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Monthly NewsNote
September 2006
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ADD AND SCHOOL -- GETTING READY
Summer is fast going and for many gone. There are a few things to think about
as the school year begins, and that is what I will discuss in this edition of
the Monthly NewsNote.
It is very important that the patient has met with the prescribing doctor after
the end of the previous year. This allows a careful review of the use of medication
and its effectiveness. With this information a plan can be made for the start
of the next grade.
There may be side effects that need to be discussed, and sometimes medication
needs to be changed. Perhaps the long acting form wears off at 1 PM rather than
at 10 hours as the drug companies would suggest. Or perhaps there is a side
effect that the patient resents, which influences the cooperation with the taking
of medication.
Eric is an example of the drug wearing off early. As we reviewed his report
cards and grades, it became clear that his test results were much worse after
lunch. He assumed it might be because he is tired after lunch. Actually, we
found that the medication was wearing off quite early. This insight was important
and we spent time during the summer finding a more suitable medication. We will
follow this closely as school gets started.
Jim, a 15 year old, resisted medication. We thought it was teenage behavior,
but in fact it was not. He felt that the medication made him focus too intently
so that he ignored his friends and also reduced his creativity. Understanding
this, we are working to find an alternative. (see Newsnote of March 2003 –
“When Kids Refuse Medication”)
It is important to discuss the correct dose. What may be appropriate in 9th
grade may be too little with honors courses. As the material gets more difficult,
more attention to the class material is needed. Also, homework can increase
and become more difficult, which then requires more time and increased focusing
ability. The increased need to focus may require a higher dose.
It is important that this be understood and that the parent, student if older,
and doctor stay on top of the educational functioning.
Another group that needs to be seen in order to plan ahead is the group heading
to college as freshmen. Leaving home is a huge adjustment in itself. The need
to use medication is clear, but the timing, dose, etc. cannot be clear until
the student gets to school, knows his class schedule, etc. It is important that
this be discussed, and if possible the student seen again at Thanksgiving time
or during Christmas vacation if no earlier time is possible.
It is important to start the medication at the beginning of the year. Don’t
delay waiting to see “how it goes”. This subject was discussed in
detail in the NewsNote of September 2004. The point is that the first quarter
is the easiest but builds the foundation for the rest of the year. A failure
to medicate can have year-long effects.
It is very important to see your doctor and evaluate the ADD situation before
the school year starts if possible, or very shortly after if necessary.
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