BY TONI LAPP
When it comes to treating children with attention-deficit/hyperactivity disorder, Penny Tenzer, M.D., is uniquely qualified to understand the challenges. That's because she's the mother of a son with the disorder.
Tenzer, associate professor of clinical family medicine at the University of Miami School of Medicine, made a presentation on the topic Oct. 2 at the Assembly. ADHD can be confused with many other diagnoses, and comorbidity is the rule, Tenzer said. Although rating scales should be employed, these don't make the diagnosis -- the doctor does, she said.
Children with ADHD have a distinct advantage when the disorder is recognized early, said Tenzer. These children need classroom interventions, and they may need advocacy on their behalf in dealing with schools. Once the diagnosis is made, the physician should request psycho-educational testing for learning disabilities because of the frequency of comorbidities.
Tenzer advocates a multimodal treatment plan. "Educate everywhere you can -- at home, school or work," she said. Sometimes educators need to be educated about the condition.
A diagnosis of ADHD qualifies a student for the Individuals With Disabilities Education Act, which can ensure accommodations for a child needing preferential seating, smaller class sizes and shorter work periods. Behavioral counseling should also be considered, said Tenzer. These children may not understand nonverbal cues. This deficit becomes more of an issue in adolescent years, when peer acceptance is so important, she said.
In addition, medications can and often should play a role in treatment. "We're treating to function," she said, not to sedate. The physician's armamentarium includes stimulants, atomoxitene, alpha agonists and antidepressants. Fear of abuse is not an issue, she said, quipping that drugs such as Adderall® have low street value.
Finally, "parents have to be willing to be educated about this," she said. "Grandparents may be telling them that they're not correctly disciplining the child, but time-outs don't work."
Tenzer was quick to point out that some patients do not outgrow their ADHD. Adults with ADHD often experience career difficulties, so job choice is important. But those who pick the right career can be hardworking and loyal, Tenzer said.
"With more education, we can take that instability and turn it into ambition," she said. "These are people that are driven."
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