June 20, 2023
Cindy Lopez:
Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen. As we know, ADHD is a brain-based disorder that leads to differences in attention, impulsivity, energy, and behavior. And all of this can be very disruptive to a child’s school and learning experience, as well as their social emotional health. So while there’s no cure for ADHD, there are treatments available to reduce the impact of these brain differences on a child’s functioning, but how do you know it will work for your child? Well join us for today’s podcast episode as we talk with CHC experts, Dr. Bayan Jalalizadeh, licensed psychiatrist and Liberty Hebron, licensed clinical counselor about effective treatment for ADHD, from behavioral therapy to medication. Welcome, Liberty and Bayan.
Liberty Hebron, LPCC:
Hi. Thanks Cindy. This is Liberty. Hi, everyone out there. I’m very excited to be here. I think it’s gonna be a rich discussion. Hopefully we can, you know, condense a lot of good information out there for folks who are listening, and I’m excited to be here. Thanks for having me.
Dr. Bayan Jalalizadeh:
It’s so great to be here. This is Bayan. I get to see a lot of young children, uh, school-aged children, adolescents, young adults with ADHD, and I’m so excited to contribute and share to our discussion today.
Cindy Lopez:
Thanks so much to both of you for being here, really appreciate you sharing your insights and expertise on this topic, especially as we think about treatment, right? Some of our other episodes have focused on other aspects of ADHD not really treatment, and I think that that’s an important topic that so many people, so many parents are wanting to hear more about. So before we jump into like the treatment aspect, tell me a little bit more about ADHD. What is it? What kind of behavior would we observe in children with ADHD?
Liberty Hebron, LPCC:
Well, I think that most people know that ADHD stands for Attention Deficit Hyperactivity Disorder. So we’re really looking at kind of two different constructs, uh, attention deficit or that inattentive type, right? We might see behaviors like, you know, making careless mistakes or spacing out, right, looking like they’re not paying attention, even though I might be speaking to the kiddo directly. They might have a tough time managing all the demands and keeping themselves organized. They’re constantly losing things, and they’re probably the most forgetful human beings you’ve ever met, right? And then there’s the hyperactivity- impulsive type. And that type will probably have the fidgeting, the squirming, the restlessness, excessive talking. You’re gonna see those kiddos as being on the go constantly or even blurting out or doing things really suddenly impulsively without thinking it through, interrupting other people, and then you can also have folks with ADHD who have a combination of those two types. So that’s kind of what we’re talking about when we’re looking at ADHD.
Cindy Lopez:
Bayan, does it look different across various age levels or does it change what happens?
Dr. Bayan Jalalizadeh:
It absolutely can. So I mean, I think of ADHD as this complex brain-based disorder. Some people call it a neurobiological disorder. So first off, it doesn’t necessarily mean that there’s a problem with the moral character of your child or you if you have ADHD. It really means that your brain functions a little bit differently, and that of course will manifest differently at the different developmental ages and levels. So I mean, we’re really thinking about like brain networks and chemical messengers or neurotransmitters that have these differences in patterns. For example, an inattentive toddler, you might see that they really have difficulty following basic directions or implementing those developmental skills they’re learning in pre-k or in their daycares, and they just really seem to not get those skills and you know, whereas in a young adult or an older adolescent, they really might have difficulty like planning the four or five, six step tasks that they’re required to do for their upcoming, you know, college applications or jobs, and they just really continually fall behind, or they might forget to turn in things that they’ve completed. So it looks a little bit different across the ages. For hyperactive-impulsive kiddos, for young toddlers, you might see them as being the kids who are, you know, having trouble regulating their emotions. They might bite the other kids on the playground, or they might be jumping off the bookshelf or a high staircase, and you’re kind of wondering why they haven’t learned that they keep getting injured every time they do it, and you might see the school-aged child just really having trouble sitting in their seat during those kind of longer class sessions, whereas every other child is able to do so. So you do see a different manifestations over time. The good news is oftentimes, you know, when you get into like the older age ranges, so an older adolescent, young adult, or into adulthood, those hyperactive impulsive symptoms do tend to mellow out a little bit. You know, you don’t see the 25 or 30 year old jumping off of things, but you might just see them being fidgety and restless and need to provide themselves with some kind of stimulation from time to time or might need some movement breaks from time to time. So it looks a little bit different across the ages.
