 Sept. 30 - Oct. 3, 2003 |
| ASSEMBLY EDITION • NEW ORLEANS |
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, presented the two-hour seminar "Understanding and Managing ADHD: From Preschool to Adulthood" yesterday. The course, which requires an extra fee, will be repeated from 4 to 6 p.m. today; check at registration for ticket availability.
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.
The child has a distinct advantage when ADHD is recognized early, said Tenzer. These children need classroom interventions, and they may need help with advocacy in dealing with schools. Once a diagnosis is made, the physician should request psycho-educational testing for learning disabilities, due to 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 gain 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. Even though the diagnosis is made in some children younger than 5, there is rarely need to medicate a child not yet in school, she noted. The physician's armamentarium includes stimulants, atomoxitene, alpha agonists and antidepressants. Fear about abuse should not stop the doctor from pursuing pharmacotherapy, 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."
And at a time when many schools offer incentive-based reward systems, this often excludes students with ADHD.
"These kids may be hearing that they're dumb," she said. "Find small things they cando (like completing homework) and reward them using a star chart."
Although much of the discussion focused on children and adolescents, 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 hard-working and loyal, Tenzer said.
"With more education, we can take that instability and turn it to ambition," she said. "These are people that are driven."
For support groups and other information about ADHD, go to http://www.chadd.org.
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by American Academy of Family Physicians.