ParentTime - ParentTime Live! Event Transcript

ParentTime Live! Transcript

Discipline
Signs of ADHD
Treatment for ADHD
Right and Wrong
Medication Choices
The Future of an Child with ADHD
Distressing Behavior
Resources for Parents
Origins of ADHD
Play Therapy
Side Effects?
The Bottom Line

ParentTime Live! Event Transcript

In this April 7 event, New York University clinical psychiatry expert and author of It’s Nobody’s Fault: New Hope and Help for Difficult Children and Their Parents, Dr. Harold Koplewicz, answers questions about parenting a child with Attention Deficit Hyperactivity Disorder.

ParentTime

elcome to ParentTime Live! We’re here tonight with Dr. Harold S. Koplewicz, a New York University clinical psychiatrist and author of It’s Nobody Fault: New Hope and Help for Difficult Children and Their Parents. Dr. Koplewicz wants to answer your questions about raising a child with ADHD.

Discipline
Question: What can I do when no type of discipline works with my ADHD son (he’s 5)? Time outs don’t work, and neither does anything else. When I spank him, he just laughs. He has to take catapres to sleep or he’s up all night. He has been getting into everything — knives, food . . . everything! What can you do when time-out doesn’t work? He thinks it’s a game!
Dr. Koplewicz: Parenting is difficult for all of us, but particularly so when your child has ADHD. The symptoms of impusivity, hyperactivity and inattention make parenting these children very challenging.
Discipline has to be premeditated. In other words, the parents have to know ahead of time what the consequences and rewards are for certain behaviors. Spanking is a bad idea since most parents use it when they are frustrated and don’t know what else to do.
Good discipline occurs when a parent is in control. For example: A child is having a temper tantrum and the parent has requested several times that he stop. After making the request, the parent should give a warning: If the child still doesn’t stop, there should be a consequence, such as time out. The child should be placed in his room with the door closed and told that he is going to remain there for 5 minutes. The parent should not talk to the child during this time period and at the end of 5 minutes, if the child is still having his temper tantrum, he is to be told that he is going to stay in the room for an additional 5 minutes.
Question: I’ve been trying time-out since he was two. If I put him in his room, he just jumps around and bangs and throws things. I’ve tried hook locks and he pulled on the door until he pulled it out of the wall!!!
Dr. Koplewicz: I think that time out has to be treated very seriously by the parent. If necessary, put a hook and latch on the door during time out. It’s important that the child see that you take this seriously, and that you don’t think it’s funny. If he keeps it up, then up the ante: The time out becomes longer. You remain in control all the time. It’s alright for him to jump around and throw things, as long as you don’t let him hurt himself or terminate the time out before he’s ready. It might be a good idea to get a consultation with a behavioral psychologist.

Signs of ADHD
Question: What are the signs of ADHD in teenagers?
Dr. Koplewicz: The signs and symptoms of ADHD are similar in adolescence as they are to childhood.
One major difference is that most kids get less hyperactive as they enter adolescence, but still remain inattentive and very impulsive. Question: Can some symptoms like hyperactivity be missing, but others like aggressive behavior and impulsivity still be present to be called ADD?
Dr. Koplewicz: Yes. There are three different versions of ADHD. The most common is the one with all three symptoms. The second type has inattention as its predominant symptom, without hyperactivity. The third type, which is the least common, has hyperactivity and impulsivity, without inattention. As a child grows older, conduct problems are frequently part of the picture. Of the teenager with ADHD, the three are hyperactivity, inattention, and impusivity.
Question: My son has trouble focusing and misreads circumstances and engages in aggressiveness. He has been in and out of psychoanalysis for ten years and not a single psychologist labeled him ADD. Could he still be ADD?
Dr. Koplewicz: Yes. Unfortunately, many health professionals miss this diagnosis.
Question: How then is ADD substantiated without a doubt? Teachers and psychologists worked together through the years on my son, and still no ADD label. We are at our wits end with him!
Dr. Koplewicz: Since the child looks very together in their office, and they never ask for observations from the child’s teachers. Psychoanalysis is not an effective treatment for ADHD. ADHD is a clinical diagnosis — that means we make it the old fashioned way: By taking a history of the patient, the parent, and the teacher. We know that symptoms have to be present before the age of six, even though the diagnosis is often made later.
Question: I have a file three inches thick on various diagnoses from many specialists. Could they have all missed the ADD clues?
Dr. Koplewicz: It seems unlikely, but it’s certainly possible. I would suggest a diagnostic evaluation by a board certified child and adolescent psychiatrist. For the name of this type of physician in your area, call the American Academy of Child and Adolescent Psychiatry at 800/333-7636.