Cindy Lopez:
Yeah, I really appreciate both of your perspectives coming into this. So Liberty as kind of more behaviorally focused and Bayan as more psychiatry and brain focused, andI’ve have always been fascinated by brain science, I’ve heard from both of you about some of the behaviors we might observe in people at all ages and stages of life with ADHD, and what I’ve heard mostly has been, you know, a little bit more of the challenges are there some strengths, or is there an upside to ADHD?
Liberty Hebron, LPCC:
There definitely is. Absolutely, absolutely. You’re gonna see some of the most empathic, creative folks out there who maybe have some of these qualities of ADHD in them, but they’re also able to just see things differently and different can be okay, and you know, a big contribution what we need in a lot of settings, in a lot of spaces.
Cindy Lopez:
Dr. Bayan Jalalizadeh:
Absolutely. I fully agree with that. I do think that ADHD can present some challenges and can also have its own superpowers associated. It’s helpful especially for, you know, the younger kiddos who have some of these challenges to recognize their strengths and for the parents, adults, and teachers around them to also label those strengths very clearly so that they don’t just get the message that they’re the bad kid or that they have to fit into the role of a class clown or, you know, the daydreamer, but that they can be the energetic front and center of the school musical, or that they can really contribute in all these creative, passionate ways that they might be able to.
Cindy Lopez:
So if I’m a parent listening to this podcast or a caregiver and say, my child was just diagnosed with ADHD, not sure what to do, should I pursue treatment?
Liberty Hebron, LPCC:
Well, I think that the first thing to emphasize is exactly what we just shared about the strengths and really that, you know, the kiddo is still the kiddo, right or your child is still your child. They’ve just received this ADHD diagnosis and the first thing to do is just see them, see them for who they are, right? They still have their talents, the jokes, the strengths that they bring to the table that makes them unique, and that doesn’t change. Diagnosis doesn’t change that. So, you know, first thing would be to see your child for who they.
Cindy Lopez:
It’s an important reminder.
Dr. Bayan Jalalizadeh:
Unlike some other you know medical or physical illnesses, we don’t really say that there’s a cure for ADHD. It really is baked into the way that the brain functions through the ages, and it might, again, have some changes over time, but the person with ADHD will have it for life both with its strengths and its individual unique challenges.
There isn’t something that we do to erase it, and we don’t try to to shame anybody with it. However, there can be things that we can do to just reduce some of the burdens and especially for the kids who are going through school or are learning social skills and how to get along with families and others in relationships. It can be really helpful to learn how to address some of those unique challenges so that they can really keep up and learn those important skills and maintain their self-esteem.
So I kind of think about it like reducing the impact of ADHD, and to me there are kind of three main areas that we can try to address. One, you can try to support the child by modifying their environment such as school accommodations, you know, learning where to place them in the classroom, learning how to set up their home environment to be really effective for them. Knowing when and how to use movement breaks and other things out there or even just the right school choice itself might be important for your child. You can also use behavioral techniques and behavioral therapies as well as medicines to kind of course correct those neurological signaling pathways in the brain.
I think for many parents out there they wonder like, how do I appropriately assess and evaluate my child? Um, and many children can be diagnosed in different ways. So much of the time, you know, a pediatrician, a school teacher or somebody else kind of brings this to the parent’s attention and there might be a very brief kind of set of questionnaires and that’s kind of all of the diagnosis, diagnostic process needed. And other times you really need to assess a lot of things to rule out physical and medical causes like, you know, heavy metal exposures or, thyroid abnormalities or other types of things to ensure that there isn’t another very important treatable thing to address that can mimic ADHD.
There are some anxiety disorders out there that can mimic ADHD symptoms with decreased concentration or, you know, struggling on tests. So you wanna make sure that there was some kind of either a psychiatric evaluation, a neurological evaluation. There are things called neuropsychological evaluations that can be out there, and really the main things we look for are, what are these areas of dysfunction? So do they have difficulties with inattention, hyperactivity, impulsivity, symptoms? Do they have, you know, combination thereof? And then what is their day-to-day functioning in the world? So are they meeting their developmental milestones? Are they able to learn? Do they have any additional learning disorders, speech disorders, challenges with reading, writing or fine motor skills? So these are all things we wanna evaluate and check on to really help answer, then how do you address it?
Cindy Lopez:
You referenced medicine might help. You also mentioned behavior and environment and experts say that medication and behavioral therapy can be a really effective combination of treatment for ADHD. What would that look like?
