Expert: Dr Billy Levin - 3/19/2007

Question
I do not know where to begin.  My son was dx in Kindergarten with ADHD (very impulsive).  Since then we have tried almost every med out there...most stimulants as well as Strattera.  We even tried Neurofeedback (45 sessions).  Nothing has really helped.  We change meds every 4-6 months trying to get it right.  We currently see a Psychiatrist.  Prior to that we went to Marcus Institute in Atlanta for over a year, and a Pediatric neurology practice for a year and half.  His current dr. thinks he may also be Bipolar.  So right now, he is on Ritalin LA 20 mg at breakfast and lunch, Risperdal 0.25 every 12 hours, and Orap 2mg every 12 hours (facial tics).  His teacher says he is much worse in class now than beginning of school year.  Though she says that he is brilliant, but just does not learn in the standard way.  He always wants to build, either with paper, wood, card houses, motors and won't stay on task.  Last week he took the ITBS tests daily, he barely made it to number 10, and quit.  I compared his handwriting from over a year ago and it has gotten much worse (very big and not on line, barely legible).  I have him scheduled for psychoeducational testing in the next few weeks to see if that helps us figure out what is going on.  I hate loading him up with drugs.  I am wondering if we do not have him diagnosed accurately.  Any suggestions?
Thanks,
Chris

Answer
Firstly if he has ADD, medication works if the diagnosis is correct and of course if medication is correctly used. My problem is I have no reassurence from you that the diagnosis is correct. I could do an internet assessment with no cost to you if you wish. Let me know. Next, I would like exact details of what medications he has used in the past. That is, name, dosage, exact times given. Thirdly, were any rating scales used to monitor his requirements? With limited  insight I might try and  comment on the medications he is taking now, without suggesting the doctor is wrong.  The Rispidol is a  very tiny dose. Tics are part of Tourettes syndrome and sometimes Halol is more effective than Orap. It is unusual to use Ritalin LA twice a day and you have not stated the times he takes it. Breakfast and lunch is to vague for me to comment on. If he has got ADD/ADHD, medication is essential and it would be very important for you to accept this, and not be negative. Does your son object to taking medication? Does he get it regularly? However you are entitled to ask for results! With more imfo and insight I might be able to make some helpful comments. I am not sure Psychoeducational testing will be of any benefit. The condition is medical/neurological!