ADHD is the most commonly diagnosed behavior disorder of childhood. It is characterized by inattention, impulsivity, and, in some cases, hyperactivity. These symptoms usually happen together. However, one may happen without the other(s).
In this information packed segment, pediatrician Ruth McCluskey, MD., joins the show to discuss raising a child with ADHD and treatment options available at Hendricks Regional Health.
Raising a Child with ADHD
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Learn more about Ruth McCluskey, MD
Ruth McCluskey, MD
Ruth McCluskey, MD, BS is a Doctor primarily located in Indianapolis, IN, with another office in Avon, IN. She has 7 years of experience. Her specialties include Pediatrics. Dr. McCluskey is affiliated with Hendricks Regional Health.Learn more about Ruth McCluskey, MD
Transcription:
Raising a Child with ADHD
Melanie Cole (Host): Is it hard for your child to sit still? Does your child act without thinking first sometimes? Does your child start but not finish things? If so, your child may have attention deficit hyperactivity disorder. Nearly everyone shows some of these behaviors at times but if these behaviors last more than six months and cause problems in school, at home and in social situations; it might be time to see your pediatrician for an evaluation. ADHD is the most commonly diagnosed behavior disorder of childhood. My guest today is Dr. Ruth McCluskey. She’s a pediatrician with Hendricks Regional Health. Welcome to the show Dr. McCluskey. What is ADHD? Give us a little working definition.
Dr. Ruth McCluskey, MD (Guest): Alright, to start out with, ADHD stands for attention deficit hyperactivity disorder. There are two main classifications of that. There is either ADHD primarily inattentive or ADHD primarily hyperactive or actually you could have ADHD combined. There are multiple diagnostic criteria in order to meet the criteria for ADHD. There are nine different symptoms of inattention and then there are nine different symptoms of hyperactivity/impulsivity that we look for when we are evaluating a child that we suspect may have ADHD.
Melanie: So, before we talk about those nine; because a parent might not spot all of them before they take them to the pediatrician for that evaluation. What red flags would you like the parents to be on the watch for so that if it’s a boy for example, Dr. McCluskey; sometimes parents will say, “Oh, well he is just all boy.” But when does it come to the point where it is like okay, this is now something we need to go take a visit to our doctor for?
Dr. McCluskey: Well typically, there are two main things that I look for when I recommend an ADHD evaluation or when parents are suspecting that and to move forward with the evaluation. Number one is if there is impaired function; so maybe kids are not doing well academically and we suspect ADHD might be contributing to that or number two; they are either not enjoying school or just not happy in general, their self-esteem is low because they’re not being successful at school or getting in trouble a lot at school.
Melanie: So, we bring them to the pediatrician. What do you do as far as diagnostic evaluation to make this determination before treatment is required?
Dr. McCluskey: Well, the way we go through our diagnostic evaluation is filling out a couple of studied and verified forms. We use Connors evaluations at our office, but there are lots of different forms that could be used. Basically, it’s a whole gamut of questions that explores activity, attention, at home and also at school and basically have one of those questionnaires filled out by a parent or both parents together or separate and then we have another form with the same questions that is completed by an educator who knows the child very well and if there is more than one educator, that knows them well, we sometimes fill out multiple forms like that and then after we collect that data; it kind of gives us an objective score as far as meeting criteria. We also go through a pretty thorough childhood history form evaluation that helps us to kind of tease out other codes of same conditions that might look like ADHD. So, certain learning disabilities can kind of manifest and look like ADHD, things like anxiety or depression can sometimes coincide with ADHD or also look like ADHD. And we try to make sure that we are not missing some root cause for the symptoms of ADHD; rather than just calling it ADHD.
Melanie: So, then if you have determined that this is what this child has; how do you work with the child? What are some of the first treatments that you might recommend whether it is cognitive behavioral therapy or and what do you tell the parents about dealing with the child at home?
