Author Archives: Sheila Woods

Update on ADHD Medications

Update on ADHD Medications

Sheila Woods MD, FAAP – SCAAP ADHD Liaison

Newer ADHD medications have arrived and will continue to arrive improving our choices of ADHD medications for children, adolescents, and adults.  The Neos Therapeutics, makers of Adzenys XR-ODT and Cotempla XR- ODT offer savings cards regardless of a patient’s insurance approval or co-pay.  First month is free and each month thereafter is $25.  Shire offers savings cards on Vyvanse as well as Mydayis.  Rhodes offers a savings card for Aptensio XR.  

Remember, that acidifying agents such as ascorbic acid, Vitamin C, in multivitamins and orange and other citrus juices will decrease the blood levels of amphetamines and methylphenidates.

Also alkalinizing agents such as antacids will increase the blood levels of amphetamines and methylphenidates. 

Amphetamines and Methylphenidates block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extra neuronal space thus improving dopamine and norepinephrine levels. Low levels can cause hyperactivity, inattention, and impulsivity.

Newer Long Acting Amphetamines: 

Vyvanse chewables (strawberry flavor) are the same product as Vyvanse capsules. Lisdexamfetamine is a long acting amphetamine usually lasting around 10-12 hours and is now available in chewables of 10 mg, 20 mg, 30 mg, 40 mg, 50 mg, and 60 mg doses.  Approved for ages 6 and up. (Shire)

Dyanavel XR is a long acting amphetamine product with a ratio of 3.2 dextroamphetamine to 1 levoamphetamine in a liquid that is bubblegum flavored and 2.5 mg per 1 ml.  This product provides a smoother onset and smooth distribution of medication throughout the 12 hour duration.  Starting dose is 2 ml and titration is 1 ml every 4-7 days as needed.  Approved for ages 6-17 years. (Tris)

Adzenys XR-ODT is a long acting amphetamine product comparable to Adderall XR except it is NOT a mixed amphetamine salt.  The salt is dissolved in solution and the remaining amphetamine micro particles are embedded in an orally dissolving orange flavored tablet.  This product has a rapid and smooth onset (no gut clinch as with older amphetamine products), smooth offset, and is consistent throughout the 8-10 hour day.  50% of the 3 to 1 ratio of d to l amphetamine micro particles are immediate release and 50% are extended release in dosages of 3.1 mg (5 mg of Adderall XR), 6.3 mg (10 mg of XR), 9.4 mg (15 mg of XR), 12.5 mg (20 mg of XR), 15.7 mg (25 mg of XR) and 18.8 mg (30 mg of XR). Approved for ages 6 and up. (Neos)

 

 

Mydayis is a long acting amphetamine and contains equal amounts of four salts: dextroamphetamine sulfate, amphetamine sulfate, dextroamphetamine saccharate, and amphetamine aspartate monohydrate resulting in a 3:1 mixture of d to l amphetamine equivalent.  Capsules contain immediate release beads, and 2 types of extended release beads. Capsules are available in 12.5 mg, 25 mg, 37.5 mg, and 50 mg and provide 14-16 hour coverage. Approved for ages 13 and up. (Shire)

Newer Long Acting Methylphenidates:

Cotempla XR-ODT is a long acting methylphenidate product with micro particles embedded in an orally dissolving grape flavored tablet.  Cotempla XR ODT contains 25% immediate release and 75% extended release methylphenidate.  Tablets are available in 8.6 mg (10 mg of ER MPH) , 17.3 mg (20 mg of ER MPH)  and 25.9 mg (30 mg of ER MPH) with combined doses of 2 of 17.3 mg = 34.6 mg (40 mg of ER MPH) and 2 of 25.9 = 51.8 mg (60 mg of ER MPH).    Cotempla XR ODT has very smooth and rapid onset and offset.  This product lasts a full 12 hours and is approved for ages 6 to 17. (Neos)

Aptensio XR is a long acting methylphenidate available in a capsule that can be opened and sprinkled.  It is available in 10 mg, 15 mg, 20 mg, 30 mg, 40 mg 50 mg, and 60 mg capsules.  Aptensio XR lasts 12 hours and seems to have about the same onset and offset as Concerta. Approved for ages 6 and up.  (Rhodes)

If you have any questions regarding ADHD medications, please feel free to give me a call at Greenville ADHD Specialists, 864-305-1662.

