was a perfect example of a child misdiagnosed with ADHD-who in fact was suffering disordered sleep.

Leslie just seemed to be a tired, sleepy little girl when she first showed up in my office with her mom. Her teacher had urged her parents to have Leslie evaluated for ADHD, because “She had so many symptoms of ADHD behavior.”

Ironically, her symptoms were poor concentration, poor attention span, and failure to complete assignments, falling asleep in class, failing grades, and acting as if she was in a daze. She was definitely not hyperactive and reportedly rarely impulsive. Several of these are indeed symptoms of ADHD, but not enough to make a true diagnosis. That’s what made Leslie’s behavior so confusing to her parents. She was tired….all the time, not just at school.

Her parents had resisted the “idea that Leslie had ADHD” for as long as they could…at least until her teacher told them she was going to fail her grade if something wasn’t done and soon.

Leslie’s story was like so many other children misdiagnosed with ADHD-She never received a thorough evaluation for her “ADHD behavior”. Her previous doctor had started Leslie on Adderall without even seeing her in his office.

That’s just plain wrong! How could he possibly know that Leslie didn’t have one of the now more than 80 things that mimic ADHD causing misdiagnosis of ADHD? How did he know that Leslie didn’t have a heart condition that would have made use of certain ADHD drugs dangerous?

While he did tell Leslie’s mother he wanted to see her a month after starting the Adderall, he didn’t follow-up on the need for an appointment-so none was made. Leslie never had a single drop of blood drawn, never had an ADHD parent-teacher survey done-never had any type of physical examination.

As a consequence, her condition worsened to the point Leslie did fail the fourth grade.

Even though she was on a stimulant medication that helped her stay awake at school, Leslie crashed every afternoon when the drug "wore off". And when she crashed, she really crashed-often in bed by supper-time.

We suspected Leslie was suffering a sleep disorder based on questions her mother and father and teacher answered on my routine ADHD surveys.

What signs and symptoms of disordered sleep did Leslie show?

  • Being just as tired when she awoke as when she went to bed
  • Going to bed earlier than expected-without being asked
  • Kicking the covers off in the middle of the night
  • Falling out of bed while asleep
  • Complaining of being restless when in bed or laying on the couch
  • Not participating in play or social events expected for her age
  • Sleeping on weekends or when out of school when most kids would be playing with friends
  • Falling asleep while watching TV or reading a book or riding in a car
  • Snoring or awakening gasping for air in the night or when laying on the couch
  • Being irritable on family outings that took her away from home for many hours.

It’s easy to see how these symptoms could be so confusing, yet…I just couldn’t get a diagnosis of ADHD from them. So, how did we finally prove Leslie was suffering from a sleep disorder instead of ADHD? And.. which sleep disorder was causing her behavior?

These will be the topic of our next article….How to Diagnose and Treat Sleep Problems that cause ADHD Behavior.

Many things can cause a child to show symptoms of ADHD behavior including disorders of sleep and most are curable or at least treatable.

Frank Barnhill, MD

 

Here’s an article that brings attention to disorder sleep causing learning and behavior problems. Enjoy!

Is Excessive Daytime Sleepiness the Cause of Learning and Behavior Problems in Children?

http://www.huffingtonpost.com/david-volpi-md-pc-facs/children-sleep_b_1534400.html

Children with ADHD at Risk for Bullying and Self Harm

Children with ADHD at Risk for Bullying and Self Harm

ADHD experts have long known that children, teens and adults with ADHD are at increased risk for bullying at school, work and even at home.

Unfortunately, a recent study showed children bullied by peerswhen they are younger are up to three times more likely to harm themselves in adolescence.”

Researchers followed 1,116 sets of twins from 1994 to 1995 until their twelfth birthday and discovered almost 8% of those who were victims of frequent bullying deliberated tried to harm themselves. In contrast, only 2% of those who were not bullied tried self-harming behaviors.

Observed self-harming behaviors included:

  • Attempted suicide by strangulation
  • Cutting arms
  • Biting body parts
  • Banging their head against walls
  • And pulling out clumps of hair.

