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Help Me Understand ADHD
Q: I wrote to you last week some time and I had explained to you about my stepdaughter and her being told that she is ADD. I also said that her mother has her on medicine and we were told that she only needs to take this when she is in school. I feel that we are not being told the whole story about this problem. When she is here, she is fine but she tends to act like a three-year-old and loves to get everyone in trouble. I feel that there is no way that the mother is helping her at all. I don't expect that you could answer all of your questions, but I would like some answers to my questions. It seems that no one wants to help us understand what to do or how to help in this matter. PLEASE, PLEASE, HELP US UNDERSTAND what is going on or suggest something that we can do for her here. She does not live with us and our only information is from the other children. We really need some sort of help to understand this problem.
A: You're right that we can't respond to all of the questions that come in, but we do try to answer those that may be of interest to many parents and teachers. You raise several important issues in your question. First of all, there's the question of who gets the information and who is able to take action when a stepfamily is part of the picture. You may want to ask your stepdaughter's mom if you can talk directly to the doctor, who prescribed the medication, so that you can get the information directly from the source. This is especially important if your stepdaughter lives with you some of the time, and you are responsible for administering or monitoring her medication. If you don't have legal permission to do this, I would suggest going to a website specializing in issues related to ADHD and learn as much as you can on your own about the condition and its treatment.
You didn't say what kind of medication your stepdaughter was taking. I will presume that it's Ritalin®, since that's the medication most commonly prescribed for ADHD. You should be aware that some children take the first dose of their medication in the morning before they go to school so that it takes effect before school starts. This is especially important for children who need the medication to help them control the impulsive behavior that can get them in trouble even before school starts. Some children who do OK on a long bus ride to school may wait to take the medication (from the school nurse) when they get into the building.
Most children take at least two doses of Ritalin® during the day (which means they would get the second dose about midday), unless they take the extended-release form of the medication, which is supposed to last over a longer period of time. Whether or not kids take medication at night or on the weekend depends a lot on how effective it is at those times. Many children who have a hard time focusing on homework take another dose of medication shortly after they get home from school. Most doctors recommend that children also take the medication on the weekends and in the summer, mainly because the symptoms do not go away when school is out. This is especially important if children have lots of homework on the weekends or if they are involved in activities such as sports, scouts, or camps. These are activities that require organized thinking and behavior that is not impulsive. A lot of academic and social gains made during the week can be undone during a weekend filled with disorganization and chaos.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.