Expert: Dr Billy Levin - 11/9/2011

Question
QUESTION: My exhusband and I are in a constant struggle over medicating our sons for their ADD and ADHD problems. He believes the boys need to learn how to control themselves, needs more discipline and structure, and that neither son has problems. Sometimes he will concede they have some trouble focusing. I believe there's some merit to teaching the boys how to cope without medicine and that some families are willing and are sucessful to raise ADD and ADHD kids without medicine. My exhusband likes to say, "Even Canada has pulled Adderall off the shelf because Adderall is killing kids!" From what I learned the fatalities from Adderall in children were that most of the prescriptions were written in the United States, and something like 4 children out of 1 million from 1999 to 2003 died while taking Adderall and had no other medical condition. Canada had lifted the ban after investigating the drug not long after banning the drug. I medicated the boys for a number of years quietly, and had gotten baseline and occasion EKGs performed, but last year, my exhusband had convinced both boys to refuse any medications (not just the adderall) I give them. The boys believe they will develop heart defects from Adderall and will die. Can you please share words of wisdom on what I can say to my exhusband and my sons? Both boys have understanding teachers, but one son's grades dropped from all A's to All C's and 1 B. It is so frustrating to know what I can do to help my children and not be able to do it.

ANSWER: It would appear that you, your ex and the children  are urgently  in need of expert advice and counciling about firstly the diaqnosis of ADHD/ADD. Then to be given expert advice about the treatment including monitoring of medication and possibly remediatrion for the children to improve their grades.  I would firstly ask your permission to call a spade a spade before giving any advice. In my opinon advice is urgently needed but not always easy to acceptand and  might shock you. Hence my request for permission to speak openly.However, sadly  your situation is not uncommon at all.

---------- FOLLOW-UP ----------

QUESTION: The boys' father first used ADD, ADHD in conversations in 2006-2007 time frame, I resisted, especially since my oldest behaved ALOT like I did as a child. Boys have been diagnosed in 2007, 2008, and again this year. No significant changes, except this last go-around there's some aspberger's that was identified with my elder, and "off the charts" ADD with my younger. I had no idea my younger was so ADD - he's got a keen memory, is busy and impulsive, and I thought the short attention span was a part of his busi-ness. Dad now likes to use words like Sensory Disorder for my older one, and feels he needs OT while in school. He says his school district offers it so the boys should be with him. We do have a PhyD who specializes in autism, aspberger, and boys. He referred us to someone 20 miles closer, but they do not accept our insurance. Another referral isn't taking new patients. And my boys are wise to counseling sessions - group seems to work better.

I have an appointment with the school to initiate a 504 plan. I don't think it will do a whole lot to help him (the teachers already do a lot), but it will be needed as he gets older.

What do you mean call a spade a spade? Am I missing something or need to change how I approach this problem? I have been resisting the idea of sole custody and keeping the kids from him, but I can see benefits of both for the boys and worry over the unintended consequences. I've already spent my entire life savings and my trust to get this far, and don't have much left to keep holding my ground.

I can't help but mull over the many things people have said about my exhusband - controlling, manipulative, self-serving, fiscally irresponsible, paranoid, passive aggresive, views himself to be without fault... and many, many more. I know this situation is common, except I think our situation has a dad with quantifiable (and undiagnosed)personality disorders. I don't think there will be an answer other than to ride it out, prepare these boys to have a mature attitude about dad, and acknowledge the war won't be over until the boys are grown and gone.

Answer
ALL Expert advice
The successful treatment of ADHD requires an expert doctor giving both parents expert advice as to what they can do, what the teachers  can do, what is expected from the children  and most important using safe effective medication to make the children more teachable.  Uneducated Parents accepting incorrect and perverted information will not only cause major strife between parents but will cause total confusion for the innocent children and an aggravation of the condition. OT makes ADD/ADHD worse!
   Stimulant medication is safe and effective if correctly used and causes no cardiac problems. Deaths were children who had cardiac conditions not recognised.
If one or both parent also has undiagnosed or untreated ADHD this is not only a frequent cause of divorce but will make the team effort even more difficult.  
The treating doctor must fully inform both parents and both children to have any hope of success. The first step is medication to make the child teachable. Then motivation to make him willing to co-operate ,then  education and if required remediation. Good luck!