Joey Wahler (Host): It can create development challenges for kids and their parents. So we're discussing attention deficit hyperactivity disorder known as ADHD in children. Our guest, Cheryl Jacobs. She's a Certified Nurse Practitioner in Pediatrics and Developmental Behavioral Pediatrics. This is Health Matters, insights from WCH medical experts.

Thanks for joining us. I'm Joey Wahler. Hi, there's Cheryl. Welcome aboard.

Cheryl Jacobs, CPNP, PCMHS: Thank you for having me today.

Host: Great to have you with us. So first, what are the signs and symptoms to look for when it comes to ADHD in children?

Cheryl Jacobs, CPNP, PCMHS: So ADHD can be considered ADHD combined, where you have hyperactivity and inattention, or it can be considered just inattentive, or it could be considered hyperactive. So, depending on what your child's symptoms are showing, that's where it would fall in the categories. So, these symptoms could be such as, I can't sit still, I'm fidgeting, I can't pay attention, I might be looking out the window instead of listening to the teacher, I might be spinning in my chair. So, there's different forms of ADHD.

Host: And what are the typical potential causes of it?

Cheryl Jacobs, CPNP, PCMHS: Well, there's no cause of ADHD, but we do know that it runs in families and it can be related to low birth weight and smoking during pregnancy and other conditions like that.

Host: What steps should a parent take if you feel your child is showing signs of ADHD?

Cheryl Jacobs, CPNP, PCMHS: So, if your child is showing signs of ADHD, so every child is a little rambunctious, every child is a little hyperactive. Every child, you know, has their own issues, but if these are out of the realm of their age development, then they should seek help through their primary care doctor or provider.

Host: Gotcha. And so how do you and yours typically go about accurately diagnosing ADHD in children since, as you just mentioned, sometimes there might be a fine line, at least to the layperson, to the parent, right?

Cheryl Jacobs, CPNP, PCMHS: Yeah, so diagnosing ADHD, the first thing is, you know, if the teacher says there's concerns, if the parent has concerns, then you want to reach out to your primary care provider. There are several screening tools that we can use to diagnose ADHD or help us diagnose ADHD. Another important thing is, if your child has an IEP, it's real important to get a copy of the ETR. The ETR is an evaluation team report that the school does. And they may have already diagnosed your child with ADHD.

Host: We mentioned IEP. What does that stand for?

Cheryl Jacobs, CPNP, PCMHS: IEP is an individualized education plan for each child.

Host: Okay. And so obviously what you're saying here, it seems, is that certainly there needs to be prompt and accurate communication between the school and the parents, right?

Cheryl Jacobs, CPNP, PCMHS: Exactly. And if the school says, the child doesn't have an IEP, but they're still concerned for ADHD, there's several screeners that we can use. We can use a Vanderbilt screener that the parents and the teacher would do. It's important to know that ADH is diagnosed if you have symptoms in two different areas. So, it has to be behaviors at school and behaviors at home.

Host: Interesting. So if you're only exhibiting those symptoms, those behaviors, as you put it, in one place, not the other, then what would that mean?

Cheryl Jacobs, CPNP, PCMHS: Then sometimes it's just help to get the parents, say it's just at home; it's helpful to get the parents some tools so that they may help their child and different ways to direct or redirect them. If it's at the school, we can have parents, ask for an evaluation. Send a letter to the school saying your child is struggling and see if they will test them. Do some psychological testing to see if they're qualified or maybe for an IEP.

Host: You 've talked about some of the things to look for, sort of, from the outside, looking in, Cheryl. What about the ways in which ADHD adversely affects children themselves? Let's start with learning, for instance.

Cheryl Jacobs, CPNP, PCMHS: So if a child is hyperactive and, or inattentive, they're not paying attention to what's going on in the classroom. Somebody may be clicking their pen, somebody may be moving their foot, and these are all distractions. And so when the teacher's talking, they don't care what she's saying. They're looking at the other person and why are you clicking your pencil? You know, a lot of people refer to it as squirrel, you know, you're looking around and there's a squirrel and oh, you know, so very distracting. So, of course, they're not going to take in the, all the academics.

Host: You meet a squirrel, as in, perhaps, outside the classroom window, showing that it really doesn't take much to have such a child get distracted easily, right?

Cheryl Jacobs, CPNP, PCMHS: Right. Correctly.

Host: So, how about ADHD's impact on a child physically?

Cheryl Jacobs, CPNP, PCMHS: Well, physically, they can't sit still. It's not their fault if they're constantly fidgeting. A lot of the schools do make accommodations for children, now they will give them little chairs that have bouncy seats. They give them fidgets. Some teachers will put rubber bands on their seats so they can fidget with their feet. There's a lot of different options that kids can do. But physically, it's very hard for a child with ADHD hyperactive to maintain himself or herself.

Host: Understood and so when we talk about treatment options; what are the most common and effective ones available today?

