n October 1, the American Academy of Pediatrics released new guidelines for the treatment of attention-deficit/hyperactivity disorder, or ADHD. Children with ADHD have difficulty controlling their behavior in school and other social settings. Though the cause of this condition is unclear, and there is no proven cure, treatment with medication and behavioral therapy has increased in recent years.
The Academy's treatment recommendations stress the importance of good communication among parents of children with ADHD and their children's doctors and teachers. Below, Dr. Peter Jensen, a child psychiatrist from Columbia University, discusses how to establish open and consistent channels of communication, and why it is so essential.
Dr. Jensen, we're just into the first few weeks of school now. Are there a lot of adjustment issues for children with ADHD?
PETER JENSEN, MD: Well, it depends on the child. Some children, for example, will actually be very calm and sedate for the first two weeks. It's only after things become more routine and not so interesting that the child's difficulties with ADHD begin to show. Other children may actually have just the opposite reaction, where they're more troubled by the strangeness or the newness, and they might be anxious or increasingly disruptive until things settle down. So it really varies from child to child.
How does the role change during the school year for parents when their child is away from home so much more of the time?
Well, during the school year, it's essential that the parent and the teacher and the doctor and the teacher increase their communication. Because the child spends so much time in school, the doctor has to know exactly how the child is doing in that setting. And sometimes the information that trickles home from the teacher really isn't sufficient. So the teacher and the doctor have to have their own line of communication, and of course, the parent needs to be continually part of that communication as well.
If a parent and teacher are not in close communication, how might that affect the child's ADHD treatment?
The teacher really is the one that knows how the child is doing in the classroom during the day. If the parent and the teacher aren't communicating regularly, the parents are only likely to hear about problems that are really, really bad. The teacher has thirty children to worry about, so if the child is having some difficulties and isn't being optimally treated, the parent may not hear about it. And therefore the child may not receive the best treatment.
How can pediatricians or child psychiatrists monitor the progress of ADHD children during the school year?
During the school year, it's essential that when the doctor makes adjustments to the treatment-whether it be the medication or some of the other therapies-that he does so with direct information from teachers at hand. Direct written or verbal information from the teacher is essential. Just hearsay, from the parent, really isn't good enough.
Are more frequent visits with the doctor needed?
More frequent visits are often a very good idea. Too often, children are only seen every three or four or six months by their doctor. We know for ADHD children, that's probably not often enough. If they're not doing well, they need to be seen more often.
What information is important for parents to share with their child's doctor?
The parents really need to be on top of how the child is doing in all his environments: in soccer, on the playground, at school, in the classroom. They need to know not only how the child is doing with things such as in-seat assignments and teacher requests, but also how the child is doing at homework and following through with parental requests. So the parent really wants to be on top of all of that information, and share it with the doctor.
Do some children perform better while they're actually in the school environment and then come home and have more problems?
Children are very variable about what they do best in. We know that some children actually have more ADHD symptoms at home. Some children have more ADHD symptoms at school. And so the treatments are often tailored to where the child has the most symptoms or the most difficulties.
For children who are old enough to participate in their own treatment, what information is helpful for them to provide?
The child should be able to share with the doctor how he feels about the medicine. Does he think it's helping? Does he have any side effects or any problems that he notices? Sometimes children will share feelings about whether they like or don't like taking the medicine, and that can be important. For example, if the child has to see the nurse at noon and go stand in line, that can be very embarrassing or humiliating for some children.
And sometimes children may not say that. They may just say, "I don't want to take the medicine any more." So the doctor and parents have to be aware of this possibility. And the doctor and the parent and the child have to talk about these kinds of issues as well.
What particular information should parents request from the child's teacher, and in what form is that information delivered?
Sometimes parents can do what we call a "daily report card," which is a little checklist that the child can bring home from the teacher that might have smiley faces on it or stars for the kinds of behaviors that the parent and the teacher agree together are the most important for the child to work on. So this could be a small sheet or an index card or an 8-1/2" x 11" sheet that has all the days of the week, that the child can bring home on a daily basis.
Many parents do this and it's a very effective way of communicating between school and home.
Do most teachers cooperate with parents in these cases? If you have a teacher that is resistant to sharing that kind of information, what should you do?
Most teachers are very pleased to be able to help a child with ADHD, since with help the child could become a more capable learner. And they'll be a more capable teacher if they put these strategies into place. But sometimes, teachers aren't fully educated or aware, and if that is the case, then it can be helpful for the parent to share information with the teacher about ADHD.
If the problems are very severe, the parent may have to have a quiet consultation with the principal or the lead teacher to see if there are some other ways in which the teacher who is having difficulties understanding or accepting can adjust to the situation.
Sometimes, it's helpful for the doctor to call the teacher. And I've done that many times. I'll call the teacher and try to rope them in and get them interested in understanding the problem. So there are a lot of ways to do it. But it can and it should be done.
Your model of a team is a very effective and useful model I would expect.
Well, I think it's the only way. Sadly, what we see going on for most children with ADHD across the country is that the team isn't functioning like a team. The doctor doesn't often communicate effectively or as frequently as one would hope with the teacher. The parent may have many questions and concerns that they haven't shared with the doctor. The doctor may not have been able to take the time and answer those questions. The teacher and the doctor may not be talking regularly about how the child is doing in the classroom, so that the doctor can adjust the medicines or the other treatments.
When it all comes together-doctor, teacher and parent all working together-we actually do see the very best outcomes for these children.
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