Dr. McCluskey: Well, I think that’s a great question. Because I think a lot of parents are anxious about an evaluation for ADHD because a lot of parents don’t like the idea of medication and certainly medication is never our first treatment recommendation. Usually a starting point would be behavioral modification or cognitive behavioral therapy with a trained therapist. As far as behavioral modification though; there are a lot of things we can recommend just as the pediatrician to help them succeed at school and also be more manageable at home and have less stress at home. Because typically kids that are diagnosed with ADHD; a lot of times will have some behavior problems that make life at home pretty stressful so there’s a lot that we can start out with, just as recommendations from us or behavior charts or we can refer on to a trained therapist to work with them. So, that would be a starting point.
Another starting point, we look into – there has been a lot of research recently on dietary management of ADHD. So, there are two main things that we look at with dietary management. We look at eliminating preservatives and additives to foods. There has been a number of studies lately and even in the past on how preservatives and things of that nature can affect hyperactivity and can even affect focus, can decrease your focus if there is a lot of food colorings and other preservatives that are very typical in the Western diet. If we can eliminate those things; a lot of kids do a lot better with ADHD and make medication unnecessary.
And the second part of dietary management is vitamin supplements or omega-3 supplements. So, oftentimes kids that have symptoms of ADHD will have deficiencies in certain vitamins and minerals; particularly iron, magnesium and zinc are things that can be deficient when a child has ADHD or symptoms of ADHD. So, we look into testing those sometimes or just supplementing them because oftentimes our diets are deficient in a lot of nutrients just because it is hard to get those things naturally from foods oftentimes. And then secondly, we recommend a good either prescription omega-3 supplement or over-the-counter omega-3 supplement because there is pretty good research indicating that certain kids, not 100% of kids with ADHD but certain kids, probably about half of kids with ADHD have deficiencies in certain long chain fatty acids that really can only be gotten from omega-3 that is typically found in fish.
Melanie: So, that is such great advice Dr. McCluskey and along with this nutritional kind of working it for the child and behavioral/cognitive therapy, so then when does it become medicational intervention and what do you tell parents when they are afraid of that zombie effect that they have heard about with medications?
Dr. McCluskey: Well, that’s a great question because it addresses concerns that a lot of parents have. I think after you do a trial period of those preliminary treatments, the behavior modification and dietary modification and you don’t see improvement; that would be a reason to start medication. I think if you are at a point where you are talking about pretty dire academic failure like if we are talking about potentially having to repeat a grade or failed standardized test scores, things of that nature; we would talk about medication or if the child is really starting to have a strong adverse reaction to school, really disliking school or really having some significant self-esteem issues and what we are trying already is not working; that would be a reason to start medication.
And I think as far as addressing the zombie effect of medications; there are so many ADHD medications out there and I feel like new ones are coming out all the time. I feel like we are constantly hearing about new formulations that potentially minimize side effects and maximize benefits and a lot of parents when they worry about medication, they are thinking about stimulant medications; which do have a lot of side effects, but there is also a number of options as far as nonstimulant medications to treat ADHD that have less side effects and don’t have I guess the potential long-term consequences. People worry about appetite suppression and growth with stimulants but a lot of nonstimulants don’t have those side effects though, plenty of different options and sometimes it just is a matter of what the primary symptoms are as far as trying to navigate and picking a medication. But we like working with people and finding the right things for kids and oftentimes can really make a significant impact on a child. One example that I think is amazing; is I tried a kid on a medication after trying everything else and failing it and I remember the parents telling me that he sat and ate dinner with the family for the first time ever because he was never even able to just sit and eat like a normal child would. But he sat and ate dinner with them and mom had tears in her eyes when she said that and that was all the medication. So, some kids just need the behavioral modification but some kids end up really like truly benefitting from medication when they need it. It is lifechanging.
Melanie: Dr. McCluskey, what do you tell parents about the school systems and dealing with the school systems and alerting their school systems to whatever the child’s behavioral issues are, attentional issues are; how do you work with the schools?
