Transcription:

Melanie Cole (Host):  According to the Centers for Disease Control and Prevention, up to 1 in 10 children in the United States are reported to have ADHD.  Nationwide, approximately 5.5 million children, ages 4-17 have been diagnosed with ADHD.  My guest today is Dr. Dave Blake.  He's a pediatrician with Pediatric Associates, Spartanburg, part of Children's Hospital of Greenville Health System.  Welcome to the show, Dr. Blake.  So, let's start with a working definition of what Attention Deficit Hyperactivity Disorder really is?

Dr. David Blake (Guest):  So, the definition of Attention Deficit Hyperactivity Disorder is that it is a condition that's characterized by people who have difficulties in three main areas.  Those three areas are those people tend to have trouble with attention, tend to have trouble attention with activity level, and tend to have trouble with impulsivity -- are kind of doing things before they really think about the consequences.

Melanie:  So, when would this be noticed?  By parents or caregivers?  When is this something that would send up some red flags?  

Dr. Blake:  So, it tends to be noticed by different people at different times, and some of it depends on the collection of symptoms that any one patient has, and so, it tends to be something that's seen in childhood.  For the kids who tend to be hyperactive, impulsive kids, those kids tend to get picked up fairly early.  So, for example, it may be the three year old who gets kicked out of daycare two or three times because he can't keep his hands to himself and can't follow rules, or it may be a kid who's picked up in kindergarten or first grade who's always on the go and has trouble sitting for instruction.  Other folks may just have trouble with attention, and for those folks, the attention difficulties tend to get picked up a little bit later, and so that may be more middle elementary school, late elementary school, even middle school or high school before the work requirements for a kid are so great that they kind of overwhelm their ability to pay attention.

Melanie:  So, if some of these things -- I mean – because some people and parents are quick to rack it up to, "Oh, he's just a boy, you know, he's all boy" or any of those kinds of things.  When would you tell them it's definitely time to see somebody and get evaluated, and also Dr. Blake, are pediatricians generally at the yearly well visit doing some sort of an evaluation to see if there are some of these symptoms?

Dr. Blake:  So, to answer your first question – actually, I want to answer your second question first -- so the second question is -- typically most pediatricians at well visits are going to be asking -- most of the pediatricians are going to be asking about behavioral concerns or if there are problems at school.  So, I don't know that most pediatricians are not going to do like a formal screen for ADHD, but more rely on the parents to kind of share what their observations are.  So, when is it more than just being a boy? I think the biggest issue is for the diagnosis of ADHD, which it's a diagnosis that's a clinical diagnosis, so there's not like a computer test you take or a blood test you do.  It tends to be more a collection of symptoms, then, and getting some questionnaires filled out by parents and teachers, but for the diagnosis , there has to be a significant impact on a child's social functioning or school functioning, and so if you're a little hyperactive, a little inattentive, but you're making it through life okay, then that's not really a problem, but if it's reaching the point where it's interfering with the family's life at home, or it's interfering with the child's progress in school, or even in preschool -- if it's interfering with being able to get along with other kids or stay in a daycare facility, then those are the sorts of things that would push a parent toward talking to their doctor about that more.

Melanie:  So, what would you tell your patients are some available treatments and therapies to begin with?  What's the first line of defense if you identify a child as having attentional issues, what do you do for them?

Dr. Blake:  So, it depends on the child's age.  We do everything we can not to diagnose ADHD in 3-5 year olds because every preschooler's probably a little hyperactive, but some kids have such significant symptoms that they meet criteria for an ADHD diagnosis.  For those kids, the recommendation is that the first thing they do is six months of working with a therapist with either their parents or with their teachers on the behaviors, and honestly, that ends up being more a -- probably more of a treatment for parents to help them understand their child and to help them know how to respond to their child so that the child functions better.  For kids who after six months of therapy are still having lots and lots of trouble, then at that point we think about medication.  For kids who are 6 and above, the recommendations are to think about medications more.  We always like to do behavioral things as a first line, so since a lot of place -- the place where ADHD is a problem for school-age kids is at school, we would want to do things at school like having the kids sit close to the teacher where the teacher can redirect the kid frequently.  Maybe let the kid have opportunities for movement during prolonged instruction.  Having the teacher watch the child as he begins working to make sure that he knows that problem of -- that 30-pages of subtraction problems and not addition problems.  Making sure that the children understands the instruction.  So, those are kind of some easy things that can be done.  If that's not working, then the other thing that can be considered is working with a behavioral therapist to work on strategies for keeping attention from getting in the way of the child's functioning, and then also think about medication.

Melanie:  So, the behavioral therapy -- what does that really involve to help a child focus on one thing or to keep their attention on their task at hand?