This article was recently published in The South Carolina Chapter of the American Academy of Pediatrics (SCAAP) Winter newsletter. http://www.scaap.org/

Is Your Child Explosive?

Is Your Child Explosive?

portrait-317041_1920Often I see children who explode over what parents and teachers consider small things. It is common in children with ADHD because these children have difficulty with regulating their own emotional responses. Anger, irritability, screaming, frustration, crying, sadness all seem to occur in a nano-second if something does not go their way. This also occurs if something is requested from them, something is changed in the plans for the moment or day, and/or some rule is broken by others or by themselves. There are many triggers and these are only a few.

If we take a step back and examine why these emotions are so close to the surface, we may be able to help your child learn better control. Most often, an explosion occurs when a child does not know what to say or do and does not have the set of skills required to handle the situation.

As an example, imagine an elementary school classroom with a wonderful teacher and a student John.

John is asked by his teacher to put his math paper away since the class will be moving on to work on spelling words. John is not finished with his math assignment and this happens frequently for John since he works at a slower pace due to his ADHD (he is NOT slow due to lack of intelligence). He feels like a loser, like he is dumb because he cannot finish work in class and he is very tired of taking work home as homework! This situation may result in any of the following: John crying and shutting down, John refusing to put the math paper away, John angrily refusing with words like “I’d be better off dead” “You think I am dumb anyway” or John making threats like “I’m going to stick my scissors into Jane” (who just happens to be sitting next to John on this day).

What are the factors involved and what does John need in order to better cooperate?

John has difficulty transitioning just like many kids with ADHD. Their mind, when focused, is sometimes “hyper” focused. This explains why some kids can spend hours and hours playing video games (hyper focused on something they like) but cannot focus on things that are not interesting to them. For John, he loves math and he wants to finish his math work. In addition, he rarely finishes his class work since he works at a slower pace. It seems that children with ADHD either rush to finish and make careless mistakes or are perfectionistic and fail to finish. John is the latter. By the way this has nothing to do with intelligence, in fact, most ADHD children are very smart!

So some of the factors leading to John’s explosive reactions are:

  • Working at a slower pace due to ADHD
  • Feeling like a loser since he rarely finishes work in class
  • Difficulty transitioning from something he likes to anything else
  • Intense frustration

What does John need in this scenario to help him better cooperate?

  • John needs advance notice that he will need to put his math paper away. For example, the teacher could have a private signal with John such as a touch on the shoulder to let him know that he has 5 minutes left, then 1 minute left, and then signal him to look up and listen when she announces the request to the entire class.
  • John may need certain accommodations that allow incomplete papers to be finished at school or not at all. Kids (of all ages) need downtime and play time after school. John could easily spend his entire evening struggling to finish work that his classmates finished in class. This adds to John’s frustration.
  • John needs to know that he can leave the classroom if he feels very overwhelmed. Having a predetermined place, usually a counselor’s office, where John may take a break will allow him to calm down and allow the class to not be disrupted. Counselors can be helpful in teaching John the skills he needs to handle frustration.
  • John needs to learn skills of self-calming such as taking deep breaths, counting in his head to 5 or 10, focusing on a focal point (can be anything) that takes his mind away from his frustrations in the moment.
  • It takes time for these efforts to help John reduce his outbursts and feel more confident so patience is essential!

All of these efforts between teacher, counselor, John, and his parents will help John avoid losing emotional control and exploding in the classroom.