Liberty Hebron, LPCC:
Well, you know, it really looks like a collaborative process, and one of the most robust studies that we have of youth with ADHD it concluded that when we were comparing youth that took medication alone, youth that had therapy alone or a combination or neither, the group that saw the most and longest lasting positive change was the group of youth that received the combination of treatment, right? And so that combination of treatment is collaborative, the therapists, psychiatrists, and the families should be working together, and the parents and the providers really have to have, you know, communication. The providers probably also are gonna reach out to, as Bayan mentioned, the school or other stakeholders, other folks that might play a really big role in setting up that environment or helping the youth behaviorally in different settings.
Dr. Bayan Jalalizadeh:
Yeah, absolutely. And as we’re getting all this data from families and teachers and trying to set up a system of tracking, you know, what are those functional impairments and what are the strengths, we then start thinking, okay, if and when is this combination of medicine also required, you know, in a combination with the behavioral and environmental approaches. And so we always wanna make sure to do no harm or to not cause any additional long-term burdens or long-term risks of the child. But usually 65 to 85% of children with ADHD do have a positive response to medicine management if they’ve been able to find the appropriate thing for them, and these medicines are essentially the best studied or most thoroughly studied pediatric medicines that we have in existence, and so there’s a lot of research to go on. Typically, we look to track the above symptoms we talked about, and we look to see how are they engaging in their learning. Are they able to follow along with their tasks or are they able to maintain their emotion regulation a bit better without resorting kind of the physical behaviors that might get them into trouble. And we kind of track those over the weeks usually with some rating scales or having parents tally up behaviors over time and then at that point we’d start to introduce medicine to see if that starts to shift the pattern, alongside the behavioral approach. So you really want to make sure that the therapists and the teachers know that you’re making a medicine trial too.
You’ve likely heard that the main medicines that you use for ADHD are called stimulant medicines. They’re the first line research medicines for ADHD. There are hundreds of studies supporting their efficacy, and they’ve been used actually since the 1930s. Uh, so we’ve had quite a bit of evidence just supporting their safety overall. There are age ranges in which we have yet to learn more and more. So like the school-aged children are kind of the best studied group out there, and we still are looking for the you know, longer and longer and longer sets of data over time, but what we’ve seen so far is not too concerning. And thankfully there aren’t any really long-term major developmental risks out there unless you already are, you know, looking at a child with severe medical issues to be watchful for.
Dr. Bayan Jalalizadeh:
So stimulant medicines are all variations on either methylphenidate or amphetamine, which are, you know, chemical compounds that are psychoactive stimulants, and there are many variations of each of these that affect things like their absorption speed in the body, the timing of when they start to take effect and how long they work, the way that they’re metabolized in the body and there’s a good percent of people who respond well to both of these classes of stimulant medicines. There are some kiddos who you trial a methylphenidate medicine and they actually are going to respond better to the amphetamine medicine. Unfortunately, we don’t know ahead of time which one is going to respond better to which class. So usually we make what we think of as a best educated guess to minimize potential adverse effects that could come up. And, we educate the families on what to look for, and then we really seek to use the medicines that are best suited to the particular symptoms involved.
Cindy Lopez:
It’s so interesting because as a layperson, right, my background is education. I think of stimulants as things that are going to like increase energy, but yet this is, you know, the kind of medication that is generally prescribed for ADHD. Can you say a few words about that?
Dr. Bayan Jalalizadeh:
Yeah, absolutely. So, you know, they’re called psycho stimulants, and they actually have a stimulating effect on a few areas of the body. I mean, if you were to take, you know, extraordinarily high doses, yes, you would probably be bouncing off the walls or you know, you’d probably be a little bit jittery, and we definitely don’t recommend taking them not as prescribed. What I will say is they can also have an effect, a stimulatory effect, slightly on the cardiovascular system. And so we do watch for what are the cardiac effects, the heart rate, the blood pressure, make sure that there are no significant challenges, but the good news is that these medicines they’ve been pharmacologically developed to be safe for the human body to tolerate. And what they do stimulate is essentially they increase the activity of two particular neurochemicals or neurotransmitters, dopamine and norepinephrine. And these are the particular ones that are kind of implicated in these certain pathways associated with ADHD, we call them the salience network, the reward pathways and dopamine modulates physical movement in the body and the brain. Uh, and so anytime we move, you know, our mouth, our hand, any part of our body there are dopamine pathways being activated. And so actually kiddos and adults with ADHD, they just have some deficiencies and deficits and differences when it comes to those particular dopamine and norepinephrine pathways, so what we’re doing is essentially correcting the neurotransmitter signals between those brain cells.
