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LISA CLARK: Welcome to our webcast. I'm Lisa Clark.
School time requires sustained focus and attention, which means that children with ADHD can often have a hard time in the classroom. Treatments are available, however, and with the right balance of therapies, children with ADHD can get back on the track to scholastic success.
Joining me to discuss some of these treatment options is Dr. Peter Jensen, Ruane Professor of Psychiatry at Columbia University. Dr. Jensen, welcome and thank you for joining me.
PETER JENSEN, MD: Thank you.
LISA CLARK: Let's talk about some of the particular challenges that children with ADHD face in the classroom.
PETER JENSEN, MD: Well, the biggest problem that most of these children face is their daily work. Getting the job done that most children define self-esteem and success by. And that's their schoolwork. How well they're doing compared to their peers and other classmates.
And so all of the routine tasks, in particular, are what they find challenging. Whether it be completing the homework, doing a longer project that takes daily follow-up and preparation and planning. Or the routine seat-work and trying to remain calm and focused, when there are so many other distractions around, and you're trying to do a list of math problems.
LISA CLARK: How do these kinds of challenges impact treatment strategies?
PETER JENSEN, MD: Well, this means that the doctor has to be in careful communication with the child and the parent and the teacher throughout the school year. Just starting the child on, say, a medicine and a behavior therapy in September may not be a good strategy for November. In November, the medicine may need to be adjusted. The timing of the doses or the amount of the doses, or putting a new behavioral strategy into place at school might be necessary in November that wasn't really seen.
The same thing happens when children come back after breaks. They've had a little time off. They've had some rest and reassurance. They might be a little fresh again for a while. But you can see that same little pattern, where things can deteriorate, particularly when they get into April and spring fever time and some of the other distractions become increased for them.
LISA CLARK: Doctor, let's talk about medication. There is some controversy about whether all children with ADHD should even be on medication.
PETER JENSEN, MD: Treatment decisions are always individualized. And we know that maybe one in four children can do very, very well with just a therapy, a behavior therapy only. So most children don't respond to behavior therapy. It takes a lot of work.
What I would like to say is that every child has the right to be tested on and tried with the medicine, but medicine isn't necessarily the right thing for every child. It's one of the important options. Parents should reject it out of hand. Doctors, of all people, shouldn't reject it out of hand, and should be -- should understand and be aware of how to use those treatments.
LISA CLARK: If medication is agreed upon, are once a day medications as effective as twice a day?
PETER JENSEN, MD: In the last year, we've actually had several medications come to market. That the child can take once daily. And this avoids going to the nurse or the teacher's office for medication at mid-day.
This is a very good thing for the children, because these medicines are just as effective as taking the multiple doses. And -- but it avoids some of the shame or the embarrassment or the stigma -- or losing your place in the lunch line, these things are important for kids -- that you have to face sometimes with the two or three times daily medicines.
LISA CLARK: Is once-a-day medication more costly?
PETER JENSEN, MD: It can be slightly more costly, but in actual fact, I think the prices are coming down in some of these medicines. And it's a good alternative for parents to explore.
LISA CLARK: What about side effects? Is there a difference between once-a-day or twice-a-day medication?
PETER JENSEN, MD: What we know about the side effects of the once-a-day medicines versus twice or three times daily is that they're actually the same or even less. So you don't have the peaks and valleys or the ups and downs of several doses, when you take the once-daily medicine, so sometimes parents notice the child might be cranky or irritable at the end of the dose.
You get rid of some of those problems, and parents actually in general prefer -- and can tell the difference in the child's behavior -- between the once-daily and the several-times-daily medicines.
LISA CLARK: Now, some parents like to give their children a drug holiday during vacations or on weekends. Do you think that's advisable?
PETER JENSEN, MD: Drug holidays can be useful, if the child is really doing well without medicine. So, in other words, if the child is happy, has good peer relationships, is doing well in soccer or ballet or whatever he or she's doing on the weekends, medicine may not be necessary.
LISA CLARK: Doctor, let's talk about behavior therapy. How can that help?
PETER JENSEN, MD: Well, the behavior therapy helps the child begin to take more active responsibility for his or her behavior. So if the child is being reinforced or assisted with appropriate kinds of rewards for staying on task, minding the teacher, playing well with peers, the child becomes more aware and more conscious of those behaviors. And when the medicine is wearing off -- or other periods where the medicine isn't being given -- the child has, then, the opportunity to actively work on those behaviors.
What we tend to think is it's the combination of the medicine with the behavior therapies that for many children is the most effective way to go.
LISA CLARK: What specific sorts of things are we talking about in terms of behavior therapy?
PETER JENSEN, MD: It's a very special form of therapy that can be done at home, at school or on the playground. And it entails giving the child rewards or consequences for the kinds of behaviors that the teacher or the parent or whoever agree should be identified and the child should be encouraged to show or not show in that setting.
So it comes down to what behaviors at school? If it's out-of-seat behavior, that's the behavior. If it's talking out of turn, that's the behavior. If it's running around wildly on the playground, if that's the biggest problem, then that becomes the behavior. And so it's different for every child. It might be dipping Sally's pigtails into the inkwell. You know, so it just really depends on the child's behavior.
LISA CLARK: How important is consistency and adherence to all of these treatment techniques?
PETER JENSEN, MD: Consistency is absolutely important. And so it's very important that the medicines be done at a regular time in a regular way. It's very important that the behavior therapies, when you use them, you really use them. You don't want to set up a reward system and then kind of become a softie and say, "Aw, heck, I'm going to give you this little treat or the extra TV time --" or what other reward might be anyway.
That's actually the worst way to implement a behavior therapy program, because it teaches the child that you can misbehave and they still got the reward, because the parent just couldn't bear in their heart of hearts to withhold it from the child.
LISA CLARK: Doctor, I know parents might wonder, is it possible for children with ADHD to have the same level of academic success as children who don't have ADHD?
PETER JENSEN, MD: Oh, absolutely. Children who are effectively treated can do very well. And, again, I think the goal that we have to have for these children is not doing a little bit better, but what we like to call "full normalization." They can be just as successful, just as happy, just as well-liked as many of their classmates, as all of their classmates. So it depends on the skills and the talents of the child, it also means effective treatment and putting them all together.
LISA CLARK: Finally, doctor, if you had one message about managing ADHD through treatment during the school year, what would that be?
PETER JENSEN, MD: Well, what I'd tell parents -- and doctors as well -- is don't settle for too little. Understand that the children can do very well. Sometimes what we see happening is that the doctor or the parent, they'll be so afraid of the medicine, they'll underdose. Or they won't give it at times when the child really could help.
And so Johnny -- who might be a little bit of a pain in the neck -- gets a little bit of medicine. And so he's still kind of a pain in the neck. He's half a pain in the neck. And that's -- that means that he's going to be half of the pain in the neck feedback from his teachers, from his friends.
And so if you don't give the treatments as fully as you might, children won't do as well as they possibly can. So don't settle for less than you have to.
LISA CLARK: Dr. Jensen, thank you so much for joining us. We really appreciate you're being here. And we also appreciate you joining us for this webcast. I'm Lisa Clark.
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