theADHDdoc.com - Your guide to medications and complementary and alternative treatments for ADD & ADHD.

Your guide to medications and complementary and alternative treatments for ADD & ADHD.

Strategies For Physicians

Suggestions for Clinical Practice

1. Do not limit your evaluation to a review of behavioral symptoms. Even the most detailed and comprehensive review of symptoms will not help you rule out if the child's inattention, impulsivity, or hyperactivity is due to allergies, anemia, hypoglycemia, diabetes, thyroid disorder, sleep apnea, dietary insufficiencies of zinc, magnesium, or Vitamin B. Medical evaluation of each of these conditions seems advisable. In our case review of over 12,000 patients, we have found that at least one of these conditions was contributing to "ADHD symptoms" in approximately 5% of our sample.

2. Don't ignore the obvious. If a child is struggling to attend and concentrate at school, insist on an evaluation for learning disabilities in reading, mathematics and written expression prior to beginning medication. In addition, in patients displaying problems in reading decoding and comprehension, request a thorough visual examination. There is mounting scientific evidence that children with "ADHD symptoms" have a greater incidence of impaired visual tracking and convergence than peers.

3. Screen patients for illegal psychoactives beginning at least in the middle school. Due to the high rate of substance abuse among pre-teens and teenagers, and the risk for drug interactions, and the adverse effects of such drugs on treatment outcome, blood screening for illegal psychoactives is routinely requested at our clinic, prior to initiating any treatment.

4. Respect the importance of nutrition in sustaining attention and maintaining behavioral and emotional control. The relationship between dietary intake and the biosynthesis of neurotransmitters is well known. Without protein in the morning and at lunch, children, teens and adults will be unable to concentrate. At our clinic, we encourage children (under 10) to consume 10-15 grams of protein at breakfast and at lunch (pre-teens: 15-20 grams; teens and young adults: 20-30 grams). Those patients who followed these guidelines demonstrated fewer side effects, and required a lower dose of stimulants than matched controls (Monastra, V.J. (2004). EEG Biofeedback treatment for ADHD: An analysis of behavioral, neuropsychological, and electrophysiological response over a two year follow-up period. Presented at the Annual Conference of the Association for Applied Psychophysiology and Biofeedback. Colorado Springs, CO.).

5. Consider using continuous performance tests and QEEG examination (in addition to rating scales) to assist in identification of an optimal dose of medication. Because many factors can contribute to less than optimal response to a particular dose of medication (e.g. learning disability, insufficient diet, lack of sufficient academic support at school, absence of an effective behavioral intervention plan at school or home), we use CPT's and QEEG's in order to determine when a medication is sufficient to help a child achieve "normal" scores on tests of attention and behavioral control, and produce levels of cortical arousal on a QEEG that are consistent with age. Children who are being treated with medications for ADHD but continue to display significantly high frequency of core ADHD symptoms, despite age appropriate performance these tests, commonly do so because of factors other than inadequate dose of medication.

6. One of the most important findings from the MTA Study (MTA Cooperative Group, 1999), was that significant functional problems persist despite effective pharmacological treatment. Parent training, social skills programs, and EEG biofeedback have all been supported by controlled group studies and merit inclusion in the treatment of patients with ADHD.

For more information, check out the video by Dr. Timothy Wilens (Harvard Medical School and Massachusetts General Hospital; Author of Straight Talk About Medications for Kids), available at our online store.