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Tuesday, May 21, 2013
Attention Deficit Hyperactivity Disorder
Starting the Assessment Process
I am currently starting the assessment process for ADHD with my seven year old son. I am working with his school and have contacted his doctor to begin this process. I know my son needs more help than I can give him. I have tried coffee and behavior therapy on my own. What I am up against is that his father refuses to support me or his son with this challenging behavior. To quote him, "no one is going to tell me my son is defective and my kid isn`t mentally retarded". Where he got this information and misdiagnoses from, I couldn`t say.
Frankly, it is embarrassing. He refuses to accept that (despite the mounting evidence) our child needs help. He only sees our son once a month and has never gone to his school to observe his behavior. There are a lot of symptoms that I see at home and he has got to have seen, but still refuses to allow me to get treatment for our son. I really want my child’s wellbeing to be the issue at hand and am at the point where excluding his father from this assessment and treatment is the only way to ensure this.
Is there any information that you can offer me regarding this? Also my child was born with a slight heart murmur. He was monitored for the first year his life and the cardiologist released him form treatment, stating that he was well and it didn`t warrant further observation. Should I request an EEG before (if he needs) begins Medical treatment for ADHD?
You present several issues, each important in its own right.
1. It is not unusual for fathers to be reluctant to admit their son has any problem. This natural reluctance is complicated if a father does not see much of his son and the son is on his best behavior for that short contact. E.g., the son might be so pleased to have his father's attention, or the excitement might give him a boost of dopamine, a neurochemical believed deficient in ADHD.
I don't understand how his father will not "allow" you to get evaluation and treatment; if he only sees him once a month, I assume you are divorced and you have custody. You have a nice precedent with the heart murmur, in which the Dr. decided no treatment was needed. Would his father agree that it makes sense to get an evaluation to see if treatment is needed? It might also be useful to note that about 10% of boys are reported to have ADHD, so it's not so unusual.
2. The congenital heart murmur is another issue, and at the current state of knowledge, it would probably be good with that history to have an ECG before trying one of the FDA-approved medications for ADHD, all of which have a mild effect on the cardiovascular system.
3. Your trial of behavioral treatment was a good move; was it with professional advice? There are good parent training courses available in most localities to sharpen your behavior management skills. The use of caffeine was less-well advised; I would not recommend that.
4. There are some other alternatives you could try on your own that his father would probably not object to. One is fish oil; there are now quite a few placebo-controlled trials suggesting a medium benefit for ADHD, but it takes 3-4 months to take effect. Make sure the fish oil is mercury-free, which it will say on the label (or else USP, which means meeting the purity standards of the US Pharmacopeia).
Another possibility is one of the computer-assisted attention-training games, some of which are available on the internet. A couple of names are Lumosity and CogMed. They are not proven to work, but seem reasonable to try if not too expensive. These, of course, are a fall-back position if you cannot get professional help.
Caution: be careful of over-the-counter herbs, which are essentially crude drugs without the quality control of regulated drugs. Some are even contaminated with heavy metals.
Good luck in your efforts to help your son.
L Eugene Arnold, MD, MEd
Professor Emeritus of Psychiatry
College of Medicine
The Ohio State University