Treatment for ADHD
Question: How is ADD treated in teens and adults?
Dr. Koplewicz: The most effective treatment for ADHD is medication. This is a no-fault brain disorder. Over 200 controlled studies have shown that medications like Ritalin are effective and safe in the treatment of ADHD in children, teenagers, and adults.
Question: My son is on 15mg of Ritalin. Is that too much for a five-year-old? I wanted to see about changing to a slow release. Is he too young for that?
Dr. Koplewicz: The dosage of medication is adjusted to the child’s clinical response. In other words, some children need medication in higher doses — as high as 40 mg for a five-year-old, or lower doses like 10 mg. However, the medicine only lasts three to four hours and should be given two to three times a day.
Question: So, it wouldn’t hurt to try a slow release — where he’d only need to take it in the morning and it lasts for eight hours? It’s just that he starts kindergarten in August and I can’t even teach him how to tie his shoes or write his name . . .
Dr. Koplewicz: In general, the slow-release is not as good as the regular Ritalin.
Question: He’s on 15 mg twice a day. Before the medicine he’s too hyper — after it, he’s too slowed down. What do you recommend?
Dr. Koplewicz: Dexadrine spanusles are much better.
Question: Thanks, I’ll mention that to his doctor tomorrow.

Right and Wrong
Question: Do these kids seem to have any concept of right or wrong?
Dr. Koplewicz: Absolutely yes. It’s just that they’re very impulsive and sometimes do the first thing that comes into their head without thinking about the consequences.
Question: I have a 13-year-old who was diagnosed at age six and has been in counseling for five years, and still we have a big problem with lying, stealing, and destroying just about everything he gets. He is also on ten mg of Ritalin three times a day. He only weighs 88 lbs. We have tried everything we could. We’re at our wits end!
Dr. Koplewicz: That’s a good dose, but it still may be too little. However, it’s possible that a more specialized therapy program is necessary. Work is being done by the N.I.M.H. to research the most effective behavioral treatments. Howard Abikoff, PHD, director of research at the NYU Child Studies Center is a nationally-renowned expert. He can be reached at 212/263-6218.

Medication Choices
Question: Are there any other drugs besides Ritalin which can treat the aggressive, impulsive problems? I have misgivings about the side effects of Ritalin.
Dr. Koplewicz: The other medications for ADHD are Dexadrine, Cylert, Wellbutrin, Tofranil, Catapres, Tenex, and Adderal.
Question: Would Dexadrine be beneficial to my son?
Dr. Koplewicz: It’s possible. If a patient is not responding to treatment after so many years, it’s time for a second opinion. Consider calling The American Academy or Howard Abikoff, PHD, for a referral.

The Future of an Child with ADHD
Question: What becomes of adults who suffer from ADD? We are very concerned about our 17-year-old’s future.
Dr. Koplewicz: Children with ADHD who are untreated are ten times more likely to drop out of high school than the general population. Further, they have more trouble with the law and with holding down a job. Studies done of hyperactive children grown-up show that giving them lots of extra support — like tutoring, behavioral therapy — along with medication provides them with the best prognosis.
Question: Is it too late for an adult to be treated or tested?
Dr. Koplewicz: No. In fact, there are many centers in the US that specialize in the evaluation and treatment of ADHD in adults. Two good books that are worth looking at are ADHD in Adults by Paul Wender MD and Driven to Distraction by Hallowell and Ratey.

Distressing Behavior
Question1: Lying, stealing, sneaking things, destroying things... are these normal affects of ADHD?
Question2: My son does that too, Question1, and he’s five.
Question3: My son also does that and he is 17. Now that he’s 17, he doesn’t want any more psychologists. The decision to medicate is his to make. In the meantime, he keeps getting into major trouble.
Question1: Well, mine’s 13 and it’s really tearing up the family. We’ve had to put locks on our bedroom doors so he can’t steal things!
Question2: Our bedroom door has had a lock on it for one year.
Question2: Our house came with locks on all the bedroom doors, but i had to turn the knobs around to keep him from getting into my kitchen knives and stabbing things while I was asleep!
Dr. Koplewicz: It’s a bad side-effect of ADHD. Not all kids with ADHD do it, but unfortunately, being impulsive puts you at high risk for these behaviors.
Question1: Is there no hope in sight for these kids and their families?
Dr. Koplewicz: There IS hope. The new treatment with medication is worthwhile and effective. If one doesn’t work, another should be tried, or a combination should be instituted.
Question3: How do these drugs control impulsive behaviors?
Dr. Koplewicz: The working hypothesis is that they increase the availability of a chemical in the brain called dopamine. Individuals with ADHD have an imbalance of dopamine in their brain.
Question2: Dr. K, what can I do when he gets violent and says he’s going to kill people that have hurt him, his sister, or me? Is it possible to get some kind of family counseling with my son(5) and my daughter(3)?
Question1: Been there too! I feel for you!!!
Dr. Koplewicz: Behavioral therapy, along with parent training, can be helpful. CHADD is an organization that can direct you to trained professionals in your area.
Question3: Can they test for this dopamine level and make an exact conclusion it is ADD?
Dr. Koplewicz: I wish there was a blood test for ADHD as well as other psychiatric illnesses. However, at the present time there is no test besides a brain biopsy (which is out of the question) that could give us that information. In the near future, brain imaging tools — like the PET-scan and the function MRI — will be helpful.