Often just realizing that your child “wants to be good” but sometimes does not have the skills to regulate emotions, is a start to problem solving. Being patient, having a teacher who understands, and having help from other school personnel can all be very important.

Also, when your child has lost control, please understand that continuing to threaten consequences, continuing to demand a certain action or behavior, continuing to scream louder than your child will just lead to prolonged explosion. A child in the middle of an explosion cannot hear you since their frustration is so intense. Your child needs a safe place where he/she can calm down. If you want to discuss the explosion and what behaviors you would rather see, then wait until the storm has passed and calmly and quietly speak with your child.

If you have questions, please give us a call at 864-305-1662

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Homework Help for Kids with ADHD and their Parents

Homework Help for Kids with ADHD and their Parents

Homework help for kids with adhdOften, homework for kids with ADHD becomes an intense battle with children getting very frustrated and parents becoming even more frustrated! It does help for your child to begin homework as soon after school as possible after a 15-20 minute break for snack, running around, bathroom, etc. If your child is on medication, it will likely still be effective immediately after school but the longer you wait the less effective the medication will be in helping your child stay motivated, focused, and able to complete homework.

Some ideas that help include:

  1. Pick a place in the home best suited for homework. Flat surface, cleared of clutter, and relatively quiet if possible. Name this spot like “John’s Launch Pad”.
  1. Turn off TV, computer, video games, music, and other distractors before starting homework.
  1. Put items needed to complete homework in a clear plastic container or bag and label them “John’s Launch Tools”. These items include pencils, erasers, crayons/markers, ruler, dictionary, and other items needed to complete homework.
  1. Develop a color-coded binder with a pocket for “Assignments”, a pocket for “Completed assignments”, and a pocket for “Notes”. Notes are for messages from the teacher to you or from you to the teacher. Continue your theme with labels such as “Satellite Transmissions”. Be sure that this binder travels to and from school with your student every day by placing it in the same place close to the door. The Assignments pocket may carry the agenda or planner that your child uses.
  1. Remembering to write down assignments and turn in assignments takes PRACTICE. At home, have your student practice keeping a calendar, one week at a time for example, in preparation for keeping an agenda at school with daily assignments, dates of tests, and other important dates.
  1. Set a timer for homework breaks every 10 minutes. The break should be for 2 minutes and your child can run around during break. Start helping your child estimate the length of time needed to complete certain homework so that you will not always have to supervise homework and your child can learn to manage their own timer.

If you need help with your own or your child’s ADHD then call us at: 864-305-1662

Accommodations In School For ADHD?

Accommodations in School for ADHD?accommodations for ADHD in schools

Do you receive calls and or notes from teachers about your child?

Does your student receive zeros for work not completed or not turned in?

 

  • Poor attention, impulsivity, and distractibility coupled with difficulty remembering to write down assignments and remembering to turn in assignments are very COMMON in ADHD
  • All children with the diagnosis of ADHD are eligible for accommodations in school up through college. You must advocate for your student to receive accommodations.
  • Plan 504 is the public school document listing accommodations agreed upon by school officials and parents.
  • IEP, Individual Education Plan, is typically used for students with learning issues such as reading disorder and others, and may also include accommodations for ADHD. Students must have testing demonstrating learning disabilities and/or speech difficulties.

Process to establish ACCOMMODATIONS:

  • Parents must request a meeting with school officials. School counselor, teachers and sometimes administration officials will attend.
  • You will need to have medical documentation of the diagnosis of ADHD.
  • At this meeting, you and the school will decide what accommodations may be helpful for your student.

