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Doctor looks at ADHD through new context
(by Sue Hoffman - January 20, 2011)
Doctor looks at ADHD through new context
By SUE HOFFMAN
Parents with children diagnosed with attention deficit hyperactivity disorder often struggle with finding a remedy that will help them. Options range from a list of medications to behavioral therapy, accommodations at school and a combination of treatments.
"I don't look at ADHD as an illness," Dr. Barry Simon, a psychiatrist, told a room filled with parents at the Solon Board of Education office last week.
"It's a brain-based disorder," he said, which is marked by inattention, impulsivity and/or hyperactivity. Some children have the disorder without hyperactivity.
"ADHD is not a disease or an illness," he said. "It is rather a place on a bell curve that causes functional problems."
The problem occurs in the pre-frontal cortex of the brain, which controls organizing and planning, he said. Characteristics such as not being able to sit still, forgetfulness, disorganization and messy work become apparent when a child is in school.
Dr. Simon, who is medical director of inpatient services for child and adolescent psychiatry at Cleveland Clinic and a Solon resident, knows about ADHD from personal experience. As a child, he was first placed in a program for students with learning disabilities.
"All my papers came back messy," he said.
Teachers complained about his behavior, he said, and later, he qualified for the gifted program and was placed on the highest track.
For the parents who attended the Organized Parent Education Network seminar, "ADHD: A Neurobiological Disorder," Dr. Simon not only gave parents insight and hope, but also served as an example of how one can succeed despite having the disorder.
There are many examples of people with the disorder who have achieved success. Dr. Simon said Olympic gold medalist Michael Phelps had problems as a child caused by the disorder.
"The brain cells you're born with is the number you're going to have," he said, but one's environment can make a huge difference. "It can turn genes on and off. The reality is that your environment can change your gene expression." So the way they are raised may help the 3 percent to 7 percent of children with ADHD, he said. "It is not a harbinger of doom."
On the other hand, he said, "This isn't one of the problems you solve in a half hour. There's no magic."
Parents should communicate with teachers about accommodations or strategies that can help their children, he said. They should work with their children in completing tasks and gaining organizational skills.
"You can yell and get angry," he said, "or you can realize there are some things you have to do -- that's not enabling a child."
Patience can help. Often, children's need to get out of their seats and sharpen pencils eight times a day wanes by the time they're in fifth and sixth grades, he said. Emotional immaturity caused by ADHD can improve with time as well, he said. Children with the disorder are often a few years behind. "A lot of them catch up" by the time they're in their mid-20s.
However, people with ADHD generally need treatment into adulthood, even though the hyperactivity is gone, he said. "We're realizing that 80 percent continue to need treatment."
Dr. Simon gave the example of a patient who did well in high school but not in college because his mother thought her job of helping him organize was over. It was not, he said.
Medical treatment of ADHD often includes stimulants, which increase motivation and alertness, he said.
"Eighty percent respond to a stimulant," he said. The drugs have been used successfully since the 1970s. Side effects, including reduced appetite and less sleep can occur. Another line of drugs that might help includes non-stimulants.
One of the difficulties in prescribing medication is the co-morbidity of ADHD and other conditions such as occupational defiant disorder, language disorders, learning disabilities, major depression and anxiety.
Sometimes depression is caused by the symptoms of ADHD, he said. In that case, it might be better to treat the patient with stimulants even though they could raise the level of anxiety. A parent has to balance the risks vs. the benefits, evaluate and re-evaluate, he said.
OPEN's programs continue monthly. Coming up are "IEPs (individual education plans) and 504 plans: What's the Difference," 7:30 to 9 p.m. Feb. 15; "Eating Disorders: It's Not Only about the Food," 9:30 to 11 a.m. March 24. Programs are held at the Solon Board of Education, 33800 Inwood Road.
For more information, call parent mentor Donna Boss at (440) 349-8039.
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