Resources for Parents
Dr. Koplewicz: CHADD has extensive parent support groups throughout the United States for parents of children with ADHD. They can be reached at 305/587-3700.
Question: CHADD is on the web, too. Do a search in any of the search engines.

Origins of ADHD
Question: Dr.K, is all ADHD organic?
Dr. Koplewicz: ADHD is a no-fault brain disorder, that means that it has a biological predisposition, runs in families, has a biological difference in the way brains of children and adults with ADHD metabolize glucose, and it responds to medication.

Play Therapy
Question: The only therapy my son’s doctor sent him to was play therapy. Should I continue to take him to this when my son just sees it as another place to play and it isn’t helping?
Dr. Koplewicz: Play therapy is not an effective treatment for ADHD.

Side Effects?
Question: Everything responds to medication one way or another. What about side effects?
Dr. Koplewicz: Not really. The medications used for ADHD only work if you have the diagnosis of ADHD. For example, if you have ADHD and receive an anti-depressant, you will most likely become more dis-inhibited and receive no benefit. In the same way, if you are depressed and receive Ritalin, you won’t respond.

The Bottom Line
Question: So your bottom line for treatment is?
Dr. Koplewicz: Medication is the best and the most proven and researched treatment for ADHD. The most important take-home message is that in the past 10 years new advances in our understanding of the treatment of ADHD have helped thousands of American children. New research with behavioral therapy and medication are ongoing, and the results look promising.
Thanks for coming, everyone. I have enjoyed our discussion, tonight. Good luck.