Dr. McCluskey: Well, a lot of that depends on the relationship that the parents have with the school and the comfort level. Some parents work closely with the schools. Some schools even do the evaluation prior to the parents ever even bringing the concern up with me. Some schools do some very nice thorough evaluations and help reach the diagnosis of ADHD. Some parents prefer to do it separately from school and do the evaluation through us or through other providers to have the diagnosis and treat without knowledge of the schools. So, it really is whatever the parents are comfortable with as far as disclosure to the school. A lot of kids in addition to needing the behavior modification may perhaps need what is called an IEP or an individualized education plan that helps them to succeed at school. That may be a matter of different examination circumstances where they can take tests separate from the rest of the group to avoid distraction. It may be more one on one work out of a group setting because that is less distracting but some children will need that IEP to help them succeed at school, so if that’s the case; we work with the school either with diagnostic letters or helping the parents just explain the situation to the school.
Melanie: In the last few minutes, Dr. McCluskey, give your best advice for parents who think their child may have ADHD and getting to their pediatrician for an evaluation and even what you, in your opinion, want them to know about their child growing into the teenage years with ADHD, monitoring their own medications and helping themselves as they grow into an adult that may still have ADHD.
Dr. McCluskey: Well, I always tell parents if there is any concern about ADHD or just school problems in general; it is worth exploring. We can always do the evaluation and we don’t need criteria and we don’t need to treat or anything of that nature, but sometimes we go through the evaluation; we uncover other things that are causing school problems, running the gamut from vision problems to learning problems to underlying anxiety that we didn’t know was going on. But it can never hurt to go through the evaluation and it is actually just going through the forms and completing the forms and gathering information, there is not even any cost at our office to go through that so, I think it is really no commitment and it is good to gather the information and either move forward with helping the situation which certainly doesn’t always have to be medication and there is lots like we mentioned before, there are lots of different things to do. Or being able to identify other problems that are potentially preventing the child from succeeding and then going forward as kids get older, I think I try to tell my older kids that have the diagnosis of ADHD, it is not necessarily a disordered way of thinking, it is just a different way of thinking and when you can – as you get older and you learn the best ways that you learn and the best ways that you function you can often modify the way you study and take things in and organize your stuff to the point where you really don’t need treatment. Some kids end up doing treatment throughout high school and college and that is completely fine but other kids just have more insight or develop more insight into the way they learn and they can manage it just strictly through behavior modification, which is what a lot of adults do that have ADHD.
Melanie: Thank you so much for being with us today. You’re listening to Health Talk with HRH, Hendricks Regional Health. And for more information, please visit www.hendricks.org . That’s www.hendricks.org . This is Melanie Cole, thank so much for listening.
Raising a Child with ADHD
Melanie Cole (Host): Is it hard for your child to sit still? Does your child act without thinking first sometimes? Does your child start but not finish things? If so, your child may have attention deficit hyperactivity disorder. Nearly everyone shows some of these behaviors at times but if these behaviors last more than six months and cause problems in school, at home and in social situations; it might be time to see your pediatrician for an evaluation. ADHD is the most commonly diagnosed behavior disorder of childhood. My guest today is Dr. Ruth McCluskey. She’s a pediatrician with Hendricks Regional Health. Welcome to the show Dr. McCluskey. What is ADHD? Give us a little working definition.
Dr. Ruth McCluskey, MD (Guest): Alright, to start out with, ADHD stands for attention deficit hyperactivity disorder. There are two main classifications of that. There is either ADHD primarily inattentive or ADHD primarily hyperactive or actually you could have ADHD combined. There are multiple diagnostic criteria in order to meet the criteria for ADHD. There are nine different symptoms of inattention and then there are nine different symptoms of hyperactivity/impulsivity that we look for when we are evaluating a child that we suspect may have ADHD.
Melanie: So, before we talk about those nine; because a parent might not spot all of them before they take them to the pediatrician for that evaluation. What red flags would you like the parents to be on the watch for so that if it’s a boy for example, Dr. McCluskey; sometimes parents will say, “Oh, well he is just all boy.” But when does it come to the point where it is like okay, this is now something we need to go take a visit to our doctor for?