Suggestions for accommodations

  1. Cues from teachers to stay on task by either nonverbal, verbal or physical signals
  2. Place the student in the classroom where distractions will be minimized
  3. Reinforce positive attentive behaviors with praise, positive reinforcements
  4. Allow fidget buddies to keep hands occupied when students should be listening
  5. Request a peer who assists with note taking and writing down/turning in assignments
  6. Request teacher to “chunk” assignments-giving smaller amounts of work at one time
  7. Allow student to take tests in an environment with less distraction
  8. Allow extended time for tests and exams including standardized testing
  9. Provide the student and or parent a copy of notes, assignments, and study guides
  10. Frequent feedback and communication between parent, student, and teacher

If there are associated learning disabilities that have been diagnosed by psycho-educational testing through the school or through private psychological services, your student may qualify for an IEP, individualized educational plan.  IEP’s also provide classroom accommodations if needed.

If you need help with your own or your child’s ADHD then call us at: 864-305-1662

 

Emotional Rollercoaster of ADHD

Emotional Rollercoaster of ADHD

 

Do you and your child feel as if you never know what emotion will come next?

Do not worry.  You are not alone. Childhood ADHD Emotional Rollercoaster

Frequently children’s meltdowns will improve with medication treatment of ADHD, however, having difficulty regulating emotional responses may still cause distress to you and your child.

We have medications to address the inattention, hyperactivity, and impulsivity of ADHD but emotional issues are another story.

> 30% of adolescents and adults with ADHD list their emotional instability as the most impairing aspect of their ADHD

Some of the common expressions of the emotional rollercoaster:

  • Flash temper
  • Low frustration tolerance
  • Being easily overwhelmed by emotions
  • Feeling the pain of others, but also can be unaware of the emotions of others
  • Exquisite sensitivity to rejection and criticism
  • Feelings of hopelessness

The ADHD brain has a hard time regulating emotion because it struggles to distinguish between dangerous threats and minor problems.

This leads to:

  • Panic over relatively small challenges
  • Hyperarousal and hypervigilance
  • Lack of feeling at peace
  • Mind feeling as if it is going 100 mph until exhaustion

A child with ADHD hears 20,000 additional critical or corrective messages before his/her twelfth birthday and therefore:

  • Most grow up with the feeling that they are uncool, unwanted, defective, and incompetent
  • People with ADHD are “the last picked and first picked on”
  • The resulting shame and guilt often negate positive feedback and the formation of a positive self-image

Sometimes the negative self-image also includes:

  • An extreme emotional sensitivity and emotional pain triggered by feeling: – rejected – teased – criticized – and having disappointed important people in their lives
  • If this emotional response is internalized, it looks like major depression.
  • If the response is externalized, it manifests as a rage at the person or situation that wounded them
  • 50% of people who are court-mandated for anger management treatment have previously unrecognized ADHD

So if this describes you or your child, what should you do?

  • Please speak with your doctor about your concerns
  • Options to help with the emotional rollercoaster are available
    • non-medication options
    • medication options
  • Recognize that parenting a child with ADHD is challenging and especially challenging if that child has significant emotional distress

Parenting Tips

  • Remember to really LOOK for the positives and give compliments on good behaviors whenever possible-CATCH YOUR CHILD BEING GOOD
    • For example, compliment your child on not crying if you say no to a request
    • Or tell your child thank you for not fighting with their sibling for the last 10 minutes
    • Or tell your child you are proud of their coloring, writing, completing a homework assignment etc.
  • Children who have negative self-images will find it hard to accept compliments but will eventually believe that you “mean it” if you continue to find positives and give honest compliments for behaviors that you value
    • Children will seek attention whether it is for good or bad behaviors
    • If you give more attention to good behaviors, then more good behaviors will occur
    • If you give more attention to bad behaviors, then more bad behaviors will occur
  • When your child escalates the drama and continues to push your buttons, show your child how to “not fight”, “remain calm”, and “walk away” (You can do this!! But it is really hard)
    • Try not to “engage” with your child when your child is angry, yelling, and in the middle of a tantrum. They cannot hear you anyway.
    • Give yourself and your child a “time-out” to calm down
    • When you and your child are both calm, revisit the issue in a rational way with a quiet voice

If you need help with your own or your child’s ADHD then call us at: 864-305-1662