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ADD and mental retardation.

Q Our son, now 12 years old, has mild mental retardation (a tested IQ of approximately 65, which psychologists classify as "educable"). He has always been in special education classes and seems to have done reasonably well. But recently, his teachers have told me that his work and attention are not as good as they could be. They feel he has attention deficit disorder, but they do not feel he is "hyperactive." They told me he might do better if he were put on Ritalin and recommended that I have him evaluated for an attention deficit condition.

Is this type of testing worthwhile? My concern is that an evaluation may be inaccurate because of our son's mental retardation. His father and I certainly do not want him on medication he does not need. If he is diagnosed with ADD, what other treatment options exist? Are there alternatives other than drugs?

A Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) may affect up to five percent of all American school age children. Attention deficit disorders are thought to be the leading cause of school failure and underachievement. They are characterized by significant attentional weaknesses, impulsivity the case of ADHD, hyperactivity. Secondary traits may include learning problems, poor peer relations and low self esteem.

Treatment options

A significant amount of research has been done on attention deficit disorders, but most studies have specifically excluded children with mental retardation. I agree with your concern that an evaluation of your son may be complicated by the difficulty of differentiating between behaviors indicative of ADD/ADHD and behaviors that are sometimes seen with mental retardation When I have dealt with seen situations - when ADD/ADHD is considered a possibility, but the diagnosis is not straightforward because of other medical or psychological conditions - I have had a more comprehensive evaluation performed by pediatricians or psychologists with a strong background in development and behavior.

If your son is diagnosed with ADD, it is important to remember that the use of medication should be only one part of a coordinated treatment plan that includes medical, psychological and educational intervention, as when as behavior management.

Psychostimulants (medications that stimulate various areas of the brain) are the most commonly used medications for ADD/ADHD. They include methylphenidate (Ritalin), probably the most widely prescribed psychostimulant; dextroamphetamine (Dexedrine) and pemoline (Cylert). Optimum dosage varies from child to child, and regular monitoring is required. The most common side effects of psychostimulant medication are loss of appetite, poor weight gain and insomnia (all of which are rare in my experience).

A 1990 study performed in Pittsburgh concluded that children with mental retardation and ADD/ADHD respond to methylphenidate in the same way as children with ADD/ADHD who are not mentally retarded. The researchers in that study noted that 75 percent of the individuals with mental retardation and ADD/ADHD who were given methylphenidate (Ritalin) showed significant increases in work output, on-task behavior and attention. However, the attentional gains did not lead to improvement in learning; nor did the researchers find significant increases in appropriate social interactions.

Antidepressants - such as nortriptyline (Pamelor) and desipramine (Norpramin), among others - have also been used to treat ADD/ADHD when psychostimulants have been ineffective or have caused side effects. More recently, clonidine (Catapres) has also been used, especially in individuals with ADD/ADHD who also have certain behavioral, psychiatric or medical problems.

Over the years, various individuals have proposed a number of "non-drug treatments" for ADD/ADHD. These " treatments" have included megavitamin and mineral supplements, additive-free diets, the suppression of yeast growth in the digestive system and, most recently, "EEG biofeedback." Although there have been anecdotal reports that one or more of these treatments have been useful, these reports of success have not been based on scientific evidence. Parents need to be extremely cautious about questionable and unproven treatments.
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Title Annotation:Ask the Doctor; attention deficit disorder
Author:Hirsch, David
Publication:The Exceptional Parent
Article Type:Product/Service Evaluation
Date:Mar 1, 1996
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