Dr. McCluskey: Well typically, there are two main things that I look for when I recommend an ADHD evaluation or when parents are suspecting that and to move forward with the evaluation. Number one is if there is impaired function; so maybe kids are not doing well academically and we suspect ADHD might be contributing to that or number two; they are either not enjoying school or just not happy in general, their self-esteem is low because they’re not being successful at school or getting in trouble a lot at school.
Melanie: So, we bring them to the pediatrician. What do you do as far as diagnostic evaluation to make this determination before treatment is required?
Dr. McCluskey: Well, the way we go through our diagnostic evaluation is filling out a couple of studied and verified forms. We use Connors evaluations at our office, but there are lots of different forms that could be used. Basically, it’s a whole gamut of questions that explores activity, attention, at home and also at school and basically have one of those questionnaires filled out by a parent or both parents together or separate and then we have another form with the same questions that is completed by an educator who knows the child very well and if there is more than one educator, that knows them well, we sometimes fill out multiple forms like that and then after we collect that data; it kind of gives us an objective score as far as meeting criteria. We also go through a pretty thorough childhood history form evaluation that helps us to kind of tease out other codes of same conditions that might look like ADHD. So, certain learning disabilities can kind of manifest and look like ADHD, things like anxiety or depression can sometimes coincide with ADHD or also look like ADHD. And we try to make sure that we are not missing some root cause for the symptoms of ADHD; rather than just calling it ADHD.
Melanie: So, then if you have determined that this is what this child has; how do you work with the child? What are some of the first treatments that you might recommend whether it is cognitive behavioral therapy or and what do you tell the parents about dealing with the child at home?
Dr. McCluskey: Well, I think that’s a great question. Because I think a lot of parents are anxious about an evaluation for ADHD because a lot of parents don’t like the idea of medication and certainly medication is never our first treatment recommendation. Usually a starting point would be behavioral modification or cognitive behavioral therapy with a trained therapist. As far as behavioral modification though; there are a lot of things we can recommend just as the pediatrician to help them succeed at school and also be more manageable at home and have less stress at home. Because typically kids that are diagnosed with ADHD; a lot of times will have some behavior problems that make life at home pretty stressful so there’s a lot that we can start out with, just as recommendations from us or behavior charts or we can refer on to a trained therapist to work with them. So, that would be a starting point.
Another starting point, we look into – there has been a lot of research recently on dietary management of ADHD. So, there are two main things that we look at with dietary management. We look at eliminating preservatives and additives to foods. There has been a number of studies lately and even in the past on how preservatives and things of that nature can affect hyperactivity and can even affect focus, can decrease your focus if there is a lot of food colorings and other preservatives that are very typical in the Western diet. If we can eliminate those things; a lot of kids do a lot better with ADHD and make medication unnecessary.
And the second part of dietary management is vitamin supplements or omega-3 supplements. So, oftentimes kids that have symptoms of ADHD will have deficiencies in certain vitamins and minerals; particularly iron, magnesium and zinc are things that can be deficient when a child has ADHD or symptoms of ADHD. So, we look into testing those sometimes or just supplementing them because oftentimes our diets are deficient in a lot of nutrients just because it is hard to get those things naturally from foods oftentimes. And then secondly, we recommend a good either prescription omega-3 supplement or over-the-counter omega-3 supplement because there is pretty good research indicating that certain kids, not 100% of kids with ADHD but certain kids, probably about half of kids with ADHD have deficiencies in certain long chain fatty acids that really can only be gotten from omega-3 that is typically found in fish.
Melanie: So, that is such great advice Dr. McCluskey and along with this nutritional kind of working it for the child and behavioral/cognitive therapy, so then when does it become medicational intervention and what do you tell parents when they are afraid of that zombie effect that they have heard about with medications?
Dr. McCluskey: Well, that’s a great question because it addresses concerns that a lot of parents have. I think after you do a trial period of those preliminary treatments, the behavior modification and dietary modification and you don’t see improvement; that would be a reason to start medication. I think if you are at a point where you are talking about pretty dire academic failure like if we are talking about potentially having to repeat a grade or failed standardized test scores, things of that nature; we would talk about medication or if the child is really starting to have a strong adverse reaction to school, really disliking school or really having some significant self-esteem issues and what we are trying already is not working; that would be a reason to start medication.
