Friday 17 November 2017

Dear David Coleman: Should I give my young son medication for ADD?

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David Coleman

David Coleman

Clinical psychologist David Coleman offers parenting advice in his weekly column.

Q. Last year, our seven-year-old son was diagnosed with specific learning difficulties in literacy and maths. He is a super wee boy and is great for doing his homework. But, his teacher says he is a handful in class, not paying attention and so on. So, the school pushed for a new assessment with CAMHS and we said ok. That assessment came back and now says he has ADD too, and they want to put him on Ritalin. We don't agree with medication at all. I'm between a rock and a hard place trying work out how we can help him without using meds to do it.

David replies: Attention Deficit Disorder (ADD) isn't a commonly used diagnostic term any more. The broader term of Attention Deficit Hyperactivity Disorder (ADHD) is usually used with specific reference to it being a primarily inattentive presentation, a primarily hyperactive/impulsive presentation, or a combined inattentive-hyperactive presentation.

Given your son's diagnosis of specific learning difficulties, some of his inattentiveness may be because he finds the academic work difficult and is not motivated to do it.

I'm not qualified to advise you about medication, since I can't prescribe it, which is why it is so important that you talk with the child psychiatrist who has diagnosed him, or the other professionals on the psychiatric team.

They have all the experience with medication and so will, hopefully, be able to answer your questions and also advise or reassure you about the value medication may have for your son.

The key thing, though, is to be very clear and to prepare, in advance, the questions you want to ask. Meeting with professionals can be overwhelming at times, with lots of potentially technical, jargon-filled information to try to process and make sense of.

You may even choose to have someone else with you during the meeting with the Child and Adolescent Mental Health Service (CAMHS) team. Having your partner, or a friend, there (who could even take notes for you) can really help to ensure you remember what gets said to help you later with your decision-making.

So, your start point might be to ask the CAMHS team to specify exactly what is the nature of the symptoms that your son shows. What is it that means he has ADHD Inattentive Presentation, rather than poor motivation linked to his learning difficulties?

In order for CAMHS to diagnose him with ADHD Inattentive Presentation, they must have observed a minimum of six symptoms from a group of nine symptoms. Moreover, those symptoms must be evident in at least two settings (typically school and home). Those symptoms include: failing to give close attention to details; having difficulty sustaining attention; not seeming to listen when spoken to directly; not following through on instructions; having difficulty organising tasks and activities; avoiding tasks that require sustained mental effort; losing things; easily distracted by extraneous stimuli; being forgetful in daily activities.

Once you are clear about the specifics of their diagnosis, ask them for further information about the nature of the medication, what symptoms it will help your son with and what, if any, side effects the medication has?

Also, ask the CAMHS team what guidance they can offer to the school in order to support your son there. Whether you do or don't choose to give him the medication, he still has to be in school and his teacher still has to manage him and his behaviour.

With whatever insights into your son the CAMHS team has gleaned from its assessment, the professionals involved should be able to tailor some advice and guidance about ways to engage with and work with your son. That might be relevant for both his class teacher and any resource or learning support teachers that work with him.

Ultimately, you are under no obligation to give your son medication in relation to his attention and concentration in school. That said, if the CAMHS team are recommending medication, then it is worth, at least, exploring and considering their recommendation.

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