Cindy Lopez:
So, we have parent support groups at CHC, and one of them is for parents of kids with ADHD, and the subject of medication is always a very hot topic. So, many people might question the use of medication. So what sources can people trust? Who should they be asking or talking to about this? How do they know if the medication choice is right for their child?
Dr. Bayan Jalalizadeh:
Absolutely. Well, first off, please bring questions to your care providers, including your therapists and your doctors, so that they can address any and all questions. They are, you know, constantly reading and learning from the latest research and are talking together in the professional networks, and they are actively sharing their learning and have the clinical experience that might be really helpful for your child and your family. Second, it’s also super helpful to know like what are those outside informational sources to turn to? I might be, you know, alone in this, but I sometimes like to just peruse like the guidance of these medical organizations that exist. There’s the Academy of Child and Adolescent Psychiatry, the American Academy of Pediatrics, and they have guidelines, they have tons of information out there, and they actually link to all the primary data. If you have free time or you just have really burning questions, you can actually look at that yourself, which is really cool. There are also advocacy and support organizations out there, and some of them are, you know, really, really good. So, the National Institute of Mental Health is a, a federal organization that conducts research and shares it with all of these other organizations and these advocacy groups. There’s the organization called CHADD that also has a website and a lot of support networks out there. They also recommend, okay, what are the books that are accurate that you can use to really learn about that are there? So those are some of the places I would start.
Cindy Lopez:
For our listeners, just so you know the organizations that Bayan just referenced will include that in our show notes and our reading resources. So I’ve also heard people talking about like natural treatments for ADHD. Are those effective?
Dr. Bayan Jalalizadeh:
Yeah, I wish that there were a lot of natural or even dietary approaches that have consistently worked. There are some individuals and many case reports that have reported benefits from specific dietary changes from specific natural remedies and treatments. Some doctors and providers are experts at, you know, having done a lot of research in areas and some are not. So it’s helpful to ask your doctor upfront, what do you know about these things? And, you know, what data have you looked at and have you had any personal experience with these things? I myself am not against someone to trying them, but I unfortunately have not found extremely consistent results with some of these things, and I think we really just have a lot more to learn about, you know, which kind of human body and brain structure could find some benefit in those approaches. The good news is these stimulant medicines are actually pharmacologically derived, but they ultimately, you know, originated with natural products that have come out of the earth, that we’ve trialed and learned from, and we’ve continued to develop.
Mike:
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Cindy Lopez:
So it seems like we talk a lot about medication for treatment of ADHD, but what about behavioral therapy? Liberty, you mentioned that a little bit. Can you share a little bit more? Does it work? What does that include?
Liberty Hebron, LPCC:
Yeah, absolutely. Behavioral therapy does work, it can definitely help and sort of as Bayan mentioned for medication, it’s not one size fits all, right? There’s definitely things to consider. There’s different kinds of behavioral therapy out there, and families should look for what works for them. One component of behavioral therapy is parent management skills or parent training for behavior management. That’s something where parents and sometimes parents and kids would participate together and really the aim is to figure out more helpful ways to do things in the home and beyond. There’s tons of frustration that comes along with the presentation of ADHD, the things that kiddos are doing, right, not listening, big behaviors, tantrums, outbursts, all of those things are really tough for both parents and the families. And so that can get addressed by looking at the interactions between parents and their children, and how can the interactions be adjusted or how can our responses look a little bit different? And maybe by doing things a little bit differently, ADHD won’t be something that’s ruling the household, I think is what a lot of folks will say or parents might say. And, you know, to touch on that, I do know that parents and families might feel just really burnt out at times, right, by ADHD, and I think something that parents are constantly questioning is why? You know, why can’t my child just do X, Y or Z, listen the first time, follow a simple instruction. And I go back to what Bayan mentioned earlier, which is just that brain chemistry. And the simple answer is if your kiddo could help themselves, they would, right, like if they could just listen that first time, they probably would, but that parent training for behavior management can really help address some of those things.
