Helen Dandurand: Welcome back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Dr. N’Djamina Robinson, family medicine provider at Riverside, to talk about ADHD in children.

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And we're back with N’Djamina Robinson. Thank you for joining me today, Dr. Robinson. We're glad to have you.

Dr. Robinson: Thank you.

Helen Dandurand: Yeah. So, can you tell us a little bit about your background and yourself?

Dr. Robinson: Sure. So, I'm a family medicine physician. I've been with Riverside since 2019. And I'm actually a military brat. I was born overseas in Germany, but went to high school in Pennsylvania and then undergrad at University of Pittsburgh. And then, I taught high school chemistry for three years in Charlotte, North Carolina, before moving on to medical school at the University of North Carolina at Chapel Hill. And then, I got married and moved to Chicago. I didn't know anybody, but loved it and did my residency at University of Illinois at Chicago and just welcomed a new baby boy into our lives, mine and my husband's life, about five months ago.

Helen Dandurand: Congratulations.

Dr. Robinson: Thank you.

Helen Dandurand: That's awesome. Yeah, that's great. So, you've been here at Riverside a few years. And what we're talking about today, ADHD in children, is something that is common that you see a lot quite a bit.

Dr. Robinson: Absolutely.

Helen Dandurand: So, let's start off by just going over what is ADHD simply?

Dr. Robinson: So when people think of ADHD, a lot of times, the first thing they think of is, "Okay, someone's just has difficulty concentrating." And that is definitely a part of it. But we often think of it in medical terms more about how really it can start as young as four years old and they show academic or behavioral concerns. They show impulsiveness, hyperactivity or inattentiveness. And it occurs in more than one setting, like at home, at daycare, at school. And you can't really explain it by another diagnosis.

Helen Dandurand: Got it. Got it. So, children with ADHD, do they normally present like with hyperactivity or how does that normally go?

Dr. Robinson: So, classically, you know, we think hyperactivity because it's like, "Okay, this kid's always on the go. They're interrupting everybody. They can't sit still. They're talking all the time." And those are the kids that are a little easier to spot. They've got the hyperactive symptoms. But then, there's the other half of attention deficit disorder. That's the inattention. And those kids can kind of go under the radar because it's more like they're easily distracted. They have difficulty finishing tasks. They're forgetful or they sometimes seem like they're not listening because they're kind of spacing out. And so that inattentive part can be a part of it as well.

Helen Dandurand: Got it. Got it. That makes total sense. So if someone thought that my child kind of has these signs and symptoms, how would it be like diagnosed in a child?

Dr. Robinson: So generally, there's a DSM criteria, which is the manual that we use for all psychiatric conditions for adults and kids. And some of the things that I listed previously about hyperactivity and inattention are a part of that criteria. You have to have six of those things. They have to be present for at least six months. And if you're looking at it in a teenager, it has to be present at least before the age of 12.

And so, when you go into your doctor and you're concerned about these types of symptoms, oftentimes, they'll probably ask you to fill out what's called a Vanderbilt questionnaire. And it's a form for the parent and there's a form for a teacher and they go through and they answer a bunch of questions about the students or the child if they're preschool age. And basically, once those forms are filled out, you bring it back and we figure out, "Okay. Are these symptoms consistent with ADHD or is it, you know, age-appropriate behavior for a four-yearold?" Or is it that they have struggles with anxiety or maybe oppositional defiant disorder. There's other things that we look for if they're exhibiting some of those symptoms.

Helen Dandurand: Got it. And I mean, this could be a whole 'nother podcast, but can it also be diagnosed for an adult?

Dr. Robinson: And the thing is sometimes kids can get through elementary, middle school and high school and not really have overwhelming difficulties. But then, they get to be an adult and they realize that they've actually had this the whole time. They've just figured out how to manage it on their own. And so, sometimes you can see it diagnosed as an adult. But when they go and look back in their history, they did have the symptoms beforehand.

Helen Dandurand: Got it. Got it. That makes sense. We're going to take a quick break to talk about finding a primary care provider, because with what we're talking about here, that's where it starts, is going to your primary care so that you can get the right diagnosis. So, Riverside knows that health is your greatest asset and that your primary care provider is your partner in health. Find a primary care provider that fits your needs at riversidehealthcare.org/primarycare.

