Expert: Christine D. DeLoatch, MA CCC-SLP - 11/2/2006

Question
I live in ND and have a 7 yr old granddaughter.  She was diagnosed with ADD a little over a year ago and is currently taking 10mg of Adderall each morning. She was off it all summer. I need to know if most children diagnosed with ADD take a "summer" break.  She was fine all summer. I wonder if sugar or family problems could be more of the problem than ADD.  I feel too many children are mis-diagnosed.  She has been living with me since Aug. 2006, when school started.  I am concerned because her teacher has called several times requesting me to up her meds because she says she cannot "focus".  At the start of school, I do admit I was not giving her meds on the weekends and then after consultation with her Dr., was told she needed to take it continually during the school year. I have requested counseling for her and have enrolled her in a "Title 1" program to help her studies and she continually gets 80% to 100% on all her evals. She also does very well in most of her daily work in school. I don't know if she has ADD, emotional problems, too much sugar or just bored.  She's well behaved, doesn't have a temper and never lashes out. Some days when I pick her up from school, she is very quiet(crabby)and doesn't want to talk. After we get home, she spends her "quiet" time and then is fine.  Is this the after affect of the Adderall? I also worry about her appetite.  I know kids have streaks, but I don't feel she eats enough. Breakfast, however, is her strong point. I don't know how much she eats for lunch in school, but supper is usually not that great. Also, her pills are in capsules and she will not swallow them, so I put them in Yogurt every morning.  Can that change the effect of the medication?  I appreciate your input on this.  Thank you

Answer
Dear Kandis,

Thanks for asking me your questions.  

The answers are not easy.  First you need to understand that having ADD is like having epilepsy.  Even though you can't see the difference in her brain, it is different & the medication - the chemicals help her brain work faster and more effectively.  It's like untying one arm of someone who has two arms to work with.  Yes you don't have to give the medication but many children and adults do better in terms of consistency if you continue the medication all year round.  True she may not need to focus as much during the summer, but it may help her make good decisions.  

What you may see as boredom may be that - but with ADD that boredom keeps us from even starting work.  We can easily get behind because of a lack of motivation.  Some people think it is a poor work ethic, but it is because everything takes so much effort, that giving up or giving in always seems like an okay option.  She may be having bouts of mental fatigue at school.  

Are there other options to increasing the medication? Yes.  You can have her exercise.  Suggest the school give her movement breaks.  Try having her chew gum if the school will permit it, or sitting on a Move & sit cushion that might give her a little more alertness.

Some children are more sensitive to chemicals & sugar, but it is not likely to be the cause for a ADD diagnosis.  If the medication is causing a lack of appetite then it may be at a good dose.  See when the teacher is feeling like your granddaughter is distracted or unfocused.  Is it after lunch?  Maybe a small afternoon dose would help her get through the afternoon.  

It is not unusual to see some moodiness when the medication tapers off, but if you are seeing tantrums and real irritability then maybe the medication is not the right one.  

You might want to allow your daughter to eat a bedtime snack to add a little more nutrition. Also you can try milk shakes with/ protein and there are also some supplements that can be ordered through your doctor that have 1.5 or 2 times the amount of calories.  

These things might help.  Also, ask your granddaughter how she feels off the medication and on the medication.  You might find that she notices a difference and that school is harder for her without the medication.  

The signs & symptoms of ADD are experienced by everyone - but not to the same degree.  Being forgetful for normal people is forgetting where you put your keys once a month.  Being forgetful for an ADDer is forgetting where you put your keys 3 times a day.  It really is a matter of degree.  

The family has to make a decision about the priority.  Is her education a priority (certainly not at the risk of her health,) but what are you willing to invest in that area.  What are you willing to tolerate.  

There are many supplemental programs that can assist including some sensory intervention like I mentioned above -an OT occupational therapist can be more helpful with those things and other things like exercise and organizational skill training.  

Blessings for being such a caring, considerate & interested grandmother.  

Christine