NEW ENGLAND CENTER FOR PSYCHIATRIC TREATMENT AND EDUCATION

SIMON EPSTEIN, M.D.
91 STRAWBERRY HILL AVE. #140
STAMFORD, CT 06902
203-348-8579

Monthly NewsNotes

Monthly NewsNote

January 2008

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The Unidentified Add Sibling

As we know, ADD is often a genetic condition, with more than one family member having the diagnosis or symptoms. I have several sets of siblings in treatment. But treatment started with one child being diagnosed and it often took a long time before the second sibling was identified. Because I feel ADD siblings should be identified as soon as possible, I would like to discuss the topic of the ADD sibling in this NewsNote.

Let me discuss three cases. Charlie has come to see me since he was in 5th grade. He has ADHD and has been treated for many years. He does well and is followed regularly as he completes high school. Charlie has an older sister and she was always considered to be fine. But after she started college, she soon found she was having trouble focusing, had problems with organization and was doing poorly. She knew about her brother's problem and successful treatment and asked to be evaluated for ADD.

Another case is Craig. He had been diagnosed and treated as a child, but in high school decided he did not want any medication. He struggled, and in college began to fail. He returned for medication and quickly began to do well.

Craig has a younger sister, age 15. She complained about distractibility but managed to do pretty well. When she asked to be evaluated her mother ignored her. Finally I did see her. She met the criteria for ADD and has done much better with medication and support.

Finally, there is Jane. She started on medication while in college and did well. She is now working and continues on medication. At the same time, her 16-year-old sister was having increasing trouble in high school. She urged (or perhaps pestered) her mom to get her a consultation, which she finally did.

The reason for these case discussions is to focus on the idea that siblings need to be reviewed and followed. My experience has been that there is a second sibling with ADD in about 35% of the families when there is a first ADD child. Why isn't the sibling identified earlier? Sometimes the identified child is more impaired, more hyper or may have something like LD, so they get the majority of attention. At the same time the second child, despite having troubles with focus and concentration, is working hard, is better organized, and is doing well. Therefore, they are not considered as possibly having ADD. But as the work gets harder, the symptoms become more significant, until they are finally brought in for a consultation.

One important point: In the cases discussed the child had to push the parents to get a consultation. The parents usually protested and it could take a year or two before they acted. When the parents finally brought the student in they felt guilty for having ignored the problem. But this brings up the point that it is often the student who identifies their own problem, often over parental protests. This potential obstacle makes it even more essential for therapists, teachers and other adults in a child's life to be aware of the possibility of ADD in children who have ADD siblings.

In cases of ADD, I believe it is the therapist's role to follow up the sibling functioning, if necessary over a period of time. It's not easy to do, but I think it would be very useful in helping with early identification, and will have many benefits.

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