Transcription:
Does Your Child Struggle with ADHD?

Melanie Cole (Host):  Are teachers and coaches telling you your child is may be disruptive and suggesting that you might need to seek professional help? My guest today is Dr. Leonid Topper. He's a pediatric neurologist at Summit Medical Group. Welcome to the show, Dr. Topper. People hear the words “ADD” and “ADHD”, and they do not completely understand the difference or what they mean. So, give us a little working definition, if you would.

Dr. Leonid Topper (Guest):  Attention deficit is a biological disorder of the brain where the focusing center is underperforming and biologically is under-activated. Functional MRI and other studies which show how the brain the works actually proves that this is a biological condition and not laziness and not a behavioral trait. Due to these features of under-activation of attention center, children and adults present with inattention and/or impulsivity or hyperactivity. There is no substantial difference biologically between inattentive type of ADD or hyperactive type of ADD but in real life children with hyperactivity come to medical attention much earlier because it's behavior is very obvious.

Melanie:  How common is the condition and does it affect more boys than girls?

Dr. Topper:  It's just somewhat likelier to affect the boys. Statistics vary but up to ten percent of all boys may have attention deficit disorder, and about five percent of all girls. Parents often ask that is it true that this condition is overdiagnosed, and I usually answer that it's both overdiagnosed and underdiagnosed. Many parents may come to conclusion that their child is inattentive because they're not paying close attention to something which is a relatively not interesting or less thrilling than video games. In that case, the wrong information is conveyed to the physicians. At the same time, there are numerous cases when attention deficit is not appropriately diagnosed even until adulthood. Then, these people are diagnosed in their 20s, 30s and even much later.

Melanie:  What do you tell parents, Dr. Topper, every day when they say, "Oh, well. My child acts up in school but, you know, he's just all boy. I mean it's just him being a rowdy boy." What are the red flags that parents and the school systems should look for that would say, “You know what? This isn't just a normal part of children growing up, or a child that is just a very active child? What do you tell them to look for?

Dr. Topper:  There is no brick wall between the behaviors which are child just temperamental or very, very active or easily excitable to child where hyperactivity is considered to be in disease range. The biggest question is impairment. If the child’s impulsivity and hyperactivity puts him or her or other kids and adults in danger, such as repetitive trauma, broken bones, or accidents in a school, or disrupting class where repeatedly despite teacher's explanations is disrupting the class, or developing clowning behaviors where the child is trying to entertain everybody around. Often, you would think that this is beyond personality trait and often when the school and parents have detail conversations with these children, you will hear something like, "Oh, Mommy, I cannot help to hold it." So, this translates essentially to main feature of hyperactivity where the child would do first, then think as opposed to first thinking and then doing. In that case, it's possibly a feature of a disease not the personality trait.

Melanie:  If you hear these things from parents and even from the child themselves, how do you diagnose that it is deficit hyperactivity disorder or ADD?

Dr. Topper:  First we need to confirm the symptoms. In case of children, we need to confirm the criteria by the Diagnostically and Statistical Manual, Version V, which is a big compendium of behavioral diagnosis issued by American Psychiatric Association. The criteria are that with this diagnosis,  the child will typically will have more than six different inattentive behavior such as not listening when spoken to directly, disorganized, reluctant to engage in activities requiring sustained effort, or getting distracted easily. Some children may also have hyperactive behavior such as, being on the go, blurting out, and so forth. There are standard questionnaire or surveys which can be given to parents and to teachers. These surveys, when completed, allow to differentiate just the normal allowed amount of inattention, absent mindedness, and fidgety, and hyperactivity from abnormally high amount.

Melanie:  So, then, if you have put together all of these red flags, and you've determined that this child has in attentional disorders, then what do you do for them? Do you use cognitive behavioral therapy? Do you look to medication intervention? What's the first line of defense that you try with parents?

Dr. Topper:  Most typically we want to assure that the child has normal health with interruptions because even little things can affect the attention. Some children have medical illnesses such as uncontrolled asthma, sleep apnea, or inflammatory disorders. So, we need to make sure the child is healthy. Lack of Iron quite often contributes to crankiness and hyperactivity. Sleep deprivation is extremely common nowadays, especially in teenagers, and sleep deprivation worsen any inattention and can keep somebody over from normal degree of absentmindedness to the extent to which falls into the category of ADD. Proper diet also affects the focus. Certain foods and ingredients, such as artificial sweeteners and coloring can worsen inattention. When all this is assured in real life, the next line of defense often are school accommodations, such as Section 504 plan, which is accommodations in accordance to the law which allows children with medical condition to have some accommodations in the school. In case of ADD, it would be preferential seatings, assignments in smaller parts, and so on. Some kids do need special education services. Our neurology books list medications as the first line of defense but this way of seeing this does not sit well with most parents. So, we're trying to work with parents the way they can tolerate this while they're being educated about the condition, establishing school help, and gradually checking if their child will actually require medical treatment on that.

Melanie:  If you determine that medicational intervention is advised, at what age, Dr. Topper, do you tell parents that it's time to let that child manage their own medication because I think this is a question many parents have and especially with a child with attentional issues. So, when do you tell them, if they are on medication, that they learn to manage this disorder on their own?

Dr. Topper:  We discourage situations where children are having access to their own pill box because many of medications for attention deficit are controlled substances and can be potentially misused if used not as prescribed. Additionally, media reports often that high school children and college students often have a habit of medication sharing such as child with attention deficit hyperactivity disorder who officially prescribed a stimulant medicine may share his pill with another student without the disorder in order to increase productivity, suppress need in sleep, allow more study time, and eventually get better testing scores. For these reasons, independence with handling medications is not advisable for any children who are technically minors up to age eighteen. After age eighteen, they are adults and they can manage their own, or at least they have legal rights to do that. So, typically differently from many other situations of chronic diseases like diabetes where children are encouraged to do their own injections and handle their own medications, with attention deficit this is not encouraged.

Melanie:  Is this something that goes away in adulthood, or, if they are diagnosed with ADD or ADHD they will have it as they turn in an adult?

Dr. Topper:  The good news that about fifty percent of all kids as they grow old usually by late adolescence, slightly higher percentage of those can also learn to go about most of their days without needing medications, and using medicine only for intense study days or the days they have classes in college. However, for substantial proportion of children with attention deficit they will grow into adults as attention deficit and they require near daily medications. It's a good hope for many kids but not every child outgrows attention deficit.

Melanie:  In just the last few minutes Dr. Topper, and it’s such great information, please wrap it up for us about ADD and ADHD; what you're telling parents and their children every day about managing this condition; and why they should come to Summit Medical Group for their care?

Dr. Topper:  We're trying to work with parents in the way they can tolerate because every parent comes with fears and anxiety and sometimes with misconceptions about the condition. We always recommend to read a good book about attention deficit. One which I recommend the most is called “Taking Charge of ADHD” by Russell Barkley. This is a good starting point. Another thing which parents need to always remember is that we can discuss multiple ways of managing attention deficit but if it comes down to medications, doctors usually have a way to do it in the safe, efficient way to sort out all the side effects, if we start low, go slow, and check frequently. This old formula for safe medication prescribing applies perfectly here. So, children are not destined to have side effects. It can be sorted if parents work with their doctor closely.

Melanie:  Thank you so much, Dr. Topper, for being with us today. You're listening to SMG Radio and for more information you can go to www.summitmedicalgroup.com. That's www.summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.