In our practice, we have seen kids who deliberated excessively tattooed parts of their body as a result of the stress of being bullying. One teenage girl told me she had done so in hopes her tormentors would leave her alone because they would think she was crazy.

Another bully-abused teen in our practice explained he tattooed his arms to keep from “slicing and dicing them with my knife.”  His tattoos were done using regular ink from writing pens he broke open. As a result of the rubbing alcohol he used to extract the ink, both of his arms were terribly scarred and disfigured under the tattoos.

Another 11 year-old showed up with dozens of bruises on his arms and legs-all in the shape of bite marks. He literally had “drawn blood” to overcome the anger and stress of being bullied by a 13 year-old who lived a few doors down.

We suspect all of the above listed self-injury, self-harm behaviors are used by the child to try to cope with the extreme stress and distress of being bullied. Even ADHD children eventually learn how to avoid pain and suffering, but unfortunately are often slow to pick up on the little social clues that warn them  of danger and are therefore subjected to more abuse and harm.

Bullies tend to get a lot of satisfaction out of seeing distress and fear in their victims. They often evoke such responses by directly or indirectly abusing the victim by frequently displaying these bullying behaviors:

  • Kicking, hitting, and shoving
  • Playing mean tricks
  • Verbally abusing them in front of peers
  • Telling and spreading lies about them
  • Excluding them from peer relationships
  • Totally ignoring their existence
  • Threatening them over the internet.

Of the children in the self-harm-bullying group of the above mentioned study, there was an increase in psychotic behavior, conduct disorder, depression, and borderline personality disorder.  It’s no small wonder as all of these psychological problems can occur as a result of stress. I expect the group also suffered loads of generalized anxiety disorder-it just wasn’t mentioned.

It’s important to note that many children who are victims of bullying resort to self-injury after they have sought help from a peer or an adult and not been successful. When all else has failed, they turn to more drastic-attention-getting behaviors in a plea for help. Sadly, they are often blamed for their own behavior.

That brings us back to the opening statement in this article: children, teens and adults with ADHD are at increased risk for bullying at school, work and even at home and are more likely to harm themselves in adolescence when bullied prior to age twelve years.

With that fact firmly in mind, our task should be to detect bullying at as early a stage as possible and prevent these kids from harming themselves.

This is best done by understanding why and how bullying occurs and recognizing the early signs and symptoms of bullying in your ADHD child, teen or spouse.

Special note: Many teens and adults with ADHD who suffer bullying probably engage in some type of self-harm or high risk behavior because of the stress of the bullying. It’s just we don’t know how often it occurs and don’t have current studies to relate numbers of victims.

We’d love to have your comments on this topic. Maybe you can share a bullying experience from your childhood or that involves a loved one that has negatively affected you or them in some way.

In our next article, we’ll explore the early signs and symptoms of bullying.

Frank Barnhill, MD

 

References:

BMJ 2012;344:e2683 doi: 10.1136/bmj.e2683 (Published 26 April 2012)
Bullying victimisation and risk of self harm in early adolescence: longitudinal cohort study
http://www.bmj.com/highwire/filestream/581440/field_highwire_article_pdf/0.pdf
Accessed 052012.

Pediatrics Staff. Modern Medicine. Victims of bullying more likely to self-harm. May 10, 2012 on-line issue. Assessed 051012.

 

Here are a few previous article you might want to peruse:

ADHD Impulsive Behavior and Risk of the Choking Game

http://www.mistakenforadhd.com/2012/04/adhd-impulsive-behavior-and-risk-of-the-choking-game/

Adolescents More Prone to Cyberbullying

http://www.mistakenforadhd.com/2010/12/adolescents-more-prone-to-cyberbullying/

Kids and Teens Who Suffer Bullying More Likely to be Misdiagnosed as ADHD

http://www.mistakenforadhd.com/2010/10/kids-and-teens-who-suffer-bullying-more-likely-to-be-misdiagnosed-as-adhd/

Cure ADHD Behavior without using Drugs

Cure ADHD Behavior without using Drugs

ADHD behavior can be cured or treated without using drugs or medications for ADHD or behavioral problems.

