Comorbidity Screening, Open Communication Optimizes School Transition for Children With ADHD

(Part 2 of 2)

In part 2 of this video, Andrew Cutler, MD, associate professor of psychiatry at SUNY Upstate Medical University, Syracuse, New York, explains best practices for optimizing medication and non-medication management of attention-deficit/hyperactivity disorder (ADHD) and screening for common comorbidities. Dr Cutler also discusses the importance of the doctor-caretaker and caretaker-teacher relationships during this transitional time.

In the previous part 1 of this video, Dr Cutler shares tips for clinicians on how to help the primary caregivers of parents with ADHD who are going back to the classroom either remotely or in person.

Also, an important thing for the parents and caregivers to understand is the conversations they need to have with various people. One conversation is between the parent and the child on the upside of ADHD.

Again, in the spirit of positivity, helping the child understand, for instance, that they may have lots of thoughts and ideas, lots of energy, lots of ways to have fun. They're very good at having fun. But also that they should think of it almost like a race car. With a race car, you need to know how to put on the brakes at times, too. Help them understand the upside of ADHD, not just the downside, and what they can't do.

Have the parent inquire about the child's friends and really pay attention to their friends. Are they getting in with the wrong crowd? Are they getting in with people who are negative for them or critical of them? Are they finding kids that are positive or have similar interests? Things like that.

Talk with your child about their teacher. Get a sense of how that interaction is going with the teacher. That's very important that the teacher and child fit, if you will. Help the child to understand the positives of the teacher, perhaps, if that's an issue.

Then, of course, talk with the teacher. This is very important to get started right away, even before the school year starts if you can, and follow up with the teacher throughout the year. Have the teacher understand what your child's needs are, what the issues are. Certainly, if you make changes in medication or stop the medication, the teacher probably needs to know to prepare.

Of course, the importance of the doctor-caregiver relationship. Talk with the doctor. Talk about the medications. Realize that most kids with ADHD, at least two-thirds, have comorbidities. They have something else in addition to ADHD.

You want to talk about those things and make sure that, as a clinician, of course, we've adequately screened for those comorbidities and we're addressing those as well. If we're just focusing on the ADHD, we might not have optimal outcomes.

Common comorbidities include conduct and oppositional defiant disorder, so behavioral disturbances, and anxiety, and depression, learning disabilities. There are a variety of various comorbidities. As children get older and get into adolescence, of course, there's the possibility of substance abuse as well.

You want to, also, have your parents and caregivers connect with other parents and caregivers or consider support groups or other ways of reaching out and just getting support. It can be very lonely and frustrating to be a caregiver of a child with ADHD.

Also, have them think about sitting down and talking about ADHD as a family because, as we know, ADHD can have a significant impact on the whole family unit. It can introduce quite a bit of stress, including if there are other children who don't have ADHD.

The child with ADHD can suck up a lot of the oxygen and take a lot of the attention. So, encourage everyone to talk about their struggles, if you will, or their perceptions or what the issues are for them.

Also, caregivers or parents should be talking with their partners. The partners should be talking to each other to try and get on the same page. It's very important. All too often, we see where the parents aren't on the same page, about the treatment, about medication, things like that, about what the issues are.

Also, you want to work on that parental or partner relationship. It's so important to the caregiving of the child and to the environment of the child.

Also, finally, make sure that a parent or caregiver knows how to take care of themselves because it can be very stressful and very consuming, and occupying. You don't want to neglect things that keep them recharged and healthy too.

There are some resources that I want to recommend. Those include the CHADD Organization, www.chadd.org, has tremendous resources on back-to-school, as does something called ADDitudeMag. It used to be a magazine called "ADDitude Magazine." It's now a website. It's www.additude.com, also a wealth of resources.

Some of the common misconceptions we should also think about, too, include things like the child doesn't need the medication on weekends or during the summer or the medication only needs to work during school. I always say parents will sacrifice home life for school. "As long as the child is doing well in school, I can handle it."

Well, ADHD affects the child in every environment and in every relationship they have. So, I think it's vitally important that we help parents understand that and raise the bar on their expectations of what is possible and of what times of the day, obviously, can be better and can be treated.

Another common misconception I find is that stimulants always cause irritability or insomnia. That's certainly true that it's related but I think it's very important, as clinicians, to be curious and ask questions.

When you hear irritability, for instance, ask what time of day that's happening because sometimes, it might be a peak effect. The blood level is peaking, in which case, you would lower the dose or do something else. It also might be the medicine is wearing off very quickly and you get a rebound irritability and moodiness kind of effect.

Same thing with insomnia. Ask when the medication is wearing off. If it's wearing off early, it could be the ADHD rebounding and the child has trouble shutting down and calming down to go to bed. You really want to think in a more sophisticated way about what's going on.

Those are some of my suggestions. I hope that those are helpful tips for you, your families, and your patients. I wish you the best of luck. Hopefully, we all have a very successful back to school season this year. Thank you.

Andrew J. Cutler, MD is the Chief Medical Officer at Neuroscience Education Institute, Carlsbad, California, and a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University, Syracuse, New York. Dr Cutler is board-certified in Internal Medicine by the American Board of Internal Medicine and in Psychiatry by the American Board of Psychiatry and Neurology.  He is also a Certified Physician Investigator (CPI) by the Association of Clinical Research Professionals (ACRP).