Tuesday, January 8, 2013

ADHD & Dropping Out

This is an article that was published in our local newspaper The Herald Dispatch on July 12, 2012.

A few years ago I had a 16 year old teenager come to my office for help with school problems. He had been retained in Kindergarten for “immaturity”, struggled through elementary school and repeated 6th grade because of poor test scores and missing assignments. Although he was now only half-way through his freshman year in high school, his parents had been notified that he was in danger of failing again. All his grades were low and he was refusing to do his work and more than once slept at his desk. Recently, he had become argumentative with the teachers and other students and was often tardy or absent from class.
            His parents remarked that even as a young child he had always been “on the go” – “full force” they said. He often forgot the rules about staying in his seat, not talking and forgetting to raise his hand. He was a slow reader and did poorly on timed tests. In middle school his lack of organization resulted in zeros for lost papers and unexpected exams. Homework was a nightmare for everyone that could last for hours and might end in tears and threats. He was becoming very moody and was staying out later with unfamiliar and unwelcome friends. In the morning it was hard to wake him up and he would complain of being tired all day. He was thinking about dropping out of school and his parents were at the end of their rope.
            I was reminded of this patient and many others like him when I read an article in the Herald Dispatch describing a new initiative to reduce dropouts in Cabell County. A multi-disciplinary team of parents and professionals lead by Laura Gilliam and Sara Blevins of The United Way of River Cities was meeting regularly to address three basic concerns: attendance, behavior, and course performance. Although it is still unclear to me if I volunteered or was drafted, I was glad to join the Education Matters team.
            As a physician I have learned that children and adolescents with school problems usually have more than one diagnosis. They may have any combination of learning differences, emotional problems, family conflicts and Attention Deficit Hyperactivity Disorder (ADHD). Effective treatment requires finding all the diagnoses present and creating a team of education, behavior, social, and medical specialists that the family can use to help them get back on track. My expertise in ADHD is based on board certification in Neurodevelopment Disabilities and on-the-job training as a parent of two children with ADHD.  
            ADHD is a neurologic medical condition that may be present in up to 10 % of all children. The American Academy of Pediatrics has recently published evidence based guidelines for accurate diagnosis and treatment of the condition. More than 50% of children with ADHD continue through adolescence to have symptoms of hyperactivity, short attention span as well as physical, verbal, and emotional impulsivity. Children with ADHD also have an increased rate of learning disabilities causing them to struggle with reading, getting their thoughts on papers, and staying organized.    Deficits in social comprehension and problem-solving lead to difficulties making and keeping friends or maintaining good relationships with parents, teachers, and school personnel.
            Research has shown that high school students with ADHD when compared to their classmates generally have significantly lower GPAs, turn in a lower percentage of assignments and are more likely to be absent or tardy. A higher likelihood of grade retention and failure to graduate has also been documented in this group.  It is not surprising to discover that a study completed in 2011 found that the dropout rate of adolescents with ADHD was eight times greater than their age and sex matched peers.  Investigators noted that other factors independently contributing to dropping out included lower IQ, marijuana use, and decreased paternal interaction.
            What can be done to solve this complicated problem and help these teenagers? Studies across the country are showing that multi-disciplinary programs based at the local school and community level can be effective. Teachers and school administrators, agency and governmental representatives, counselors, mental health professionals, and physicians can work together to provide their special expertise. Parent leadership, however, is the key to success. North Carolina has developed a model protocol which provides the combination of education, behavioral, and medical treatment that allows these students to reach their full potential both academically and socially.
            There are happy endings. My patient’s parents obtained IQ testing for him through his school eventually resulting in an Individual Education Plan that maximized his educational strengths while providing needed modifications. Family counseling and a behavior modification system to reward correct decisions was implemented.  Medical therapy was added resulting in improved attention span and better grades. He graduated, went on to technical school, found a good job and a stable, loving relationship. 
            Education Matters, with the help and support of our community, is building a comprehensive program for these Cabell County students that can spread this kind of success to everyone.  This is an opportunity for all of us to lend a hand and get the dropout rate under control.

Monday, January 7, 2013

START ME UP - The ADHD Doctor (with a little help from the Rolling Stones)

January 2013 -A new year is the perfect time to for an introduction.

I have been a pediatrician for a while now and a husband and father to our 6 children who are rapidly growing up and leaving home.  They are good kids but half of them had problems in school and home with short attention spans and short fuses.  Their personalities and styles of learning and behavior were all very different but some were much more challenging than others in academic, social and spiritual arenas.

There is today an epidemic of children who are struggling at school.  They are constantly at odds with the system and are hopelessly unorganized.  They have trouble keeping friends.  At home there are constant arguments and physical fights with siblings.  There are addictions to video games or computer time, unfinished homework and bedtime battles.  The well-meaning but conflicting advice from relatives, friends and self styled know-it-all experts proves to be worthless.   Parents feel both guilty and powerless as they watch their cherished child spiral downward out of control.

These children defy categorization.  They don’t fit well into the school's definition of a good student – one who sits quietly, writes neatly, follows the rules, pays attention and memorizes facts to be correctly repeated on request.  They are instead bursting with energy and excitement.   They have a million new ideas and perspectives that they want to share with everyone loudly and immediately.  They notice incredible new details that most of us miss.  They are persistent, determined and passionate about their feeling and ideas.  They do not have a medical disorder - they are just a little different in a world that often doesn’t value their gifts.

Trending psychobabble, expensive leafy garden supplements and shallow religious formulations of tough love are no help. What parents really need is a comprehensive, practical approach that helps them understand how their child’s brain works.  The best solution is a parent-led team approach centered on the strengths of the child.

 My personal experiences and professional training eventually led me into a medical school practice which is limited to children and adolescents with school and behavior problems.  Over the years I have listened carefully and learned valuable lessons from the parents and children that I work with.  I know there is hope for these families.  Parents can find the answers to help their children achieve their best potential in grades and relationships. I see it every day.

I teach parents to use my medical problem solving strategy.  If it works for me for to manage a fever, it should work as well to help them take charge of their child's school and behavior problems.   We focus on defining the chief complaint and making accurate diagnoses by using information from history, physical and laboratory testing.  Next we develop a logical multidisciplinary treatment plan and evaluate the results by measuring risks and benefits.  Parents learn how to recruit and coordinate a team of experts in education, psychology and medicine for advice on learning disabilities, ADHD and emotional concerns.  All decisions, however, are completely in the hands of the family.

Our goal is for children to reach their full potential.  Everything we do should clear their path to consistently achieve their best capability in academics and relationships with their family, friends and themselves.  Their self-esteem, confidence and happiness are at stake.  We look forward to discovering how to make the diagnosis in our next installment. 

Thanks for reading and always remember:  Don't get distracted!