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Articles by Dr. Billy Levin

Treating ADHD

"Successful treatment requires not only remedial work and medication, but also a very definite attempt to inform the parents fully of the implications of the total situation. They should be encouraged to continue gathering information to give them more insight and understanding, and so become an integral part of the therapeutic team.

The treatment depends on the type of dysfunction, the severity of it, the amount of secondary emotional overlay already present, the IQ of the child, the co-operation from parents and school, and the response to medication. The overactive, high IQ behavior problem child with little or no learning problems will respond well to medication and sometimes needs very little else. The under active (learning) perceptual problem child requires early intensive and prolonged remedial therapy after medication has been adjusted to the optimum dose. Children with learning and behavior problems will require both remedial therapy and medication and a lot more patience from everyone concerned both at home and at school.

For some very young children but not all, a special diet that excludes artificial flavoring and colouring will improve their behavior and concentration to a point where less medication is given. It appears that diet is an aggravating factor in an already existing neurological condition, and not the cause. Older children do not respond very well to the diet.

Psychotherapy is seldom required unless there is major family psychopathology, but on-going parent counseling is vital.

For a child with a reading problem (dyslexia), there are specific reading programs (e.g. paired reading). There are also specific programs for hand writing (dysgraphia), for spelling problems (dysorthographia) and dyscalculie (maths problems). For the most difficult of all -Dysrationale, (no logic) one can not even convince them they have a problem, let alone treat it, until they reach "rock bottom". For some, a coloured lens (Urlin lens) named after Helen Urlin, a remedial teacher, can do wonders for reading. The human retina rejects black print on a white background. Far better for reading is black print on a soft yellow background.

Dosage monitoring to achieve success.

Medication does not cure but allows the child to function closer to his expected age norm until he matures. The medication stimulates the formation of deficient biochemical neuro-transmitters in the brain and so normalises neuronal function. After enlightening both teachers and parents and reassuring the child, a trial of medication is started and titrated to the optimum dose and timing. The dose is individually tailored to suit each patient by titration, disregarding the child's age or weight. For some children the dose over weekends and holidays can be reduced or even stopped as progress is made, but to begin with it is essential to give the medication every day including on week-ends and holidays. This is done on a trial basis. Some children, especially the very hyperactive type will need medication every day. There are also specific methods to determine when medication should be stopped. There are no long-term side effects to Ritalin what so ever. The minor short-term side effects present no problem to good management.

The time required for maturity varies from a few months to a few years, and in rare individuals medication could be a lifelong maintenance. Periodic "off medication" holidays are not essential, but may be helpful to assess the further need for medication. Weekends off medication are possible, but only when some success has been achieved and an "off medication trial" proves successful.

There are perhaps five aspects that need re-emphasizing.

FIRSTLY, the under active (hypoactive) child who does not have a behavior problem and consequently is often overlooked because he is so quiet and loveable.

SECONDLY, the very high IQ (gifted) child who has A.D.H.D. and achieves average marks despite his high IQ, and presents a behavior problem or an under achiever.

THIRDLY, the older child (teenager), who has outgrown some of the behavior problems but is underachieving, could still benefit from treatment and must not be overlooked.

FOURTHLY, the adult who still has a problem and has never had treatment, had inadequate treatment, or had treatment prematurely stopped, should not be over looked. They are entitled to treatment. And what is more, it is just as successful as in the child if correctly used.

FIFTHLY, many a parent cannot come to terms with the idea of medication, despite the American Surgeon- General's investigation a few years ago, indicating not only the need to medicate, but also the safety of stimulants. In South Africa the Government's Health Department has come to the same conclusion. The same health department has more recently published their definite condemning of smoking as a major health hazard. Under these circumstances, it is difficult to understand the parents' reaction to medicating their children, when some of these parents condemn medication while being smokers themselves. Nevertheless a non-condemning, sympathetic attitude must be adopted towards these parents until they come to terms with their own anxieties and their children's problems.

Although Ritalin (Methylphenidate) is the most effective and frequently used medication, there is certainly place for other medication. The medication used for A.D.H. is neither habit forming nor dangerous but requires careful selection."

Dr. Billy Levin (2 May 2001).

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