Expert: Norm Bishop - 4/23/2004

Question
Yes my daughter is on medication, she takes 10 mg of ritalin in the morning and then 10 mg at lunch time.  I thought maybe her meds needed to be adjusted and I guess puberty is starting to come around so that would have an affect on things.  The medication is helping quite a bit.  I have talked to her teachers at school and they haven't found a difference in her attitude, it seems to be just at home.  And her last pill is taken at noon and she gets home at around 3:45.  By this time I figure there is no more medication in her system?  So what can I do to help her and us at the same time to make living all together a better place?

Thank you.
Nathalie

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Followup To
Question -
My daughter will be 10 next month; she was diagnosed as being ADHD 2 years ago.  Lately she has outbursts at the mall, she wants something and she wants it now.  Some days are good and others are very hard.  She is aggressive, impulsive.  I have to make her other appointments with he pediatrician.  She is very hard to control in public.  What can I do to help her and make it easier for all of us?

Thank you for your time and information.

Nathalie Rowe

Answer -
My initial reaction has to do with the diagnosis.  When diagnosed, was she medicated and is she now?  If she is medicated, it may be that the medication needs adjustment.  With ADHD, about 1/2 the individuals medicated have a positive effect, hopefully that was true for your daughter.  As kids get larger, the dosage needs to change.  Then you add in hormones and those chemical changes in the human body and you get even different reactions.  You may want to consider stratera, which is a non-stimulant drug used for ADHD.

Assuming she has positive results from medication, I would go there first.  The second thing you can do is be as consistent as you can when relating to these behaviors.  When she is being aggressive or insisting that she have something, you need to have a standard "script" like, "that is not a choice," or "when your behavior improves we can think about earning that."  Consistency helps to keep the behavior in check.  When being consistent, you will find an initial increase in the bad behavior, the child tends to "up the anti."  In time, the behavior negates and the child actually looks forward to the steady controls over a life where she has little control.

If medication isn't effective, sometimes limiting sugar, or additives like preservatives and dyes can help.  I can't impress enough that consistent treatment dealt with matter of factly, can make all the difference.

If you want to answer my questions and ask more detailed questions, feel free.

Norm

Answer
This is a tough one.  The medications are working at school...good!  The problem that occurs if she takes more meds after school is that she will then not eat enough and probably will have sleep problems.

How much sugar does she consume during the day?  Does she drink a lot of soda?  What does her after school snack look like?  

I would start by making sugar a rare treat, including pop, boxed juices, kool aid, etc.  After school I would make certain that she has a healthy snack, some fruit, nuts, with something like Orange Juice or Milk.  Her energy levels are probably running low following the medication regimin, which actually speeds up her entire neurological system, then when her bloodstream is depleted she will have the counter "down" effect.  That would and probably does cause an increase in negative behaviors.

Following her healthy snack, I would give her time to really unwind...active play time or physical work out (maybe she likes to run or walk for exercise).  I would have her homework study time be after dinner, giving her a better chance to be able to concentrate.  Break that time up with frequent rest periods.  (20 minutes of on task time gets a 5 minute break time).  Also create consistent rules regarding her behavior, and take or reduce privileges consistently when she steps over the line.  

It will continue to be a struggle.  The more you can structure her life, the better it will become...let me emphasize that the structure has to be done for her, she will not be capable of providing herself total structure until she is well into adulthood.

If this response has been slow in coming it is because I never received an email stating I received it, which is normally the way they notify me.  I just happened to be answering another question when I noticed it said I had two messages to respond to...sorry if it has been sitting there awhile.

Check out the website...http://www.ldonline.org, the sections on ADD for parents will be helpful!

Norm