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How I Treat Pediatric ADHD: Summer Time Prep for 'Back to School' Case Presentation
The Case Part 1:
Juan is an 11-year-old who follows up in your office for a routine check-up with his mother Anna.
Juan is the middle of 3 children and is transitioning from 5th to 6th grade.
In 3rd grade, Juan’s parents were contacted by his teacher who stated
“he's really bright but is getting frustrated and interrupts the class’
At that point, his pediatrician saw him and based on a Vanderbilt rating scale and a clinical assessment diagnosed him with ADHD and referred him to your office.
After evaluation in your clinic, his diagnosis was confirmed for ADHD ( moderate to severe, ADHD-RS= 39) and Oppositional Defiant Disorder (mild to moderate severity).
He was then started on extended-release methylphenidate and his parents reported a dramatic reduction in “problems”. His grades improved from B’s and C’s to A’s and B’s and his teacher felt he was "happier and more engaged”. In addition, Anna stated that "our family is doing better" and he’s just easier to be around.
Over the next few years, he continued to do well with mild medication side effects and his teachers report that he does better on the days he “remembers" his medication.
The Case Part 2:
Numerous studies have found that the majority of children with ADHD continue to have ADHD into adolescence and up to 90% continue to have ADHD symptoms into adulthood.
As environmental demands increase, most children will continue to struggle with ADHD and appropriate treatment is never more important.
Optimal management will investigate breakthrough symptoms throughout the day and explore preparing for the transition from grade school to middle school.
Are we having any troublesome side effects?
Are we having any breakthrough symptoms-beginning, the middle, or end of the day?
Is his ADHD medication starting to be a bit less effective?
Reassuring Juan and his mother that as he heads into middle school with class transitions and increased homework and academic demands, it has never been more important to have an optimal improvement in his ADHD symptoms.