ParentTime Live! Transcript Discipline Signs of ADHD Treatment for ADHD Right and Wrong Medication Choices The Future of an Child with ADHD Distressing Behavior Resources for Parents Origins of ADHD Play Therapy Side Effects? The Bottom Line		ParentTime Live! Event Transcript In this April 7 event, New York University clinical psychiatry expert and author of It’s Nobody’s Fault: New Hope and Help for Difficult Children and Their Parents, Dr. Harold Koplewicz, answers questions about parenting a child with Attention Deficit Hyperactivity Disorder. ParentTime elcome to ParentTime Live! We’re here tonight with Dr. Harold S. Koplewicz, a New York University clinical psychiatrist and author of It’s Nobody Fault: New Hope and Help for Difficult Children and Their Parents. Dr. Koplewicz wants to answer your questions about raising a child with ADHD. Discipline Question: What can I do when no type of discipline works with my ADHD son (he’s 5)? Time outs don’t work, and neither does anything else. When I spank him, he just laughs. He has to take catapres to sleep or he’s up all night. He has been getting into everything — knives, food . . . everything! What can you do when time-out doesn’t work? He thinks it’s a game! Dr. Koplewicz: Parenting is difficult for all of us, but particularly so when your child has ADHD. The symptoms of impusivity, hyperactivity and inattention make parenting these children very challenging. Discipline has to be premeditated. In other words, the parents have to know ahead of time what the consequences and rewards are for certain behaviors. Spanking is a bad idea since most parents use it when they are frustrated and don’t know what else to do. Good discipline occurs when a parent is in control. For example: A child is having a temper tantrum and the parent has requested several times that he stop. After making the request, the parent should give a warning: If the child still doesn’t stop, there should be a consequence, such as time out. The child should be placed in his room with the door closed and told that he is going to remain there for 5 minutes. The parent should not talk to the child during this time period and at the end of 5 minutes, if the child is still having his temper tantrum, he is to be told that he is going to stay in the room for an additional 5 minutes. Question: I’ve been trying time-out since he was two. If I put him in his room, he just jumps around and bangs and throws things. I’ve tried hook locks and he pulled on the door until he pulled it out of the wall!!! Dr. Koplewicz: I think that time out has to be treated very seriously by the parent. If necessary, put a hook and latch on the door during time out. It’s important that the child see that you take this seriously, and that you don’t think it’s funny. If he keeps it up, then up the ante: The time out becomes longer. You remain in control all the time. It’s alright for him to jump around and throw things, as long as you don’t let him hurt himself or terminate the time out before he’s ready. It might be a good idea to get a consultation with a behavioral psychologist.
		Signs of ADHD Question: What are the signs of ADHD in teenagers? Dr. Koplewicz: The signs and symptoms of ADHD are similar in adolescence as they are to childhood. One major difference is that most kids get less hyperactive as they enter adolescence, but still remain inattentive and very impulsive. Question: Can some symptoms like hyperactivity be missing, but others like aggressive behavior and impulsivity still be present to be called ADD? Dr. Koplewicz: Yes. There are three different versions of ADHD. The most common is the one with all three symptoms. The second type has inattention as its predominant symptom, without hyperactivity. The third type, which is the least common, has hyperactivity and impulsivity, without inattention. As a child grows older, conduct problems are frequently part of the picture. Of the teenager with ADHD, the three are hyperactivity, inattention, and impusivity. Question: My son has trouble focusing and misreads circumstances and engages in aggressiveness. He has been in and out of psychoanalysis for ten years and not a single psychologist labeled him ADD. Could he still be ADD? Dr. Koplewicz: Yes. Unfortunately, many health professionals miss this diagnosis. Question: How then is ADD substantiated without a doubt? Teachers and psychologists worked together through the years on my son, and still no ADD label. We are at our wits end with him! Dr. Koplewicz: Since the child looks very together in their office, and they never ask for observations from the child’s teachers. Psychoanalysis is not an effective treatment for ADHD. ADHD is a clinical diagnosis — that means we make it the old fashioned way: By taking a history of the patient, the parent, and the teacher. We know that symptoms have to be present before the age of six, even though the diagnosis is often made later. Question: I have a file three inches thick on various diagnoses from many specialists. Could they have all missed the ADD clues? Dr. Koplewicz: It seems unlikely, but it’s certainly possible. I would suggest a diagnostic evaluation by a board certified child and adolescent psychiatrist. For the name of this type of physician in your area, call the American Academy of Child and Adolescent Psychiatry at 800/333-7636.
		Treatment for ADHD Question: How is ADD treated in teens and adults? Dr. Koplewicz: The most effective treatment for ADHD is medication. This is a no-fault brain disorder. Over 200 controlled studies have shown that medications like Ritalin are effective and safe in the treatment of ADHD in children, teenagers, and adults. Question: My son is on 15mg of Ritalin. Is that too much for a five-year-old? I wanted to see about changing to a slow release. Is he too young for that? Dr. Koplewicz: The dosage of medication is adjusted to the child’s clinical response. In other words, some children need medication in higher doses — as high as 40 mg for a five-year-old, or lower doses like 10 mg. However, the medicine only lasts three to four hours and should be given two to three times a day. Question: So, it wouldn’t hurt to try a slow release — where he’d only need to take it in the morning and it lasts for eight hours? It’s just that he starts kindergarten in August and I can’t even teach him how to tie his shoes or write his name . . . Dr. Koplewicz: In general, the slow-release is not as good as the regular Ritalin. Question: He’s on 15 mg twice a day. Before the medicine he’s too hyper — after it, he’s too slowed down. What do you recommend? Dr. Koplewicz: Dexadrine spanusles are much better. Question: Thanks, I’ll mention that to his doctor tomorrow.
