Autonomy is critical for teens with ADHD: make adolescents partners in terms of deciding whether, or when, they will take their medications.
ATLANTA -- Adolescents with attention-deficit hyperactivity disorder Attention-deficit hyperactivity disorder (ADHD)
A condition in which a person (usually a child) has an unusually high activity level and a short attention span. People with the disorder may act impulsively and may have learning and behavioral problems. need to be listened to by their physicians and given a sense of being in control of their lives and their therapy, Dr. Howard Schubiner said at the annual meeting of the American Academy of Pediatrics.
This approach tends to improve compliance, increase motivation, and create an atmosphere for success for the adolescent, he said.
Teenagers must be made to feel that they are respected and that they are equal partners with their physicians in terms of deciding whether, or when, they will take ADHD Attention-Deficit/Hyperactivity Disorder (ADHD) Definition
Attention-deficit/hyperactivity disorder (ADHD) is a developmental disorder characterized by distractibility, hyperactivity, impulsive behaviors, and the inability to remain focused on tasks or medications, said Dr. Schubiner of Providence Hospital, Southfield, Mich.
"Teens want to be in control.... So I give them control, assuming that they are ready to make reasonable decisions for themselves. I ask them what their goals are, and they tend to respond well to this," he said.
"The reality is that I do not have access to any different medications than you do. What makes me effective with teens is my relationship with them," Dr. Schubiner told his audience.
ADHD can impair a teen's chances of success in life if it is not treated. It is true that adolescents can be difficult to reach, but if the physician makes an effort to "really listen to them, find out what they are good at and what they like to do, encourage them to pursue positive activities, and believe in them, they tend to do well," said Dr. Schubiner, who specializes in treating children, adolescents, and adults with ADHD.
A plethora of studies has demonstrated that taking stimulants improves distractibility, fidgeting, parent-child interactions, and problem-solving activities with a child's peers.
The studies also have shown that academic progress often is dramatically improved, and that spelling, math, and reading skills are enhanced when children who have ADHD take the appropriate medications, said Dr. Schubiner, who disclosed that he is a member of the speakers' bureaus for McNeil and Shire pharmaceutical companies.
Dr. Schubiner stressed the importance of rolling with a teen's resistance and never pushing medication use.
He gave some tips on ways to talk to patients, giving examples of how he talks to his teen ADHD patients to allay their fears (and the fears of their parents) about taking medication and--most importantly--to establish a good rapport with them and encourage them to be motivated:
* First, explain what ADHD is. "I explain that ADHD has no relation to intelligence, that it is a mild disability. Take myself, for example, I wear glasses. If I didn't have them, I wouldn't have been able to go to medical school and become a doctor. So my glasses have allowed me to use my potential," he said. He tells patients that "it is the same with you and medications for ADHD. You have potential, and you can realize your potential if you are successfully treated."
* Ask the patients what they are good at. "That is the most important question. I don't care if it's video games. I found out that one of my patients was interested in NASCAR racing, so I asked who was his favorite driver, what was that driver doing, and so on. The critical thing is to find something that you can connect with these kids on, to get them to show you their strengths," Dr. Schubiner said.
"I encourage them to recognize how they have been successful at learning new skills, such as video games, NASCAR NASCAR (National Association for Stock Car Auto Racing), organization that sanctions American stock-car races, est. 1948. It held its first race in Daytona Beach, Fla. , dance, art, or music, and show them that these same skills can help them in school or in any endeavor," he said.
* Reassure them they can stop taking their medication any time they want. "I treat a lot of people with medication because it works. I tell them, 'I don't care if you take the medication or not. It doesn't matter to me. But I care that you achieve your goals. I use medications because they usually help teenagers achieve their goals. But if you don't want to take medications, that's fine. We can discuss how you plan on achieving your goals without it. If you ever want to stop your medication, just let me know.'"
* Put the patients in control. "I tell them, 'If you choose to try medications for ADHD, I will work with you very closely to ensure that there is benefit and there are no side effects, because I would not want to give you any medications if you're not being helped or you are having any side effects.'"
Dr. Schubiner said that he has zero tolerance for side effects, and emphasizes to his patients that side effects simply mean that they are not on the right dose, or not on the right medication.
Common stimulant side effects include headache, insomnia, decreased appetite, dry mouth, and feeling sweaty, jittery, or spaced out. Rare side effects include tics, psychosis, seizures, glaucoma, arrhythmia arrhythmia (ārĭth`mēə), disturbance in the rate or rhythm of the heartbeat. Various arrhythmias can be symptoms of serious heart disorders; however, they are usually of no medical significance except in the presence of , and sudden cardiac death Sudden Cardiac Death Definition
Sudden cardiac death (SCD) is an unexpected death due to heart problems, which occurs within one hour from the start of any cardiac-related symptoms. SCD is sometimes called cardiac arrest. .
"Sudden cardiac death is extremely rare, and most are due to an underlying cardiac abnormality. The rate of sudden cardiac death in children taking ADHD medication is 0.4 per 100,000 person-years. But the rate of sudden cardiac death in the general population of children is 1.5-8.3 per 100,000 person-years. So it's actually higher in the general pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. population," Dr. Schubiner said.
Teens with a personal history of chest pain, shortness of breath, dizziness with exertion, syncope syncope
Effect of temporary impairment of blood circulation to a part of the body. It is often used as a synonym for fainting, which is loss of consciousness due to inadequate blood flow to the brain. , hypertension, palpitations, or other potential cardiac problems should be evaluated further. In addition, physicians should inquire about a family history of sudden cardiac death, myocardial infarction prior to the age of 50 years, congenital heart disease congenital heart disease, any defect in the heart present at birth. There is evidence that some congenital heart defects are inherited, but the cause of most cases is unknown. , or rhythm problems.
BY FRAN FRAN Functional Reactive Animation LOWRY