Expert: Dr Billy Levin - 3/25/2009

Question
QUESTION: My son was diagnosed with ADHD a yr ago, He has problems focusing in school and has had many incidents where he would show his privates to other kids for attention. I have talked to him about how it is unappropriate behaivor but within a few weeks he does it again.I ask him why he does it and his response is every time " shouldn't do it " or "not supposed to " never a direct answer.I have taken many steps to find a result i got him seeing  therapist once a week and also is in a support program called big brother big sister and he is on medication. I was just informed from school that he did it again on playground and he is going to be suspended. I just don't understand what is going on in his head he don't see anything like that at home and he never stays the night anywhere cause most kids don't want to hang around with him because of his behavior. Can you help me

ANSWER: His behavior is certainly typical of ADHD. They have a talent for doing without thinking! On correct and most important effective medication this all changes. Thus, it is very easy to say that if he is on medication it is certainly not working! As you have not stated what he takes, when does he take it and what doses is he taking, it is impossible to comment on. Therapy is a waste of timec if the medical treatment is not only incorrect but the dose has not been  optimised. With more information I certainly  would be able to help you.

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QUESTION: He is taking METHYLPHENID 10mg 3 times a day 2 before school and then 1 at noon. The therapist is thru the school she is just trying to find out why he insists on showing his privates i am scared if this don't get under control he is gonna end up on a sex offenders list by age 10 for indecent exposure.. Its wrong and I try so hard to make him understand that , I am seriously lost right now wondering how to fix this

Answer
Is is unfortunately obvious you are not accostomed to give details, probably through no fault of your own. There are different brands of  Methylphenidate and most have a different effect on the patient. The generics are not as effective as the original. Next, I hOpe your doctor does not take offence if I suggest his medication might be making the child worse. As I do not know when he starts school I cannot with accuracy comment. The treatment with Methylphenidate require absolute attention to detail if it is going to work. If 20mg in the morning is a good effective dose,then 10mg at noon must be seen as an underdose! If the second dose is more than 4 hours from the first, he will be in the rebound phasse and be made much worse. The noon dose will wear off at four in the afternoon and the child is now not on any medication till the next day.This can only be detrimental. If the therapist does not understand ADHD, how can she help? The currect dosage must be adjusted till it is effedctive for him to become more teachable.