Expert: Christine D. DeLoatch, MA CCC-SLP - 6/13/2006

Question
New Jersey

Hi.  I hope you can help me.  My 6 year old son has had an IEP since he was 3.  He receives speech therapy, OT, classroom FM system, and is in a self-contained ILA and math class consisting of 8 children.  He has recently been diagnosed with ADHD.  He is a very smart child when he puts his mind to it, but when it is something he is not interested in, such as reading and writing, he just won't his work and tells me its boring.  He has recenly been on Ritalin, Focalin and most recently Adderal.  All worked wonderful in the beginning and after a several time had horrible side effects.  Now doctor is recommending behavioral therapy for his attention and possibly trying a different med - Straterra.  What are your thoughts on behavioral therapy?  My concerns regarding the Strattera are the possible liver problems.  How safe is it?  Is it an effective med for this type of problem?  

I appreciate any advise you can give me.  Thank you.

Answer
Dear Diane,

Thanks for asking me your question.  Let me answer your questions in reverse order.  The safety of straterra is based upon recent trials and approval from the FDA.  These trials have not studied its use over the span of years, because it is too new.  No child has been on the medication for many years.  That is not to say that it isn't safe, it is to say that not all the data is in yet.  

You do need to know that medications are usually broken down in the liver or the kidneys.  That is not unusual.  When medications that have to be taken over a long period of time are given, individuals are given tests to see how the liver is functioning and to ensure that the medication is not causing any damage.  That’s good medicine.  Your doctor would do those tests to ensure there was no damage routinely in your son's case also if you choose to try another medication.

This medication is technically in the class of medications of newer anti-depressants.  It works on 2 main chemicals in the brain.  The medication was first released as an anti-depressant, however did not have as positive an anti-depressant effect as some of the other medications in the same family, so they took it off the market.  Later it was studied and found to be helpful for children with attention deficit disorder.  

Any medication can have side effects, you just have to choose the medication you & your son feels you can live with the easiest.  

Now about behavior therapy… I think that it is a wonderful thing and all children and adults and parents need some training in behavior modification.  Right now it may be that you son doesn’t see the value in what you are asking him to do.  One way to improve things is to show him what people do when they grow up with all that math or language.  If he has a particular interest in a field see if you can find a mentor that will encourage him.  

Another way to work on the ‘work ethic’ is to use rewards or reinforcers.  That’s a way of helping someone do what is hard for him or her with the promise of something they desire.  It could be an activity, a movie or DVD or having a friend over.  You can make a picture of the thing he is earning & cut it into pieces say 5 for homework 5 days out of the week.  When he earns all 5 pieces you can reward him with the item.  He could also earn extra time on the computer or staying up late.  

You are seeking long-term change & remember sometimes motivation is difficult when interest is low.  I still have not yet mastered the ‘need to do it,’ thing – but it is improving.  I do think that if I had better role models & structure then it would be easier for me now to use self-talk to do somethings that are hard anyway.  It is so important for you to learn how to provide structure & support for your son so that he can use the tools available to him, even if he uses them inconsistently at the beginning.  If you don’t expose him to the tools, then he is starting off further behind.

Some kids kind of have a map in their mind about how things are supposed to be or go. Many observe it around them.  They see order in things easily.  We on the other hand are divergent thinkers.  We see many possibilities – but have trouble pulling things together to make things all nice & neat.  We need more practice at these skills.  The sooner you expose your son to the tools the easier it will be for him to remember he can use them, access them and then use them.  

I hope that makes sense to you.  I really do recommend the 2 pronged approach though- because so many kids don’t internalize the voice that answers the question ‘Why they should do the work,” and I think it is important to help them experience the rewarding nature of working itself sometimes so that it doesn’t seem so abstract and also so that they can  have someone to encourage them when things get tough.  

Thanks again for asking me your questions.  Many Blessings.

Christine