Zabrin Inan,ADD/ADHD,mood disorders,depression,eating disorders,anxiety

Dr. Zabrin Inan, MD
Child, Adolescent and  Adult Psychiatry
Chicago  Northbrook

HOMECONTACT DR. INANNEW PATIENT INFOPATIENT FORMS and SELF TESTSFAQ about Mental Health

LEARN MORE ABOUT...
ADD/ADHDAnxiety DisordersBipolar DisorderMood DisordersEating Disorders
Sexual Orientation

OTHER INFOOnline ResourcesSITE MAP

ADHD Q&A Attention deficit/hyperactivity disorder

ADHD: Diagnosis and Treatment page

Here are answers to some of the most common questions about ADHD.

What is ADHD?
Our ADHD assessment questionnaires offer an in-depth list of ADHD symptoms,  and allow you to rate their frequency and severity. They also provide the needed medical and family history for ADHD evaluation.  

New patients should print out the appropriate forms, complete them PRIOR to an appointment with Dr. Inan and bring them with you. Dr. Inan can then focus on clarifying any needed information and formulating a specific treatment program.

Click here for the Adult ADD/ADHD Intake Form and Questionnaires.

Click here for the Child ADD/ADHD Questionnaire.
(Note: This form must be filled out by a parent or legal guardian).

Are teens hard to treat?
An ADHD diagnosis can be a relief but it also can be frightening. Teenagers sometimes  perceive an ADHD diagnosis as an excuse for adults to impose control over them. They may feel that treatment is the equivalent of enforced submission, or that medication may negatively affect their personality, creativity, aggressiveness or athleticism. Taking medication may conflict with the teenager’s self-image as autonomous and invulnerable.  Some may be concerned that taking medication for ADHD will label them as stupid or a loser. 

One way to quell those fears is to search the Internet for “famous people and ADHD.”  Many accomplished people have successfully dealt with ADHD and made significant contributions to society. The supportive parent or other significant person in the teenager's life is very important during the diagnostic period and throughout the course of treatment.

The supportive adult should encourage the teenager to maintain a diary of (1) specific school, peer or family pressures that may have decreased or increased, and (2) their medication regimen.

  • The diary helps the teenager and psychiatrist evaluate changes in symptoms, the medication regimen, and academic and behavioral interventions. The diary also supports the teen’s growing responsibility for well-being as the teen becomes an adult.
  • The parents or other significant person also should keep a diary. 
  • These diaries can help the teen, parents and psychiatrist understand “how and why” the same events can be experienced and remembered differently.

How can the school help?
The ADHD diagnostic assessment focuses not only on the symptoms and psychopathology of ADHD but also evaluates cognitive, academic, and adaptive functioning to identify targets for intervention, and strengths or protective factors to emphasize in the treatment plan.

The common characteristics of ADHD include poor organizational skills, limited self-monitoring, and deficient planning skills. These result in ongoing problems with homework, especially long-term assignments; preparing for and taking tests, and meeting deadlines. These problems are compounded if there also are learning disabilities in memory, coordination and language.

TABLE 1 Modifications in the approach
to learning can help students with ADHD  

Select recommendations from this list for the individual patient.

  • Provide written instructions to accompany verbal instructions
  • Assign student preferential seating close to the teacher or front of class
  • Check to make sure assignments are understood, copied correctly, taken home, and submitted on time
  • Suggest student use a laptop computer for writing and note-taking
  • Increase time allowed for examinations
  • Reduce the amount of written work or use worksheets to avoid frustration
  • Encourage active reading with note-taking
  • Avoid punishment for spelling, grammar and punctuation errors
  • Encourage student to dictate reports and use a word processor
  • Reward performance rather than speed
  • Encourage performance in areas of strength (e.g., art, music, drama, athletics)
  • Avoid classroom humiliation (e.g., papers should not be graded by other students)
  • Distribute notes before lectures
  • Assign note-takers for student if necessary
  • Provide supervised study periods
  • Break down long-term assignments into shorter segments

Modifying an ADHD student’s curriculum to compensate for neurodevelopmental weaknesses can help.  For example, the student can be given written instructions in addition to verbal instructions, be seated closer to the teacher, and allowed more time to take examinations than other students. These tactics put the focus on quality of performance rather than speed (see Table 1 at left).  

In fact, federal law requires secondary schools and colleges to accommodate students with ADHD when it can be demonstrated that ADHD prevents the student from benefiting from their educational program (see Table 2 below).

Which medication and how much?

The goal of treatment with medication is to achieve the optimum benefit--to help the child, teen or adult with ADHD function as well as his or her peers who do not suffer from the disorder.  There are a number of strategies for finding the optimum medication balance to control ADHD symptoms. (Click to Fast Facts: ADHD.)