And I think as far as addressing the zombie effect of medications; there are so many ADHD medications out there and I feel like new ones are coming out all the time. I feel like we are constantly hearing about new formulations that potentially minimize side effects and maximize benefits and a lot of parents when they worry about medication, they are thinking about stimulant medications; which do have a lot of side effects, but there is also a number of options as far as nonstimulant medications to treat ADHD that have less side effects and don’t have I guess the potential long-term consequences. People worry about appetite suppression and growth with stimulants but a lot of nonstimulants don’t have those side effects though, plenty of different options and sometimes it just is a matter of what the primary symptoms are as far as trying to navigate and picking a medication. But we like working with people and finding the right things for kids and oftentimes can really make a significant impact on a child. One example that I think is amazing; is I tried a kid on a medication after trying everything else and failing it and I remember the parents telling me that he sat and ate dinner with the family for the first time ever because he was never even able to just sit and eat like a normal child would. But he sat and ate dinner with them and mom had tears in her eyes when she said that and that was all the medication. So, some kids just need the behavioral modification but some kids end up really like truly benefitting from medication when they need it. It is lifechanging.
Melanie: Dr. McCluskey, what do you tell parents about the school systems and dealing with the school systems and alerting their school systems to whatever the child’s behavioral issues are, attentional issues are; how do you work with the schools?
Dr. McCluskey: Well, a lot of that depends on the relationship that the parents have with the school and the comfort level. Some parents work closely with the schools. Some schools even do the evaluation prior to the parents ever even bringing the concern up with me. Some schools do some very nice thorough evaluations and help reach the diagnosis of ADHD. Some parents prefer to do it separately from school and do the evaluation through us or through other providers to have the diagnosis and treat without knowledge of the schools. So, it really is whatever the parents are comfortable with as far as disclosure to the school. A lot of kids in addition to needing the behavior modification may perhaps need what is called an IEP or an individualized education plan that helps them to succeed at school. That may be a matter of different examination circumstances where they can take tests separate from the rest of the group to avoid distraction. It may be more one on one work out of a group setting because that is less distracting but some children will need that IEP to help them succeed at school, so if that’s the case; we work with the school either with diagnostic letters or helping the parents just explain the situation to the school.
Melanie: In the last few minutes, Dr. McCluskey, give your best advice for parents who think their child may have ADHD and getting to their pediatrician for an evaluation and even what you, in your opinion, want them to know about their child growing into the teenage years with ADHD, monitoring their own medications and helping themselves as they grow into an adult that may still have ADHD.
Dr. McCluskey: Well, I always tell parents if there is any concern about ADHD or just school problems in general; it is worth exploring. We can always do the evaluation and we don’t need criteria and we don’t need to treat or anything of that nature, but sometimes we go through the evaluation; we uncover other things that are causing school problems, running the gamut from vision problems to learning problems to underlying anxiety that we didn’t know was going on. But it can never hurt to go through the evaluation and it is actually just going through the forms and completing the forms and gathering information, there is not even any cost at our office to go through that so, I think it is really no commitment and it is good to gather the information and either move forward with helping the situation which certainly doesn’t always have to be medication and there is lots like we mentioned before, there are lots of different things to do. Or being able to identify other problems that are potentially preventing the child from succeeding and then going forward as kids get older, I think I try to tell my older kids that have the diagnosis of ADHD, it is not necessarily a disordered way of thinking, it is just a different way of thinking and when you can – as you get older and you learn the best ways that you learn and the best ways that you function you can often modify the way you study and take things in and organize your stuff to the point where you really don’t need treatment. Some kids end up doing treatment throughout high school and college and that is completely fine but other kids just have more insight or develop more insight into the way they learn and they can manage it just strictly through behavior modification, which is what a lot of adults do that have ADHD.
Melanie: Thank you so much for being with us today. You’re listening to Health Talk with HRH, Hendricks Regional Health. And for more information, please visit www.hendricks.org . That’s www.hendricks.org . This is Melanie Cole, thank so much for listening.