Medicine, tutoring help

This is the third article in a four-part series on Attention Deficit Hyperactivity Disorder.

By Cortney L. Hill, Salisbury Post

Medication and education are two of the biggest worries for parents of children with Attention Deficit Hyperactivity Disorder (ADHD).

Once a child has been diagnosed with ADHD, doctors must determine a course of treatment, and teachers must come up with the best way to help those students excel in school.

"Nearly 85 percent of (ADHD) children treated with medication respond positively,"said Dr. Jill Aiken, a pediatrician with Salisbury Pediatric Associates, in Rowan Regional's Medical Center's Healthy Living magazine.

"When you think about it," she continues, "it's phenomenal."

Dr. Wayne Koontz, also with Salisbury Pediatric Associates, says the medication helps more than it hurts.

Koontz, 64, discovered he was ADHD when his daughter was diagnosed while in college.

"The drugs won't change their personality, but we do get better behavior and it does help them to learn better," Koontz said.

Beatrice Hair, founder, owner and director of the Salisbury Tutoring Academy, is working on a study that proves adults who were medicated as children will have less symptoms (of ADHD).

"Many parents have the option whether or not to put their children on medications," said Hair. "But when I compare the students not on medication to the ones who are on medication, my records show that the ones on it are doing significantly better."

How the drugs help

"To understand how the drugs will work, one must understand how the chemical imbalances in the brain occur," Koontz said.

ADHD appears related to two neurotransmitters: dopamine and norepinephrine.

Neurotransmitters are used by the brain to stimulate or repress stimulation in brain cells.

"To pay proper attention, the brain must be adequately stimulated," said Koontz. "To have proper control of impulses, areas of the brain must be adequately controlled, repressed or slowed down."

In ADHD children, systems of stimulation and repression are not working correctly.

Inattention and distractibility appear to be related to low levels of norepinephrine. Such levels make it very difficult for ADHD children/adults to sustain their focus on a task, plan ahead and understand such concepts as sequence and time.

The impulse and behavior problems found in ADHD appear related to low levels of dopamine in the brain.

When dopamine levels are normal, the urge to do or say something in public, grab something interesting on a desk, or blurt out opinions can be controlled.

Medications that alter levels of dopamine and norepinephrine are effective in treating ADHD.

"Before medications are given, a diagnosis must first be done," said Koontz who has treated ADHDpatients for over 30 years, hundreds of ADHDchildren each year.

Koontz and other pediatricians follow guidelines set out in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

"The reason we use the criteria we have now is we want everybody to be on the same page,"he said. "Everybody should make the diagnosis the same way."

Before a doctor can diagnose ADHD, the patient should have at least six of the specific characteristics listed for inattention, hyperactivity and impulsivity for at least six months.

"I'm not a doctor out to medicate these children just because," said Koontz. "The child must be evaluated by the teachers, a psychiatrist, then by the doctor. The medication is usually the last thing that's discussed."

Ultimately, the decision rests with the parents.

"If the parents want to get away from medications, there are other options that can be done," Koontz said. "But with the drugs, the parent can determine how much medication the child gets or how much they need."

What the drugs do

The three stimulant medicines prescribed most often to ADHDpatients are Ritalin, Dexadrine and Adderall.

Though they all act similarly, children will not get the same results from them all.

Ritalin comes in a short-acting tablet form that begins to work within 15 to 20 minutes and lasts between three and five hours.

Possible short-term side effects are loss of appetite, trouble sleeping, headaches, stomach pain and weight loss.

Dexadrine and Adderall are slightly slower-releasing medications that may be effective for five to eight hours.

In August 2000, the U.S. Food and Drug Administration approved a long-acting form of Ritalin, Concerta.

Concerta goes slowly in the blood and is slow to taper off,Koontz said. "It needs to be only taken once a day and is effective for 10 to 12 hours." One of its major side effects is loss of appetite.

Then there's Strattera, the first non-stimulant prescription medication approved by the FDA for treatment of ADHD. It is said to help more with regulating attention, impulsivity and activity levels.

"Many parents often wonder about their kids getting addicted to Ritalin," Koontz said. "But because these children lack Dopamine, they won't get high. Plus taking it by mouth makes it impossible to get high, too."

Koontz said that statistics show that children who do not take medications to treat their ADHD are more likely to become addicted to drugs than those already taking it.

"Them taking Ritalin or any other stimulant now will lessen the chance of their addiction," Koontz said. "The medicines will not only help them perform better in school, but keep them off the streets."

Medicate to better educate

Hair, owner of the 8-year-old Salisbury Tutoring Academy, is doing a 20-year study to prove that adults who were diagnosed as ADHDand medicated as children will have fewer symptoms.

She surveys the children enrolled in her school and their parents. They answer several questions with some pertaining to whether the child feels disorganized, hyperactive, impulsive or has trouble with learning.

Each parent must decide whether it occurs "somewhat," "usually," or "all the time."

The children are then put in to four groups: Ritalin/Concerta, ADHD/Non-Meds, Adderall, and Not ADHD/No Meds.

She takes all of the information and follows each child's progress.

"In my two years of study, I am finding that the medicated children have higher self-esteem, and are doing better than the non-medicated," Hair said.

