health & wellness >> on the cover

Helpful therapies vary, but diagnosis is key.

Ronelle Grier I Contributing Writer

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Because the condition carries over
into adulthood, men and women with
ADHD are frequently late, harried and
disorganized. Those who may be labeled
absent-minded, ditzy or scatterbrained
may actually have ADHD that has gone
undiagnosed since childhood.
Mann eventually left the teaching field
to become a parent educator, coach, con-
sultant and advocate for children and fam-
ilies struggling with ADHD and its rami-
fications. Through her practice, Academic
and Behavior Consultants in Sylvan Lake,
Mann helps parents develop strategies
and navigate through the maze of issues
involved in raising a child with ADHD.

The Missing H
While ADHD is the commonly used term,
many children are missing the "H" fac-
tor: They have the attention problems
but not the hyperactivity component. For
this reason, the number of children, espe-
cially girls, who have ADHD may actually
be higher than the CDC study showed
because girls often lack the hyperactivity
component, which makes the condition
harder to diagnose.
Mann said those kids who are not
hyperactive often fall under the radar at
school because they do not misbehave or
disrupt the classroom.
"These kids are the hardest to treat
because they often slip through the cracks:'
Mann said. "They may be considered lazy,
but they're not singled out because they're
causing trouble in the classroom:'

Mann and other experts agree it is
essential to get an accurate diagnosis
before an effective treatment plan can be
developed. However, this is often easier
said than done.
"It's not something you can take a blood
test for:' Mann said. "There are a lot of dis-
orders with self-regulation issues that look
like ADHD, such as Asperger's Syndrome,
anxiety and depression.
"Anxiety and depression can look like
defiance:' said Mann, adding that other
disorders, such as bipolar and even
Tourette's syndrome, can be present along
with ADHD. Behavior problems or inatten-
tiveness also can be caused by conditions
such as allergies or lack of sleep. "I always
advise parents to see a trained psychiatrist
to rule out other things:'

Medication Options
While there are varying opinions about
medicating children with ADHD, most
health care professionals agree that a thor-
ough medical evaluation should be done
before any medicine is prescribed.
ADHD medications can fall into two
basic categories: stimulants, such as Ritalin
and Adderall, and non-stimulants, such as
Stattera.
Dr. Randy Dean, a Bloomfield Hills-
based psychiatrist, said she evaluates
children based on a variety of factors,
which include medical history along with
observations of parents, teachers, tutors
and caregivers.
"It is a clinical diagnosis based on a con-
stellation of symptoms that pervade most

areas of life and have been present since
early childhood:' she said.
When it is determined that medication
is warranted and the parents are in agree-
ment, Dean said she prescribes it as part of
a multi-modal treatment plan that includes
other components such as therapy, coach-
ing, tutoring and behavioral plans.
Melissa A., a Birmingham parent who
asked to remain anonymous, tried a
variety of prescription drugs to help her
10-year-old son, Max (not his real name),
who was diagnosed with ADHD and anxi-
ety five years ago. She also tried over-the-
counter supplements and special diets, but
the results were inconsistent and hard to
track.
"There is no magic pill:' she said. "There
is a lot of stress, heartache and a constant
learning process"
After determining the stimulant drugs
were more effective, it took a process of
trial and error to find the right dosage.
Because Max could not swallow pills at the
time, his mother would crush the tablets
and sprinkle them on yogurt. Max got the
best results from a low dose of Adderall
XR, a time-release stimulant medication,
combined with the anti-depressant Zoloft
to address his anxiety. He also sees a thera-
pist and an academic tutor.
As a parent, you have a huge responsi-
bility to make everything work:' she said.

Parents' Role
Because parents play such a critical part
in creating and managing the child's home
life, Mann believes parent education

should be the first priority for families
dealing with ADHD.
"If parents change the environment
properly, the child will be more success-
fur she said, adding that new routines and
strategies should be research-based. "The
best behavior plans, at home and in school,
are consistent, positive and repetitive:'
Because there is a hereditary component
to ADHD, many parents have the condi-
tion themselves, making it difficult to
stay organized and maintain consistency
at home. Keeping accurate records about
medication, school progress and behavior
plans also is a challenge.
In addition to providing individual
coaching, Mann offers "Parenting Boot
Camp" classes that educate parents about
the disorder and provide strategies to
improve behavior and foster teamwork and
communication between home and school.

School Strategies
Mann encourages parents to be proactive
when it comes to dealing with their chil-
dren's school.
"The [educational] system is not well
versed in ADHD," she said. "Don't wait to
hear from the school; communicate with
them first. Send a letter before the first
day, and set up a meeting as soon as pos-
sible. Never assume:'
Mann said that punishment usually does
not work because ADHD is a neurobiologi-
cal disorder, and those who have it cannot
usually control its effects without the right

ADHD on page 62

April 25 • 2013

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