Avoiding medications for treating ADHD and other behavior disorders now seems to be a hot topic on both parent’s and other healthcare professional’s minds.

Why you ask? I believe it’s because so much research is now available showing ADHD behavior can actually be caused by so many things that clearly are not ADHD. In addition, most of us have now heard the recent news of statistics that show as many as 1 in 5 US children will be diagnosed as ADHD by the end of this year.

If one in five children in the US is diagnosed as ADHD, nearly 14 million kids will be treated with either ADHD drugs or behavioral therapy by the end of this year. Of those, we expect between 5 and 7 million will have been misdiagnosed with attention deficit hyperactivity disorder.

That’s scary and in fact is scaring so many parents of children treated with medications for ADHD that they are now asking questions – questions they never asked before. Yes, with more and better information available, parents like yourself; are indeed thinking outside of that deep dark ADHD drug box.

Parents are now worried their son or daughter might have been misdiagnosed as ADHD and may really be the victim of mislabeling and inappropriate drug treatment.

Recently, on Your Carolina with Jack and Kimberly, I invited viewers to suggest topics for my next book on Curing ADHD without Drugs. I shared a case of ADHD misdiagnosis involving a 13 year-old with gluten sensitivity with Jack’s and Kim’s audience and apparently many parents had suspected the same of their ADHD child.

The 13 year-old to whom I refer had been on three separate ADHD drugs without improvement over a four year period.  Once the diagnosis of gluten intolerance was confirmed and his diet changed, his ADHD behavior went away within a month.  

Boy was I surprised at the emails I’d receive over the next three days.  Many who responded had stories of children, teens, and adults-all diagnosed as ADHD-who really were suffering from some other medical problem mimicking the ADHD. One grandmother told of how successfully treating her granddaughter’s depression over a parent divorce, brought about a cure of her ADHD behavior.

Thankfully, most of their loved one’s stories ended happily as the offending chemical, social disorder or medical problem causing their ADHD behavior was finally figured-out and eliminated.

I’d love to have suggestions from you as well. Hopefully, the book will be ready for publishing (it’s about 50% done now) by late September and you can help me help others by including stories of your loved one’s struggles with ADHD.

Once again, I’d like to remind everyone:

It is just as important to make an accurate diagnosis and treat ADHD as it is to accurately assess the child with a behavior problem and avoid overdiagnosis or misdiagnosis of ADHD. Both scenarios can cause a child or teen to fail in life.

Before we close, I’d to remind you that the most common sign that a child’s behavior is not ADHD and they might have been misdiagnosed is:

The suspected ADHD child’s behavior doesn’t get better or actually worsens when treated with appropriate doses of medications for ADHD.

Frank Barnhill, MD

 

Here’s a link to my interview with Jack and Kimberly.

 

http://www.yourcarolina.tv/ycvideo/entry/diet_and_adhd

(If the website can't be displayed when you click the link, try refreshing the page.)

 

Anger issues can be part of ADHD

Anger issues can be part of ADHD

Many ADHD children and adults have problems with anger. After all, many times anger occurs as a result of poor impulsivity control. If you can’t delay an impulsive action, then it’s hard to delay the feelings that often escalate to frustration and anger.

It’s not unusual for both parents and doctors to assume that anger results from being spoiled, from lack of discipline, as a side effect of bipolar disorder or depression, or one or more of dozens of other problems.

Sometimes the fact that anger can often be a part of the behavior of ADHD goes unrecognized. Other times, I suspect it becomes a subject of gross denial, as parents and healthcare professionals try to sort through the many causes of anger.

ADHD experts point out all of the frustration that children and adults with ADHD have to suffer is one of the major reasons for anger in these persons. Why? It’s hard enough for a child or teen who is not ADHD to deal with frustration and failure, but just think about how difficult it is for the ADHD kid, teen or adult.

As a result, ADHD anger can keep a child from being accepted by his family or peers. It can cause relationship problems that make it hard to keep a job, make dating almost impossible, and of course; destroy marriages.

