ADHD Help

ADHD Specialist / Child Psychologist, Dr. Sam Caron answers your questions about ADHD. Send them to: drc@adhd1.net

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Stephanie Deering from South Plains College writes:

I just received and viewed the first 2 Dr. C and Elwood videotapes. Planning to use them in an inservice for early childhood teachers! On that subject, would you like to comment on the use of medication with very young (preschool) children? We are seeing a drastic increase in the number of 3-5 year olds diagnosed as ADHD, with medication. Our concern in the early childhood field is that many behaviors interpreted as ADHD symptoms are actually developmentally appropriate for young children.

Dr. C’s response:

Dear Ms. Deering, First of all, thank you for ordering my videos. I hope that you find them to be helpful teaching devices. Your question is an excellent one. The DSM IV requires 6 hyperactive/impulsive symptoms prior to diagnosing ADHD, Primarily Hyperactive and Impulsive

The same is true for diagnosing ADHD Primarily Inattentive. Six symptoms in each area is required in order to diagnose ADHD Combined type. Even though it is not stated in the DSM, symptoms reduce in number as a person ages. Therefore it is prudent to require more symptoms be endorsed before diagnosing younger children

For example 8 to 10 symptoms instead of 6 should be endorsed when diagnosing a 3 year old. Additionally one should endorse a symptom only if it is in excess to the norm for the age group. Finally there must be some impairment in two or more settings and clinically significant impairment in social, academic, or occupational functioning.

I, personally, only diagnose ADHD in young children if the symptoms are extreme. If the symptoms are severe enough to be causing the needed clinically significant impairment, medication is, I believe, an important part of the treatment.In order to diagnose a child, the evaluator should obtain input from the child’s teacher; after all, who knows more regarding normal expectations for any specific age group than one who spends her/his day with members of that age group.

Teachers concerned that their students have been misdiagnosed should ask, I believe, to provide their input to the evaluator. Unfortunately children are often diagnosed without obtaining any of the necessary input from the teacher but rather entirely based upon a parents input. I hope this is helpful.

Sincerely,
Samuel R. Caron, Ph.D.

Dr. C & Elwood
adhd1.net

Behaviors tend to be cyclical. We deal with the same problems over and
over again.  This means that we don’t necessarily need to have good
skills thinking on our feet.  If we don’t get it right the first time,
we can plan how to handle the problem the next time around.

A general principal is that it is better to act than to react. If a
problem occurs and you are unhappy with your response, sit down with
your spouse or some other trusted adult, discuss what happened, and come
up with a plan regarding how to respond if and when the problem recurs.

Look at management of problem behaviors as problem solving. If a
particular response is not effective, come up with another one.
Eventually you will get the problem under control.

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The majority of medications used to treat children with ADHD are stimulants. Most mental health providers prefer sustained release preparations rather than short acting ones. With the short acting ones, you have to take them every 4 hours. Sometimes there are symptoms rebounds when the medication wears off. A symptom rebound is when the symptoms return, possibly even worse than normal.

The sustained release medications do not appear to have significant problems with symptom rebounds. Because you have to take them every 4 hours, more energy is put into the act of taking the short acting medication. I like to deemphasize the medication if at all possible. It is also more likely that you might forget to give some of the doses if you need to give the medication 3 times a day. Finally, the child will have to take the medication at school, thus increasing the child’s stigma or possible embarrassment. As you can see, there are many advantages to the sustained release preparations.