Back into the ADHD. In children, how is it treated?

Dr. Robinson: So, there's lots of ways to treat it. The most common one that people are aware of is stimulant medication. So, those are the medications like methylphenidate, amphetamine, things like that, that help with concentration. And they are actually very effective. And so, in terms of medication, that's the first-line treatment. But there are also non-stimulants like guanfacine and atomoxetine that actually can be used as well. Not quite as effective as stimulants, but they can work if there's any issues with the stimulants. But outside of medications, there's other things we can also recommend, especially in younger kids, because you don't always want to start with medications with younger kids.

You know, there's actually parent training. There's a specific type of behavioral management called parent training behavior management. And basically, what that does it encourages positive reinforcement for encouraging sustained behavior change, working on ways to extinguish negative behaviors. And it also really over time helps them develop like age-appropriate expectations for the child, creates a better parent-child relationship and really can help these kids manage their symptoms without medications.

And then, in older kids and adults, there's other things just working on time management, staying well-organized, those types of things that kind of help bring some of that focus to a head, so that they can still be productive.

Helen Dandurand: Gotcha. Gotcha. That's good to know that there are different things, different types of medications and also different things that you can do to work on to, you know, lessen the symptoms of that. I've heard before that some of the medications can possibly be addicting. Is that true? Is that myth?

Dr. Robinson: Right. So no, medications are things that can be stopped at any time. So, stimulants can be stopped. At any point, if there's side effects or if the parent decides they feel like they don't want to use them anymore. Non-stimulants, they tend to need to be tapered. But in general, they're not addicting. And they've actually done studies to see, "Okay. If someone, if a kid uses ADHD medications early in life, are they going to end up having substance use problems later?" And they've shown time and again that they don't. So, I would not be concerned about that as a possible side effect.

Helen Dandurand: That's great. I think that's a great thing to address to make sure that people know that that is really not the case. But what are some side effects of the medications that people can expect?

Dr. Robinson: Yeah. So, oftentimes people take these medications without any side effects. And so, that's the best part of it all, you know, not having any. However, of course, there's no medication that is without some chance of side effects. So, with stimulants, you can notice that a kid can have decreased appetite, sometimes it'll cause a headache. Sometimes it can disturb their sleep, especially if they take the medication too late in the day. And then, there's a small percentage of kids that may have a change or an increase in their heart rate or blood pressure. The non-stimulants tend to cause some similar things, but dry mouth is a common one there, headache. And sometimes the non-stimulants actually cause sleepiness, so we often dose those in the evening.

Helen Dandurand: Ah, that makes sense. That makes sense. So, with what you were saying a couple of questions ago that there are some different things besides medications you can do to help. Our foods, diet, does that play a role in that?

Dr. Robinson: There's a lot of different people that would say, "Yeah, definitely changed diet changed my kid's life." And if it helps, great. A well-rounded diet with less sugar is great for every kid. But there's not actually really good evidence that major diet changes can make a huge difference in the symptoms of ADHD.

Helen Dandurand: Gotcha. Okay. Cool. That makes sense. So ADHD, is this a lifelong condition or I've heard that like some kids, "Oh, I had that when I was younger. I grew out of it," that kind of thing?

Dr. Robinson: Yeah. So, it's not exactly that they grow out of it per se. It's just that sometimes as kids grow up, they just learn how to manage the symptoms. So, they learn different techniques to stay better organized, to stay focused, different things that they do to just like fidget and that helps them. And so, there may be ways as they get older that they can just manage it without needing medications. And so, that's a reason why some people, some kids, after they're done with high school, they may not need it. But then, there's others that do continue it and then they may need it for a much longer time and through their adulthood to help them remain focused and be productive.

Helen Dandurand: Great. That is all such good information. I feel like a lot of those are little like myth-busting questions that I've heard about before. So, I'm glad that you could shed light on those.

Dr. Robinson: No problem.

Helen Dandurand: Thank you for joining us today, Dr. Robinson.

Dr. Robinson: Absolutely. It's a pleasure.

Helen Dandurand: Yes, of course. And thank you listeners for tuning into the well within reach podcast, brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.