		Right and Wrong Question: Do these kids seem to have any concept of right or wrong? Dr. Koplewicz: Absolutely yes. It’s just that they’re very impulsive and sometimes do the first thing that comes into their head without thinking about the consequences. Question: I have a 13-year-old who was diagnosed at age six and has been in counseling for five years, and still we have a big problem with lying, stealing, and destroying just about everything he gets. He is also on ten mg of Ritalin three times a day. He only weighs 88 lbs. We have tried everything we could. We’re at our wits end! Dr. Koplewicz: That’s a good dose, but it still may be too little. However, it’s possible that a more specialized therapy program is necessary. Work is being done by the N.I.M.H. to research the most effective behavioral treatments. Howard Abikoff, PHD, director of research at the NYU Child Studies Center is a nationally-renowned expert. He can be reached at 212/263-6218.
		Medication Choices Question: Are there any other drugs besides Ritalin which can treat the aggressive, impulsive problems? I have misgivings about the side effects of Ritalin. Dr. Koplewicz: The other medications for ADHD are Dexadrine, Cylert, Wellbutrin, Tofranil, Catapres, Tenex, and Adderal. Question: Would Dexadrine be beneficial to my son? Dr. Koplewicz: It’s possible. If a patient is not responding to treatment after so many years, it’s time for a second opinion. Consider calling The American Academy or Howard Abikoff, PHD, for a referral.
		The Future of an Child with ADHD Question: What becomes of adults who suffer from ADD? We are very concerned about our 17-year-old’s future. Dr. Koplewicz: Children with ADHD who are untreated are ten times more likely to drop out of high school than the general population. Further, they have more trouble with the law and with holding down a job. Studies done of hyperactive children grown-up show that giving them lots of extra support — like tutoring, behavioral therapy — along with medication provides them with the best prognosis. Question: Is it too late for an adult to be treated or tested? Dr. Koplewicz: No. In fact, there are many centers in the US that specialize in the evaluation and treatment of ADHD in adults. Two good books that are worth looking at are ADHD in Adults by Paul Wender MD and Driven to Distraction by Hallowell and Ratey.
		Distressing Behavior Question1: Lying, stealing, sneaking things, destroying things... are these normal affects of ADHD? Question2: My son does that too, Question1, and he’s five. Question3: My son also does that and he is 17. Now that he’s 17, he doesn’t want any more psychologists. The decision to medicate is his to make. In the meantime, he keeps getting into major trouble. Question1: Well, mine’s 13 and it’s really tearing up the family. We’ve had to put locks on our bedroom doors so he can’t steal things! Question2: Our bedroom door has had a lock on it for one year. Question2: Our house came with locks on all the bedroom doors, but i had to turn the knobs around to keep him from getting into my kitchen knives and stabbing things while I was asleep! Dr. Koplewicz: It’s a bad side-effect of ADHD. Not all kids with ADHD do it, but unfortunately, being impulsive puts you at high risk for these behaviors. Question1: Is there no hope in sight for these kids and their families? Dr. Koplewicz: There IS hope. The new treatment with medication is worthwhile and effective. If one doesn’t work, another should be tried, or a combination should be instituted. Question3: How do these drugs control impulsive behaviors? Dr. Koplewicz: The working hypothesis is that they increase the availability of a chemical in the brain called dopamine. Individuals with ADHD have an imbalance of dopamine in their brain. Question2: Dr. K, what can I do when he gets violent and says he’s going to kill people that have hurt him, his sister, or me? Is it possible to get some kind of family counseling with my son(5) and my daughter(3)? Question1: Been there too! I feel for you!!! Dr. Koplewicz: Behavioral therapy, along with parent training, can be helpful. CHADD is an organization that can direct you to trained professionals in your area. Question3: Can they test for this dopamine level and make an exact conclusion it is ADD? Dr. Koplewicz: I wish there was a blood test for ADHD as well as other psychiatric illnesses. However, at the present time there is no test besides a brain biopsy (which is out of the question) that could give us that information. In the near future, brain imaging tools — like the PET-scan and the function MRI — will be helpful.
		Resources for Parents Dr. Koplewicz: CHADD has extensive parent support groups throughout the United States for parents of children with ADHD. They can be reached at 305/587-3700. Question: CHADD is on the web, too. Do a search in any of the search engines.
		Origins of ADHD Question: Dr.K, is all ADHD organic? Dr. Koplewicz: ADHD is a no-fault brain disorder, that means that it has a biological predisposition, runs in families, has a biological difference in the way brains of children and adults with ADHD metabolize glucose, and it responds to medication.
		Play Therapy Question: The only therapy my son’s doctor sent him to was play therapy. Should I continue to take him to this when my son just sees it as another place to play and it isn’t helping? Dr. Koplewicz: Play therapy is not an effective treatment for ADHD.
		Side Effects? Question: Everything responds to medication one way or another. What about side effects? Dr. Koplewicz: Not really. The medications used for ADHD only work if you have the diagnosis of ADHD. For example, if you have ADHD and receive an anti-depressant, you will most likely become more dis-inhibited and receive no benefit. In the same way, if you are depressed and receive Ritalin, you won’t respond.
		The Bottom Line Question: So your bottom line for treatment is? Dr. Koplewicz: Medication is the best and the most proven and researched treatment for ADHD. The most important take-home message is that in the past 10 years new advances in our understanding of the treatment of ADHD have helped thousands of American children. New research with behavioral therapy and medication are ongoing, and the results look promising. Thanks for coming, everyone. I have enjoyed our discussion, tonight. Good luck.