Last week, I had the pleasure of attending a psychcentral.com webcast about ADHD, Anger and Marriage hosted by Zoe Kessler, BA, B.ED. and Melissa Orlov, marriage consultant. Both of these young ladies offered insights and discussions about anger in marriages where one (or both) of the partners suffer attention deficit hyperactivity disorder that I think you will find very valuable.

They have kindly provided a link to the podcast for me to share. I encourage you to invest about an hour of your time to listen and think you will be rewarded.

http://blogs.psychcentral.com/adhd-zoe/2012/05/did-you-miss-it-podcast-of-adhd-anger-and-marriage/

It’s a great chance to learn and be entertained at the same time.

Enjoy!

Frank Barnhill, MD

Medications for ADHD: When to change drug treatment

Medications for ADHD: When to change drug treatment

Many things should be considered before changing an ADHD child’s medication. Failure to do so usually results in the child’s ADHD behavior or grades getting worse, leading to more frustration on the part of parents and teachers and even much more dread and gloom in your child.

Parents often ask how they decide and when doctors need to change their ADHD kid’s or teen’s medications. Here are a few tips to lead you in the right direction:

When it comes to your child’s ADHD behavior or grades:

  • If they have improved by at least 75%, then he or she is responding to their ADHD therapy, regardless of what type it is.
  • If they have not improved by at least 75% and they are being treated with only behavior therapy or ADHD coaching, then it’s time to consider drug therapy for their ADHD.
  • If they have not improved by at least 75% and they are on one ADHD drug, consider increasing the dose until that goal is met or unbearable side effects rear their ugly heads.
  • If that doesn’t work, some ADHD experts will change the medication to another one, even if it’s in the same class of drugs. Just because one ADHD stimulant-amphetamine doesn’t work, doesn’t mean that another won’t.
  • It’s best to use one drug at the lowest dose possible to achieve adequate treatment of your child’s ADHD. That’s the best way to avoid unwanted side effects and uncomplicated dosing schedules.
  • If increasing your child’s ADHD medication to the maximum dose or changing to another single drug therapy doesn’t work or nasty side effects show up, consider backing off on the first ADHD drug and adding an ADHD of a different type.
  • Rarely, an ADHD child might need to be on 3 or 4 different medications to reach agreed upon goals or end-points for therapy.
  • Your goal in using stimulant type ADHD therapy should not be to control hyperactivity type behavior. The non-stimulant ADHD medications work better for helping that type of behavior.
  • ADHD stimulant and non-stimulant medications work well together and usually have fewer side-effects as compared to mixing different classes of stimulants.
  • If nothing seems to be working, consider ADHD misdiagnosis as a strong possibility. Your child might really not have ADHD and instead might be suffering from one of the more than 75 things that can confuse the diagnosis of ADHD causing the misdiagnosis of ADHD behavior.

The therapy of Attention Deficit Hyperactivity Disorder is wrought with many pitfalls and potential for disaster. Most of the failures in treatment and many of the bad things that occur do so because of illogical or unnecessary changes in therapy. Examples include:

  • Changing an ADHD medication before reaching a maximum dose or before side-effects are noticed for any reason. Just like many other drugs, medications for ADHD usually require weeks or even months to become effective. In some cases, we’ve seen ADHD drug therapy take as long as three months to reach full effect. The key in those cases has been the fact that the kids were definitely improving slowly, but surely the entire time.
  • Adding additional medications before trying time-released or extended release versions to help with behavior or study later in the day.
  • Abruptly stopping an ADHD drug without discussing it with your child’s ADHD doctor.
  • Trying to advance dosages of ADHD medications too rapidly or adding multiple medications at one time.
  • Not being sure your ADHD child or teen is actually taking the medication as prescribed (I’ve known ADHD kids who didn’t really want to take their meds simply palm the pills, pretend they took them and flush them later. One 13 year-old girl actually put them in a sock and saved them for some unknown reason. She didn’t like the way they slowed her down and just didn’t want the edge taken off of her behavior!)
  • Not making sure that another disease or disorder is responsible for making your ADHD child’s behavior worse. There are many things that can occur simultaneously with ADHD (comorbid conditions), such as teacher-student mismatch, bipolar disorder, depression, anxiety and post-traumatic stress disorder. In many cases, once a comorbid condition is properly treated, your child’s ADHD behavior will improve dramatically.