And then there’s also behavioral therapy that focuses on executive functioning. So all of the things that we’ve talked about in terms of planning or organizing, time management, you know when a kiddo, especially with inattentive type has all of these things, let’s say in school, presenting in school, or even in work, as young adults they might find themselves falling behind, right and not able to meet deadlines and demands, and everything just kind of feels overwhelming. So that executive functioning coaching that can be found, or behavioral therapy with an executive functioning emphasis just really teaches the skills and strategies that are helpful for navigating responsibilities and demands, and I love something that Bayan mentioned earlier of, you know, we’re not curing ADHD, right? We’re not removing any of the things that kiddos might be presenting with, but we’re really helping them to learn how to live with it. And that’s what behavioral therapy is, how do we really live with ADHD?
Cindy Lopez:
So, in my 35 plus years in education, seen a lot of kids with ADHD and parents who are trying to work through it with them and you kind of reference this Liberty, but you know, I’ve seen that it just takes so much time and energy for parents and caregivers to support their child with ADHD, and it gets frustrating because things don’t seem to stick. So what can parents do? What can caregivers do if that’s happening?
Liberty Hebron, LPCC:
Yeah. And really, Cindy, it’s not really a question of if it’s happening, it’s likely that it is, so when it’s happening, and it’s kind of to be expected, we’ll often see even when we have some of these interventions and strategies, we wish that just by doing them all the problems will go away, but you know, the truth is that it works sometimes, sometimes it doesn’t, right, or kiddos might saturate on something like a reward system, and that gets boring and tired and we’re not, you know, adapting to what the kiddo needs, right? So it is definitely something that takes a lot of time and energy and collaboration, really just sharing that load. Again, I wanna emphasize that I think at school, you know, teachers and school staff, they really know how to engage children in something called positive behavior interventions and supports – PBIS. So families out there that are listening, you know, really understanding what PBIS is in your child’s school can be really helpful just because they’re incorporating interventions at different levels. Everything from like breaking down the directions and assignments, or providing visual supports or a self-monitoring checklist, right? These things are important in the classroom, but maybe they can also help you at home. So, you know, having a conversation around some of those PBIS strategies with the school staff, it could be helpful. There’s always other options for accommodations beyond that, like a 504 plan or an individualized education plan or IEP. And I also want to recognize when it comes to those things that some families wanna keep information about what’s happening with their child, private, right? And they look at a diagnosis like ADHD, and they’re thinking, well, I don’t want everybody to know that my kid has challenges.
And, and likewise, the kiddo might have some self-consciousness around that as well, but I really encourage parents to think of, you know, knock on wood, if your child were to break their arm for example, and they had to go to school with a cast on their hand, they likely would need some support in writing, in typing, playing sports wouldn’t look the same. And so those are accommodations just so that the kiddo can continue to function in the school environment, access their education at the level of their peers, at the level that they were before they broke their hand, right? And so we accept accommodations in that regard and thinking of the fact that your child can’t help the fact that their hand is in a cast, your child also can’t help the fact that their brain chemistry is just a little bit different, right? So, it is hard, and I think it’s something we need to talk about, families need to talk about with providers about that stigma and the fears around disclosing a diagnosis and getting that support and accommodation, but if you’re gonna accept it in those cases of having a cast on your arm, think about it, of how your child is not accessing that same education as everybody else just because we’re not giving them the accommodations that they need and deserve. So that’s something to think about for sure. And outside of school, you know, there’s other supports, with academics and, you know, structured social opportunities or even the emotion regulation piece, that Bayan mentioned earlier. And it doesn’t have to be something where, you know, therapy is the immediate response or that medication is, lots of these things are, you know, support with academics or social opportunities. They can all be found in the community. The public library is a great resource for folks to find some academic support for their kiddos. So there’s lots of places that it doesn’t just have to fall on the shoulders of the parents.
Cindy Lopez:
As an educator, I’ve seen like so much of what you’ve referenced Liberty, positive behavior interventions, all kinds of systems that I think educators work with at school that are also good for home. What does it look like though, like how long does it take for any kinds of interventions or treatments that are put in place for them to really make an impact?
