Author Archives: Sheila Woods

Anxiety 101 for parents

Anxiety is a normal response to stressful events such as tests or friend drama

Anxiety disorders arise when the anxiety is out-of-proportion to the situation and impairs daily functioning

If anxiety impairs functioning, then it is important to recognize and seek treatment. First line treatment is usually Cognitive Behavior Therapy through a trained therapist/counselor

Symptoms include overwhelming worry, difficulty tolerating uncertainty, an overactive response to fears and avoidance of situations

Some children react with explosive fear and others react by shutting down emotionally

Children with anxiety disorders often avoid situations that may trigger anxiety

What can you do to help?

Explain that anxiety is a normal part of life and learning to identify and respond to anxiety thoughts can really be helpful

  1. Model positive coping skills in your own everyday anxiety provoking events
  1. Remain calm and carry on
  2. Reframe (change) your own thoughts to recognize that you can work through the anxiety
  3. Make positive comments such as “I know this is stressful, but I can handle this”
  4. Avoid negative comments like “I’ll never get through this”
  5. If you think/say that you cannot handle everyday events, your child will quickly think the same about themselves
  1. Help your childidentify the anxiety provoking thoughts he/she may have and show them how to reframe (change) their own thoughts
  1. It is okay to validate fears by asking your child what makes them afraid
  2. For a simple example, if a child is afraid of the dark at bedtime
  • Turn on the light, look under beds, in closets to show there is nothing to fear
  • Turn off the light, lie with your child, point out shadows that are stuffed animals, furniture, etc.
  • Turn on the light and point out the items that caused the shadows
  • Repeat this process as many times as necessary for the child to gain confidence that the frightening shadows are really not frightening at all
  1. You are showing the child that he/she can think through the fear using logic
  2. And that he/she is in control of their own thoughts
  • I can be afraid but face the fear and make it go away
  • I am not in danger
  • I can be strong/brave
  1. What not to do
  • Do not say or think: “He probably won’t hold up if I don’t help him”
  • “I have to save her from this awful feeling”

There are many types of anxiety in children and adolescents:

  • Separation anxiety: When children are worried about being separated from caregivers
  • Social anxiety: When children are excessively self-conscious around others or in groups
  • Selective mutism: When children cannot speak in some settings, like at school
  • Generalized anxiety: When children worry about a wide variety of everyday things. Kids with generalized anxiety often struggle with perfectionism
  • Specific phobias: When children have excessive fear of particular things. This includes arachnophobia, fear of spiders, or school phobia, refusing to go to school
  • Panic disorder: When children have sudden, unpredictable panic attacks that may cause feelings of impending death or doom and symptoms of rapid heartbeat, difficulty catching their breath, and sweating
  • Obsessive-compulsive disorder (OCD): When children have unwanted thoughts that feel stuck in their minds and they try to neutralize the thoughts with ritualized behaviors such as touching the light switch 3 times or counting steps
  • Post-Traumatic Stress disorder (PTSD): When children have symptoms after a disturbing event such as difficulty sleeping, nightmares, irritability, and flashbacks or reliving the event

Does your preschooler have ADHD?

All preschoolers are naturally active, impulsive, oppositional, sometimes defiant, and impatient. ADHD is a neurodevelopmental disorder, so how can you tell if your child’s behavior is typical or outside the range of typical development?

1. How Often Are You Getting Calls from Preschool?
Are you getting calls about your child’s behavior a couple of times a month? Or is it multiple times a week? Typical preschoolers push boundaries and may get in trouble occasionally. However, preschoolers with ADHD are more disruptive and get into things they shouldn’t much more often than their peers. Preschool teachers are concerned because they frequently can’t sit in one place and have problems with impulse control.

2. How is Your Child Doing with Circle Time?
Preschoolers with ADHD often have difficulty with circle time. The teacher is interacting with the whole class and not directly with your child. Kids with ADHD have difficulty in these settings and their attention wanders. They do much better with one-on-one learning situations in which they get immediate feedback.

3. Can Your Child Follow One or Two-Step Directions Without Getting Distracted?
Preschoolers should be able to follow one- and two-step directions, such as, “Hang up your coat and put your shoes away.” Sure, there are some “typical” preschoolers who won’t follow instructions because they’re feeling defiant. But kids with ADHD often have more problems with working memory than other children. They may want to do what you’ve asked, and may begin to attempt it, but get distracted by something else.

4. Does Your Child “Dart”?
Kids with ADHD will frequently “dart.” They’re flight risks. They’re supposed to be in line at school, moving from class to recess, but go in another direction or “dart” in a parking lot or store. This could be an indicator of your child’s distractibility and impulsivity.

5. Do You Avoid Taking Your Child Out in Public, Even to Casual, Family-Friendly Places?
Children with ADHD can’t sit still and will frequently run off and get into things. This can become so problematic that parents avoid taking them to family-friendly restaurants. Some refrain from short trips to the store because of this problem.

6. Could Your Child Have Another Health Condition?

For example, some behaviors are due to other issues but look like ADHD.

A) Difficulty Hearing can lead to not seeming to listen when spoken to directly

B) Language or Learning Issues can also lead to not seeming to listen or not following through on directions

C) Sleep Apnea or Poor Sleep can cause symptoms of hyperactivity and inattention. Preschoolers do not typically snore so if your child does, it could be a sign of sleep apnea

7. Have There Been Recent Acute Stressors for Your Child?
If you’re seeing an acute behavioral problem following a big family stressor, be patient and help your child deal with the stressor before considering ADHD. For example, a recent death in the family, an illness, a parental separation, or a new baby can all impact a child’s behavior negatively. Behavioral issues should be going on for six months or longer before we would consider ADHD as a possibility.

PUTTING IT ALL TOGETHER
Remember that children with ADHD are often:

  • More sensitive to environmental factors than other children
  • Tend to do better in one-on-one situations with adults rather than in a group
  • Act differently in the presence of an authority figure when rewards are present
  • Despite this day-to-day or moment-to-moment variability in behaviors, children with ADHD show ADHD-related behaviors in more than one setting. Not just at home or just at school, but in both.

As you’re answering the above questions and considering whether your child’s behavior is consistent with ADHD or not, think about how often the behavior is happening and how intense it is. When a child has ADHD, there is a long-standing, high frequency, chronic nature to the concerning behaviors. If this is the case for your child, it may be time to contact Greenville ADHD Specialists, P.A.

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