Dr. Blake:  So, it depends on the therapist, and so some therapists are going to use activities that are designed to help extend attention and focus.  Some therapists might work on strategies for helping kids to be mindful of where their attention is and mindful of when they're losing attention and to come up with strategies for pulling their attention back in.  As with the preschoolers, sometimes it's working with the parents or the teachers to give them strategies for how to help the child function better.  A lot of kids who have trouble with ADHD also have a lot of trouble with planning and organizing and just figuring out how to carry out tasks and so the behavioral therapy can also be directed at helping those kids come up with strategies for getting things done.

Melanie:  And what about medication because here's a lot of parents aren't quite sure what to think or, you know, things that they read on the internet or things that they've heard about medications for ADHD?  What would you like to tell them, Dr. Blake, about available medications for treatment?

Dr. Blake:  So, I think there are very few parents who are eager to put their kids on medications, and I think we as medical professionals understand that.  With the medicines, when I see patients, and I'm discussing medications with them, I'm always going to tell them about what the benefits are.  So, the medicines can help with attention.  They can help with focus.  They can help with activity level.  They can help with impulsivity.  I tell them what they don't help with.  So, they're not going to make a kid be a good kid, but as some of their bad behavior is caused by impulsivity, it can be helpful for that.  The medicine's also not going to help with planning and organization.  You need to work on that more with a therapist or somebody who's skilled at teaching kids those skills. Certainly, there are side effects from the medicine.  For most kids, those side effects are manageable.  I think the biggest side effect that most parents worry about is worrying about their kid becoming a zombie, and so what I always tell folks is if we're making your kid a zombie, we're absolutely doing the wrong thing for your kid, and with the number of medicines and the variety of medicines that we have available to us now, I think there's really not a good reason for a kid to end up being a zombie because of his ADHD treatment.

Melanie:  Is this something that will stick with them for life or does it kind of go away in through the teenage years into college?

Dr. Blake:  That's an excellent question, and once again, it depends on the kid.  I think one thing that you're probably picking up on is that each person who has ADHD is unique, and sometimes it's hard to put everybody in this category of ADHD and say, "Oh, you're going to do this, this, and this."  So, with ADHD, for the people who tend to have trouble with hyperactivity and impulsivity that tends to get better as they get older.  The attention problems tend to stick with people longer, so a lot of kids, they start out as a bouncy, on-the-go, six year old and end up being a more of an inattentive 13 year old, and so, as far as medicine goes, a lot of people are able to get off the medicine by middle school/high school, probably about a third get off by middle school.  About a third get off by the time they're through college because they find that for college it can be helpful to get them through college, and about a third of people now actually take the medicine into adulthood because they find that it helps them in their daily functioning and their jobs.

Melanie:  So, wrap it up for us, Dr. Blake.  What would you like parents to know?  Some tips to help their kids and maybe even adults with ADHD stay organized, maybe manage their medications.  What would you like to tell them about this as the child develops and grows?

Dr. Blake:  I think what I would like for parents to know is that I'm actually not crazy about the term ADHD.  It's what schools use; it's what medicine uses.  I tend to think of kids as a collection of strengths and weaknesses, and I think what’s really important is that parents kind of look at their kids that way, too, and teachers, because it's really easy to start looking at kids as ADHD kids and putting everybody in this group and having kind of negative feelings or emotions towards that, but I think it's important for parents to make sure that they're helping their kids to find their strength -- find what they like to do.  Find what really gives them energy in life because that's what they're going to make their life out -- that's what they're going to make their life out of.  If you focus so much on the deficits or the weaknesses that you have, that that becomes all your life ,and it becomes really a struggle for those kids to be more successful in life because they are constantly being told, "There's a problem with you," and so when I see kids in the office; when I'm finished talking to them -- well, when I start, I always ask what their strengths are, and I ask the parents to name off strengths, and at the end, I'm going to say, "Timmy, you have this list of strengths, so these are the things that you're good at.  Keep working on those things.  Keep doing those things.  Keep being successful at those things.  You know, you're like every other kid.  You have some weaknesses, and so your weakness is attention or your weakness is hyperactivity or you weakness is impulsivity," and so when kids come to me with that weakness, then I have medications that can be helpful for them for that, and I have strategies that we can teach you to be helpful for that.  I try to keep things positive with the kids -- help kids understand their brains.  I'd like for parents to help kids understand their brains and for parents to help kids develop their strengths and just help their kids maximize their outcome.

Melanie:  Thank you so much for such great information Dr. Blake.  Thank you for joining us today.  You're listening to Inside Health with Greenville Health System and for more information, you can go to ghs.org.  That's ghs.org.  This is Melanie Cole; thanks so much for listening.