As you can see, changing an ADHD child’s medication can cause many problems, some which may cause your child’s ADHD behavior or grades to get much worse. ADHD experts advise parents and doctors avoid letting others push them into making hasty, poorly thought-through decisions when it comes to re-evaluating a child’s or teen’s ADHD behavior and ADHD therapy.

Frank Barnhill, MD

ADHD Drug Abuse in High School Students

ADHD Drug Abuse in High School Students

In this article, I’ll discuss ways to spot ADHD drug abuse and illegal use of stimulants in high school students as we near the end of school.

It almost always happens in the first week of May each year, but for some reason occurred earlier in April this year. Sometimes, it’s the student that shows up in my office-usually asking for Adderall-because they didn’t realize they had all the symptoms of ADHD until just a couple of days ago. At other times, it’s a parent who requests the drug, because their child’s concentration has suddenly gone south for some unexplained reason.

All of these parents and high school students have the same thing in common-bad grades, poor test scores and failing marks in class. They suddenly either want to be treated for ADHD or want their high school student treated for ADHD, because of failing grades or they won’t go to the next grade or won’t get their diploma and graduate.

Whatever the reason, most have memorized the signs and symptoms of attention deficit hyperactivity disorder and can recite them just like they are reading them out of a book. In other words, they are faking it all-just to get the drugs!

It’s true that illegal use of ADHD drugs-particularly Adderall-has increased among college student as they have discovered they can use them to better study and cram to improve test scores at the end of each semester. As a result of this knowledge spreading, more and more high school students are buying, borrowing or illegally obtaining ADHD stimulants for the same reasons.

ADHD stimulants help students study by: allowing them to stay awake for days at a time to study more and making them hyper-alert increasing their ability to concentrate and focus. ADHD drugs do so by stimulating the parts of their brains that improve concentration, memory, and wakefulness and decrease impulsivity and easy distractibility.

These are the very same things that happen in the brain of an ADHD student when he or she is taking ADHD medications. It’s just that in the students that really aren’t ADHD and don’t need the medications, we often see many side-effects or tell-tale signs they are using illegally obtained ADHD stimulants.

You should suspect your high school student is abusing ADHD drugs or other stimulants if you notice:

  • Sudden changes in their behavior-either better or worse
  • They don’t sleep for days at a time or stay up very long hours to study, but don’t appear tired
  • Their appetite decreases for no reason-they eat little and drink little-and start to lose weight
  • They complain of unexplained headache, stomachache, racing heart, skipped heartbeats,  being hot for no reason or problems with their vision
  • They appear fidgety or nervous
  • Suspicious behaviors such as hiding things or losing important documents or medications
  • They become paranoid.

The biggest problems in taking ADHD drugs for short periods, when they really aren’t needed, lies in the potential for addiction and withdrawal from suddenly stopping the drug.  I’ve seen students experience withdrawal vomiting, confusion and seizures after taking borrowed or bought off the street amphetamine salts for only three weeks. These can all be potentially life threatening and could of course lead to permanent physical harm or death.

The illegal use of ADHD medications by children and teens who are not ADHD is just one more of the more than 75 things that can act like ADHD causing confusion and misdiagnosis of ADHD. It’s the time of the year we should be on the alert for the illegal use of ADHD to improve study and grades in high school students.

Frank Barnhill, MD

 

Here are a few previous posts you might want to take a look at:

College Student ADHD Drug Abuse a Serious Problem

http://www.mistakenforadhd.com/2011/08/college-student-adhd-drug-abuse-a-serious-problem/

College Students Misuse ADHD Drugs to Improve Grades

http://www.mistakenforadhd.com/2011/08/college-students-misuse-adhd-drugs-to-improve-grades/

ADHD Drugs and the College Student

http://www.mistakenforadhd.com/2011/08/adhd-drugs-and-the-college-student/

ADHD Impulsive Behavior and Risk of the Choking Game

ADHD impulsive behavior increases the risk of teens playing the choking game and what parents and teachers should watch for….

