Back to school means different
things to different parents. For most, it's a matter of
cruising the malls to spruce up the kids' wardrobe and
combing the stationers for reams of school supplies. But
for parents of kids with attention deficit hyperactivity
disorder (ADHD), the end of August can also be the end
of the drug holiday.
DOG
DAYS FOR ADHD
Dr Marshall Korenblum, Psychiatrist in Chief at the
Hincks-Dellcrest Centre for Children in Toronto and
Associate Professor in the Department of Psychiatry
at the University of Toronto, is booked solid from mid-August
onward, seeing children ready to get back on the meds
before school starts. In summer, most kids lead a fairly
unstructured life � they don't need to sit still or
pay attention like they do in class. They don't need
the same degree of control over their attention," says
Dr Korenblum. "I feel strongly about recommending a
drug holiday unless there's some compelling reason not
to." Since most of the drugs prescribed for ADHD cause
a degree of appetite and growth suppression, Dr Korenblum
thinks it's important to allow appetite and growth to
resume and catch up over the summer.
He notices parental anxiety starting
to rise in the first weeks of August as they anticipate
the return to school. Some of the more savvy consumers
among them use the summer to experiment with newer slow-release
or long-acting formulations. The hottest newcomers are
Concerta and just-approved Adderall.
Learning
curve
For their physicians, back-to-school also means forging
new relationships with teachers and school support staff
and encouraging them to participate in monitoring the
child's response to medication. "My ideal plan of care
would include two-way communication between physician
and parent, physician and school, and school and parent,"
says Dr Korenblum.
Brian Elecker, a special education
consultant for the Toronto District School Board, thinks
this is a great idea, but says sometimes it's tough
to get parents to agree to let the school and physician
speak directly.
Dr Korenblum relies on teachers
to complete rating scales, especially in the first months
of school, to ensure that the child is responding well
to the dosage prescribed. "Back from the summer, you
want to use the teacher's input as the baseline, and
then repeat the rating scale in a few months," he says.
This may be especially important if the medication has
been changed over the summer.
Mr Elecker is adamant that teachers
shouldn't try to judge whether or not to medicate. "You
might find a teacher who says in frustration "Maybe
your child should be on medication,'" he says, "but
that's definitely not professional conduct." On the
other hand, Dr Korenblum notes that teacher/doctor cooperation
can be a great way of opening the door to alternative
or additional non-medication therapies for children
with ADHD.
|
