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Monthly NewsNote
April 2008
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Medication For More Than ADHD
Very often Attention Deficit Disorder is combined with another condition, most commonly anxiety or depression. Sometimes the diagnosis of the additional condition is not clear. What is clear, however, is when there is a problem that ADD medication isn’t solving, additional approaches have to be tried. This is a discussion of three children whose problems extend beyond ADD and a treatment that helped them. My hope is that those reading this will think beyond the boundaries of ADD when medication seems to fall short.
I have three cases to discuss. Because of their similarities I thought I would discuss them in one presentation. All three are male, all have been adopted, and all have loving and involved parents. Their ages are 5, 6, and 7. They were hyperactive, distractible, and oppositional. They had been diagnosed as having ADHD and treated with stimulants. They had shown improvement, but significant problems with social behavior, aggressiveness, and oppositional behavior continued and they were referred for a consultation
The children’s conditions did vary in details. But all had difficulty making appropriate social contacts, were overly aggressive, and were hard for their parents to control. I had to work to keep my office from being taken apart during the consultations. One child showed symptoms consistent with those children with a pervasive developmental disorder. A second seemed to be out of touch much of the time, perhaps fitting the criteria for psychoses. I am still not clear about the diagnosis for the third, but his behavior was inappropriate and disruptive. These children were quite disturbed and their parents were having a difficult time controlling their behavior and maintaining a normal home. The children were receiving special help at school. However, all were in difficulty and special schools were being considered.
I approached treatment in three steps. First I assessed medication. All three were on stimulants, which I found to be helpful and were continued.
Getting all supports in place was next. This included parental guidance and socialization groups for the kids. But when the major social and behavior problems continued, I determined the problems called for an additional medication. Each was treated with Risperdol. While there can be several side effects, the most important is weight gain. This has to be watched as weight can become a serious secondary problem if it gets out of control. Fortunately all three tolerated the medication well.
I’m quite pleased with the results in these three children. All parents report that they have better control and that the children are calmer and happier. The schools have stopped complaining and can now handle the children in regular classes.
Of course, these are complicated conditions and the prognosis is not clear. But the important piece is that because the children are now being treated for problems they have in addition to ADHD, they have been helped. This has been of great importance to the children, families and schools.
While these are difficult cases, there are many less disturbed children who do have an additional condition that is overlooked. Sometimes it is known about and ignored. Sometimes it is not spotted. As I mentioned at the beginning of the Note, anxiety and depression are the most common. But whatever the condition, when it is treated it brings about a better total result than just the stimulant medication alone.
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