Impulsivity is one of the key symptoms of attention deficit hyperactivity disorder as most of us who deal with children and teens with ADHD can readily attest.

Sometimes, ADHD impulsive behavior can be of great benefit both for the person who is ADHD and for others around him or her. It’s often said that without impulsivity the world would have no great military leaders, no outstanding sports heroes, no successful entrepreneurs and maybe even a lot fewer doctors. 

The reason is simple: Most of the great discoveries, most of the best inventions, most military endeavors, and most of the world’s most successful surgeons have one trait in common. They are risk takers and on top of it all, they are impulsive extreme risk takers. So, in some cases, impulsivity and risk taking behavior may benefit us all.

Unfortunately though, not all risk takers are striving for advancement or betterment. Some impulsive boys and girls are engaging in risk taking behavior just for the sake of a quick high.

The choking game played by preteens and teens is one such example of this type of behavior. Ok…I heard that. You mentally said; “My child wouldn’t do something so stupid.” Are you sure? Have you been watching for signs that your son or daughter might be using controlled choking to “fit in with his or her friends”?

The reason we should be concerned about the choking game in ADHD teens and pre-teens is obvious. ADHD kids and teenagers are much more likely to participate in impulsive behaviors that produce immediate reward or a high…and the choking game is one such behavior.

Other impulsive behaviors that give instant rewards include:

  • Speeding and racing cars
  • Stealing and shoplifting
  • Unprotected sex
  • Illegal drug use
  • Playing violent video games
  • Street gang related activities
  • Tattooing and body piercings.

If your ADHD child or teen has been caught doing any of these things, then you should look closely for signs they have been joining in the choking game with or even without their friends.

Recent medical research has shown children were more likely to participate in the choking game if:

  • They engaged in high risk or unprotected sexual practices-both homosexual and heterosexual
  • They were exposed to paternal violence and had a father in prison
  • They had a mother with illegal drug addiction or mental illness
  • They were poorly nourished or suffered from malnutrition
  • They had poor self-esteem or body image problems (I believe victims of child abuse and childhood bullying fall into this group)
  • They engaged in gambling and high risk legal behaviors

Here’s what happens in the choking game or the practice of strangulation entertainment:

  • A ligature of some type (belt, scarf, tie, tie-downs, bed sheet, pillowcase, backpack strap, towel or piece of cloth) are tied around the neck
  • The ligature is progressively tightened by hanging from a support such as a clothing rack, shower curtain rod or hook on a door; or by another person who assists in “the choke”
  • Pressure on the child’s or teen’s neck cuts off most of the blood flow to the brain to the point of almost passing out from lack of oxygen
  • The ligature is abruptly released, which rapidly returns blood flow and oxygen to the brain producing an intense “high”.

Some of the symptoms of or signs you might see if your child or teen has been playing the choking game include unexplained bruising or red marks on the neck, little red or blue hemorrhages about the eyes (petechiae occur from increased facial pressure and forced blood flow) and frequent complaints of headache and neck pain.

Many more issues surrounding the choking game and signs and symptoms of the game can be found in my previous article on this topic found on www.ADHDbehavior.com:

Beware the Choking Game

http://adhdbehavior.com/mistakenforadhd2/?p=118.

As parents and doctors of ADHD kids and teens, we should all be on the outlook for symptoms and signs of dangerous risk taking and impulsive behavior. The best way to do so is to be sure we interact frequently and communicate well with our young charges.  Just simply discussing the risks and long-term side effects of a popular behavior might be enough to make your ADHD child or teen to think twice before following the lead of others. Talk to your kids and learn about what’s important in their lives.

Frank Barnhill, MD

Reference:

Risk behaviors can indicate participation in the "choking game"

http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=769911&cid=PEDS

Last Minute School Tips to help Children with ADHD

Last Minute School Tips to help Children with ADHD

The last six weeks of the school term can be the most stressful out of the entire year for parents and teachers of children and teens with ADHD.

