Expert: Dr. Sharon A. Mitchell - 4/5/2007

Question
My 8 year old son (in last months of 3rd grade) has been diagnosed and treated for ADHD for the past 3-1/2 years, due to his inabilities to concentrate and stay focused in a class room setting. At first the medication help greatly. however every 6-8 months we are having to adjust his medication and now are at the level that i am thinking that its possibly not ADHD. How do i know that its more and not just an 8 year old boy like his father thinks?  He is very smart and considered to be at the higher level of his academic in math, science and arts. however what should my next step be so he stays at this level.  

Answer
While kids with autism spectrum disorders generally display some degree of attentional difficulties, not all kids with attention problems have autism.

It sounds like you need some medical help. It's encouraging that initially your saw good results when your son began taking medication. And it's discouraging that you are no longer seeing the same beneficial results even with increased dosages.

What do his teachers say? Are they noticing signs that seem out of keeping with typical ADHD? Kids with autism show some differences in the way they react with peers. Unfortunately, kids with ADHD and learning disabilities also often display weaknesses in the area of socialization.

There are specific symptoms associated with the various autism spectrum disorders. You can read about them and diagnosis here:

http://www.psychiatry.emory.edu/PROGRAMS/autism/pdd.html

And in more medical detail here:

http://www.nichcy.org/pubs/factshe/fs20txt.htm

Here is a short, free, online checklist your could look at to see if you think your son is showing characteristics of Asperger's Syndrome:

http://www.udel.edu/bkirby/asperger/aspergerscaleAttwood.html

Here's a checklist on characteristics of autism:

http://www.hmc.psu.edu/psychiatryservices/child/outpatient/autism/Revised%20Auti...

These checklists are not definitive and do not mean that your child has or does not have autism. They may provide you with some information that you can take to your doctor, though.

Let's talk more about the attention deficit symptoms and the sort of information you can compile for your physician. When are the symptoms most noticeable? Non-stop? When he's in structured situations? When he's unsure of what is expected of him or what will happen next?

Are they worse before mealtime or after eating? Some children experience low blood sugar levels before eating or from eating the wrong foods (for their body) and may show ADHD-like symptoms during these times.

Other children experience sensory difficulties where there body has trouble processing incoming information. I've given some sensory strategies in these brief articles:

http://www.autismsite.ca/html/hands_in_pants.html

http://www.autismsite.ca/html/homework.html

http://www.autismsite.ca/html/wiggles_in_desk.html

http://www.autismsite.ca/html/gym_and_music.html

Have things changed in your home? Some people handle change more easily than others and the normal ups and downs of our lives can have a more profound impact on some children than you might think - especially young children who may not have a complete understanding of what is going on. While all kids flourish with routines and clear expectations some kids require this type of stability all the more.

Getting a handle on when your son is experiencing better or more difficult times may help in tailoring the medication to his current needs. There are some monitoring suggestions at these sites:

http://www.ldonline.org/article/5993

http://school.familyeducation.com/add-and-adhd/medications/39327.html?page=6

Here's a good ADHD primer in a free, pdf form. It includes other strategies you may find helpful:

http://www.addsolutionscenter.com/ARE%20WE%20THERE%20YET.htm

This article gives a brief overview of ADHD and some of the strategies you can try:

http://www.schwablearning.org/articles.aspx?r=26

Take a look at some of the items in the following article, "Is It AD/HD" from Schwab Learning's and LD Online's excellent sites:

http://www.ldonline.org/adhdbasics/isitreally

http://www.schwablearning.org/articles.aspx?r=319

If you son's symptoms point primarily to ADHD, possibly the medication he's currently on is no longer the correct one for his body chemistry, size and weight. There are a variety of meds to choose from. There's no clear-cut way to know which one would offer your boy the most help; unfortunately it's often trial-and-error. Here's some information on pharmaceutical options to discuss with your medical practitioner:

https://www.ldonline.org/adhdbasics/treatment

My suggestions are that you start by talking to your school - your son's teacher and the special education teacher to get their take on what may be going on with your son. Then, armed with their observations, go the medical route. A complete physical, including a visual and hearing examination would not hurt. Then, discuss the options with your physician. If there's a medication change, solicit the school's help in monitoring the efficacy of the new medications.

In the meantime, I've talked some more about sensory strategies and medical options in a recent All Experts question here:

http://en.allexperts.com/q/Autism-1010/Aspergers-Meds.htm

Sharon A. Mitchell
www.autismsite.ca