Cheryl Jacobs, CPNP, PCMHS: The most important thing, and this is what I tell all my patients, please, please, please read the food labels, okay? Red dye, red dye 40 is horrible for children, causes ADHD, causes anxiety, causes aggression, and people will tell me, well, no, my child doesn't eat anything with red dye. But then I have them start using and looking at the labels and voila, yes, there's red dye in everything.

And sometimes just eliminating food dyes from the diet can cause a huge change in their child's behavior. I always recommend a magnesium supplement. Magnesium is calming. So, before prescribing any kind of pharmaceutical, I always make sure that the parents do these things first.

Host: Interesting. So let me just ask you a little bit about a couple of things you said there. First red dye. What's the damaging connection there?

Cheryl Jacobs, CPNP, PCMHS: You know, red dye is banned in Europe, in Mexico, in Canada. You know, they're not allowed to put food dyes, because it's so detrimental to our health, and even all the GMOs and all of those things, you know, they can cause irritation to the child's brain.

Host: And then how about magnesium on the other hand that you said can be a positive influence; what's going on there medically that makes that work.

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Cheryl Jacobs, CPNP, PCMHS: So, magnesium is very calming, our soil used to be very rich in magnesium, and it's not so much anymore, so just adding a regulated dose, you know, whatever is appropriate for your child, it's calming. It will help them calm, it'll help them sleep, and it'll help them be able to control their behaviors a little bit better.

Host: Great, so sticking with discussing treatment here, what about medication for children with ADHD?

Cheryl Jacobs, CPNP, PCMHS: So there is several different medications for ADHD. I think back in the day that everyone was put on Ritalin, and Ritalin kind of got a bad name for it. You know, people considered people medicated with ADHD are like zombies. It changed their personality. So there's a lot of newer medications out there now. There's non-stimulant medications, and then there's stimulant medications.

And then the stimulant medications, there's amphetamines, and then there's methylphenidates. So it's a huge choice, you know, but we do have many, many options for families.

Host: And so when you have a number of those options, how do you and parents go about diagnosing what's best in a particular situation?

Cheryl Jacobs, CPNP, PCMHS: Well, I always tell parents that there's no crystal ball to determine what would be best for your child, but with experience, you kind of know what medications work best. And if I have a child that maybe has other comorbid things, such as autism and has a difficult time eating, you know, then you would choose a non-stimulant. So a lot of thought goes into what does that individual child look like?

Host: And of course, anytime we talk, Cheryl, about meds, people wonder about side effects. How about in this case?

Cheryl Jacobs, CPNP, PCMHS: Yeah, I get that a lot. The main side effect of any of the stimulant medicines is decreased appetite. Kids don't like it when they don't feel hungry, when they can't eat their lunch. Typically it's just at lunchtime. By the time the kids get home, they're famished. They'll eat, eat, eat. So it's something that you have to balance.

Host: Couple of other things, for instance, can ADHD in children be cured or is the goal to simply manage it better?

Cheryl Jacobs, CPNP, PCMHS: Yeah, there's no cure for ADHD, but we can manage, you know, with your physician, with counseling, sometimes therapy, you know, you can control the symptoms.

Host: How about advice based on your experience for parents whose children are suffering from this? What would be the number one or perhaps number two thing as well, couple of items that they should keep in mind?

Cheryl Jacobs, CPNP, PCMHS: Any way that we can help our child achieve their full potential is what I aim for. When I treat for ADHD, my main goal is not to change who the child is, but to help their symptoms; control those symptoms so they can learn. When you treat a child for ADHD, it's amazing because their self esteem really improves.

They're not constantly being hounded by the teacher to pay attention. They're not constantly hounded by their parent. You didn't listen. You didn't, kids with ADHD, they don't mean to be like that. They just can't help it. And then when they get treated and they're listening and they're paying attention and then their grades go up, they're proud of themselves and their self-esteem is improved. So it kind of helps in many different ways.

Host: And speaking of which, in summary here, Cheryl, what would you say your message is to people? I know it's a general question, every case is different, every child is an individual, but what would you say, generally speaking, are the chances of helping the typical child with ADHD?

Cheryl Jacobs, CPNP, PCMHS: You know, seek out to your provider. The main thing is, I tell people, if you have asthma and you're wheezing, I would give you albuterol. If you have an ear infection, I would give you an antibiotic. If you have ADHD and I can help you with some medication or your provider can help you with some medication, then help your child.

So many people do not want to put their kids on medication, but you know, if you can help them, help their self esteem and help them reach their full potential, I say reach out to your provider and work with them because it is a combination effect. You have to have intake from the family and trust from the family that you're going to do the best for each of them.

Host: Very well said. Well, folks, we trust you're now more familiar with ADHD in children. Help is available, as you've just heard. Cheryl Jacobs, keep up the great work and thanks so much again.

Cheryl Jacobs, CPNP, PCMHS: Thank you for having me.

Host: Absolutely. And to schedule an appointment at Wood County Hospital, please call 419-354-3295. If you found this podcast helpful, please share it on your social media.

Thanks again for being part of Health Matters, insights from WCH medical experts.