Most of us have noticed it’s during these last couple of months of school that an ADHD child suddenly drops his or her grades, seems to daydream more, has a harder time studying, and gets into trouble more frequently both at and away from school. Why you ask?

The answer is not as simple as 1-2-3 or A-B-C, but involves complex interactions that are unique to each child. Those interactions are best dealt with by evaluating each child individually and assessing changes that have occurred in the classroom, at home and in social occasions because of impending deadlines.

Here are a few of my observations and some suggestions from treating children with ADHD and ADHD teens that will hopefully give you a little edge in helping your ADHD child make it through the rest of this school year successfully:

  1. Spring fever is highly contagious and more so for ADHD kids and teens. Since they have a hard time focusing anyway, once other members of their class slow down on doing homework or focusing on classroom projects, ADHDers usually go more to the extreme and almost quit studying altogether.
  2. Help relieve some of their peer stress by moving them away from other students who aren’t focusing as well as normal. Sometimes just putting a little space between ADHD kids or assigning new seats will help delay the spread of spring fever.
  3. Divert their new-found energy elsewhere. Field trips to the edge of the school grounds to explore for insects, plants and green things work well when combined with normal studies. At home, parents can do the same to help them study for tests and complete science projects and papers. A trip to the public library just might be the answer to help your child focus in quiet surroundings…plus, it gives them a perfect chance to practice good behavior.
    My mother realized the power of the public library in shaping my reading skills and behavior. She took me there every Friday year ‘round.
  4. This is the time to make absolutely sure your ADHD child or teen gets enough sleep and eats properly. I know how tempting it is to back off a little after spring break and let them eat more junk food and stay up later to watch movies or play games, but those are the things that rob your child’s concentration the next day.
    If an ADHD child is sleepy, he or she won’t and can’t focus on class work. Maintain a good sleep schedule and diet at least until school is out.
  5. The end of school is very threatening to ADHD kids and teens. What was a normal pace for them to learn and remember what they study is suddenly thrown into high gear as final exams approach. I know teachers don’t mean to do it, but there seems to be an awful lot of catching-up that has to be done in the last six or seven weeks of school. My mother (a teacher) always called it her “rat-race quarter”.

    Help your child deal with his or her fears, anxiety and pressure by telling them you understand and offering to provide whatever assistance they need. What they might need to make it over the hump is a short-term tutor in a subject they are having problems. You’d be surprised at how much stress you can solve by just listening-lend a good ear.

  6. Be sure not to focus on the grades, instead, focus on your child. It’s his or her stress that is probably causing the problem with grades or behavior. Once that stress is dealt with, the behavior problem will usually go away and the grades will usually go up.
  7. Help you child organize everything needed for the last 6 weeks of school. We all know how the pressure of a deadline can make us forgetful, fidgety, misplace things, and fall behind in everything. For the ADHD child, disorganization at the end of school will be much worse and often will be the thing that causes grades and behavior to slide into a deep, dark hole.
  8. Don’t forget that children forced to study to excess, not allowed to play or have fun, will often rebel and make bad grades and cut-up for spite. Remember the old saying, all work and no play….?
  9. You should ask your child’s doctor to re-evaluate their ADHD diagnosis if extreme sudden behavior changes or an outright learning catastrophe has occurred. Something more serious than spring fever and end-of-the-school-year-syndrome might be going on! Just maybe, the diagnosis of ADHD was in error and your child may be suffering ADHD misdiagnosis.

These are just a few of the many things I’ve noticed about ADHD kids and had told to me by parents of ADHD children and teens as the end of school approached. Hopefully, you can see a way to apply some of these to your ADHD child and prevent their end of the school year crash as June rapidly approaches!

Frank Barnhill, MD

PS…My series on building self-esteem in ADHD kids has gotten very good reviews and a lot of positive feedback.

In case you missed the start of the series:

How to Build Self Esteem in ADHD Kids One

http://www.mistakenforadhd.com/2012/03/how-to-build-self-esteem-in-adhd-kids-one/