  • The medication plan should provide for smooth control of symptoms.
  • Among ways to achieve this smooth control are coupling longer-acting preparations with shorter-acting ones, and overlapping stimulant doses so that one dose does not wear off before the next one is given. 

TABLE 2  Federal law addresses
educational services for students with ADHD
Individuals with Disabilities Education Act (IDEA) of 1990 (and amendments of 1997) Part B

Requires public schools to provide a free and appropriate education for all children with a disability

To be eligible, evaluation must show the child has one or more specific physical or mental impairments that require special education. Adolescents with ADHD who do not have a specific learning disability may be eligible under the following categories: 

  • “Other health impaired" (because ADHD leads to heightened alertness to environmental stimuli, resulting in limited awareness of the educational environment, which adversely affects educational performance and requires special education);  
  • "Co-existing specific learning disability";  
  • "Serious emotional disturbance" so that problems in relationships with teachers and peers markedly impair educational performance.

Requires schools to identify adolescents with ADHD and use an Individualized Education Program (IEP) process to evaluate educational needs and plan an IEP tailored to each student 

Section 504 of the Rehabilitation Act of 1973 and Americans with Disabilities Act (ADA) of 1990

Modification of the regular curriculum is essential because of a diagnosed impairment (ADHD) in an otherwise qualified individual that substantially limits a major life activity (global learning and academic performance), leading to a major disability compared to students of the same age and grade

Requires public schools to provide free and appropriate education using regular education with various accommodations or special education if necessary

It is important to understand that underdosing is as serious as overdosing, particularly for ADHD children, because ineffective treatment can lead them to have a sense of hopelessness about achieving normal function.  Medications work to smoothly control symptoms of ADHD only if the treatment plan is the correct one for the individual patient.

Three main criteria govern how dosage is adjusted to the individual child, adolescent or adult:

  • specific symptoms
  • metabolism and medical history

  • stressors at home, at school or at the workplace.

In developing the medication plan, the physician must evaluate time points—frequency, dosage and timing—and determine whether any side effects are related to other disorders or current environmental stressors.  After making this determination, the physician can adjust or add medications accordingly.

To determine the correct medication plan for an individual with ADHD, the physician will gradually increase dosage until the optimum benefit is achieved.  “Optimum” is defined as maximum control of symptoms with tolerable side effects, based on the patient’s functioning at home and school or work. 

  1. Stimulants dosage is typically increased at weekly intervals, while any needed antidepressant or mood stabilizer (atomoxetine) is increased after three days. The starting point is an average dose that is adjusted for the patient’s individual metabolism, comorbidity, severity of symptoms, family medical history, physical health and stressors such as school, workplace, family and peer interaction. 
  2. The dosage is then increased by increments (typically in 3-7 day periods), along with any needed adjustments in timing, until there is a significant decrease in symptoms and side effects are tolerable.
  3. Another stimulant (and/or atomoxetine) can and should be considered if needed to achieve the desired benefits with manageable side effects. 
  4. Some children initially will need weekly appointments; others may be seen at the end of the first month.
  5. Throughout this period of medication adjustment, all patients are required to keep a daily log of dosage and time, and increases and decreases in stressors. The medication follow-up ppointment examines the medication, side effects and symptoms, including any comorbid problems. Height, weight and blood pressure will be monitored, with laboratory tests as needed.
  6. Patients, parents and teachers will be asked to complete relevant rating scales before the visit.

books12_nav.cmpbooks12_nav.cmpbooks12_nav.cmpbooks12_nav.cmpbooks12_nav.cmp

Acknowledgements

Tables 1 and 2 and material related to educational options and teen trust has been excerpted from an article written by Mark A. Stein, PhD, and Martin Baren, MD (Contemp Pediatr 20(8):83-110, 2003. © 2003 Medical Economics Company, Inc.) http://www.medscape.com/viewarticle/460591

Dr. Stein, PhD is a professor of psychiatry, section of child and adolescent psychiatry, department of psychiatry, University of Chicago.

Dr. Baren, MD is a consultant in behavioral and developmental pediatrics in Orange, Calif., and clinical professor of pediatrics at the University of California at Irvine School of Medicine.

Statistical material and ADHD comorbidity statistics are from the National Institute of Mental Health.


Home Page | SITE MAP


Dr. Zabrin Inan, MD
  Chicago  and  Northbrook
  312.952.3054   312.337.0859 Fax  
  
drinan@zabrininanmd.com
  Copyright 2003-2004 All rights reserved.