This study will be her dissertation for her Research Methods class for the University of Phoenix On-line campus.

"No one in the United States has ever done a 20-year study on this before," said Hair, who is her second year of the study. "This takes a tremendous amount of time and risks, but Ibelieve it's going to be successful."

Hair believes that non-medicated ADHDstudents suffer from symptoms both long-term and short-term.

"I know this for a fact because Ihave seen the non-medicated kids struggle in their studies, while the medicated ones soar," she said.

"I just see too many students with the potential to succeed fail because they are not taking anything."

Hair's 7th grade student, Sam Shore, is diagnosed as ADD and is medicated. When he was in the third grade, he was neither diagnosed nor medicated, and Hair saw all the signs of an ADDchild.

"When Sam was in the third grade, he scored 82 percent on his reading and 84 percent on his math on the state's End of Grade testing,"said Hair. "He was a point away from being in the gifted program. And to help him get there, I suggested to his parents he be taken to a doctor and diagnosed."

His parents declined, and took him out of the tutoring academy.

By the end of the fourth grade, Sam's scores dropped to 53 percent.

"I was so upset, Ihad to walk out of the room when they told me,"Hair said. "But that was when they decided to go ahead and get him diagnosed and on medication."

"He was really upset and became frustrated and unhappy,"said the boy's mother, Kim Shore. "Now he's on medication and is doing much better."

Today, Sam is in the gifted program at Southeast Middle.

Shore's other child, Leah, is 8-years-old and ADHD. She gets tutored at the Academy.

Her mother did not want to risk her grades dropping like Sam's did,Hair said. "So when she began showing signs of ADHD, she did not hesitate to get her diagnosed and on medication."

"Discipline and spanking never helped this child, she was always bouncing off the wall," said Shore about her hyperactive little girl. "Dealing with her takes lots of prayer, lots of patience, lots of family support and lots of hair color ..."

Though improvement has been slow, Shore said the medication has helped.

"She's easier to deal with at school, at home, and she gets along better with her siblings," she said.

Leah, a third grader at Faith Elementary School, has been taking Adderall since kindergarten. She takes two pills twice a day.

Rosa Wilson, Leah's tutor at the Academy, has been tutoring her for two years.

"Before, Leah did not want to do her reading, and she didn't concentrate well," she said. "Now I see improvement in her confidence, reading skills, and her math has improved."

Leah is tutored for two hours once a week.

"Ilike coming here (to the academy), and seeing Mrs. Wilson," she said. "But when it's time to go, I'm sad."

Because Leah is severely ADHD, Hair said that Leah is going to struggle with her studies.

"But she will be successful, and she improves everyday,"she said.

Heather Morrison's parents waited six years before they put her on medication.

"And Iregret I did that because she probably wouldn't have gotten so far behind," said her dad, Donnie Morrison.

Heather, a tenth grader at North Hills Christian Academy and student at the tutoring academy, was diagnosed with mild ADDin the second grade, but wasn't medicated until the sixth grade.

"I remember having trouble concentrating, and Iused to daydream a lot," Heather said.

Her mother said that teachers never really caught her daydreaming, "because she would be looking right at you, but looking through you at the same time."

The Morrisons waited to put her on medication because they were afraid.

"We just didn't know what to expect and were just skeptical about it,"said her dad. "But now, she gets her homework done faster, she's able to pay more attention, and she's very active in school."

Now Heather talks about college.

"I want to go to East Carolina and become an underwater archaeologist," Heather said. "Reason being because it incorporates all of my hobbies: swimming, history, science, and digging."

Donna Ginn, mother of 6-year-old Hannah Ginn, feels her daughter isn't up to par with the other children in her class.

Hannah has not been diagnosed with any disorder, nor is she taking medicine.

"Her teachers told me she was a little behind the rest of the class when it came to doing activities or working on spelling,"Ginn said.

"I've had her tested for ADDbut the doctors didn't know if it was ADDor just immaturity,"she said. "I'm just unsure, so I'm choosing to wait a couple of years before putting her on medications."

Ginn was the only parent with the Academy who chose not to medicate her child to volunteer to speak about her situation. "The other parents of non-medicated children declined to comment," Hair said.

Hair's school tutors ADHDchildren from five surrounding counties.

She has been awarded local and national awards for excellence with ADHD. "I know that my study will be proven correct," she said. "And if the medication will help the child learn better, have higher self-esteem, and help relieve his or her symptoms, Ireally think everyone will win.

"But you can't just depend on the medicines alone, you have to involve family support, doctor support and school support," she said. "Never do medication without behavior modification. Now that you've gotten their attention, show them how to study, be organized, show them how to do it right."

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Want to have your child tested for ADHD? Contact Salisbury Pediatric Associates, 129 Woodson St., at 704-636-5576.

For more information about the Salisbury Tutoring Academy, 818 Corporate Circle, call 704-633-8207.

Contact Cortney L. Hill at 704-797-4249 or chill@salisburypost.com

Coming Tuesday in the final piece on Attention Deficit Hyperactivity Disorder, will be the first day of the ADHD camp at Dan Nicholas Park.