Dr. Bayan Jalalizadeh:
Well first off, I totally agree with all of these supports are usually going to be just so helpful, and they may or may not stick forever. It’s important to put in some time early to do the learning about ADHD, talk to your providers and therapists and plan out some approaches and try to be systematic. And usually, you know, make one change at a time. So like, add on one thing at a time and, follow it along for a few weeks, maybe a month or maybe six weeks or so. And depending on what you’re trying, you know, if you’re trying these behavioral approaches at school, it might start kicking in in a few weeks, and you might even notice within the first few days that you might start seeing some benefits and improvements, especially if there’s a lot of very quick responsiveness from the teachers, the staff around the child, the parents, and they’re really doing this very active support that can be helpful. The child can learn quickly. They might also, you know, forget some of the things that they have started picking up from time to time. And a lot of us in this field say that ADHD often presents in ways that are consistently inconsistent, which, to me means, you know, yeah like 80% of the time Tommy is learning the skills and they’re implementing them, and then there’s those days that they just wake up, and they seem to have forgotten a lot of those skills, and it’s really important to stay the course if you’re starting to see general improvements.
If you’re not seeing a strategy stick, after a number of weeks, you know, or a month and a half or so, it’s definitely okay to go back to the teacher, go back to the psychiatrist or therapist and say, “oh my gosh, Tommy is really resisting this strategy, or he might have started showing a little bit of benefits and he’s really now struggling with this, let’s modify it. The good news is there are a lot of resources and behavioral strategies out there and different kids can respond differently to the various strategies. And there are also different intensities of those kind of supports. You know, including the parent management support. You know, there are the ones where you meet every so often with a therapist, but there’s the ones that you sign into the playroom with the earphone in your ear and the therapist is working with you second to second or minute to minute and that might be what’s required. So, you know, you try it out for a few weeks. You try it out for a few months and if it’s not working you, you go back and you keep going. I wanted to say like, thankfully over the years, these hyperactive, impulsive symptoms, especially change in flavor from those big outbursts or dangerous stunts to things that are more manageable. And, you know, you might start to just have the child turn into a teen who’s very collaborative, and they will want to work on their challenges and symptoms very actively with you. And so you can get more bang for your buck and you know, more output for the time and energy you’re putting in.
Cindy Lopez:
Yeah. You referenced this Bayan, but I’m wondering about ADHD meds and why is it that it appears to be like so much trial and error with ADHD meds?
Dr. Bayan Jalalizadeh:
Yeah. Absolutely. Well, the good news is that a vast majority of kids will find something that works, but it does take some trial error. We don’t yet have like the resolution of our diagnostic approach and our ways of assessing the exact internal chemistry and neurobiology of every single child and correlating that with exactly which medicine is the one for them. I suspect that over time we’ll get closer to that and we might even really know ahead of time which of these, you know, medicine categories, the methylphenidate, the amphetamines, or even non stimulant medicines are really the category to try, but we do thankfully have some good educated guesses on which ones might be the category for them at the outset. And if it doesn’t work, we are quick to adjust and to, to modify. What I will say is also every medicine has potential benefits as well as potential drawbacks. Some have side effects to expect. And, you know, there are some most common pitfalls to look out for and many parents have already heard about these horror stories or these challenges that kids can run into. So for example, the most common ones are you might see a little bit of decreased appetite or weight gain, and in those cases you really want to find a different medicine so that the child can grow and develop physically. If this happens before puberty especially, you want to make sure that the child is able to gain and grow to their capacity.
You might also see sometimes if the medicine’s given too late or if it’s a really long-acting medicine it might cause some difficulties in sleeping, kind of like if you take a high amount of caffeine or coffee late at night and you can’t sleep, uh, you might still run into those challenges too. And in those cases, you can modify the timing or modify the dose, or if you have to, you change the medicine. Sometimes you run into slightly decreased height growth over the years. Again it tends to be correlated with the higher the dose and the longer you give a particular medicine, and if you give it before puberty, there can be an effect, especially if the child is already on the shorter side or significantly below the average of height. It doesn’t happen to everybody, but it can happen to some. So we just track those things over time.
Cindy Lopez:
Yeah. Thank you. Thank you so much. So it’s interesting because lots of different types of treatments we talked about in terms of behavioral and medicine and lots of different types of medicine and many different aspects of behavioral therapy and supports for the student, both at home and at school. So with so many kind of variables in this picture of ADHD, what type of specialists would you recommend for treatment of ADHD?
Dr. Bayan Jalalizadeh:
Great question. So yeah, oftentimes if the challenges are simple and straightforward and there’s only one realm of behaviors and challenges that your child struggles with a general pediatrician might be all that you need alongside the teachers and the support of a therapist. However, if there are multiple domains of challenge, so for example, these other specific learning disorders and you know to 30% of kids with ADHD can develop anxiety disorders. A large number can develop oppositional defiant disorder or other behavioral challenges. There are depressive disorders involved, and sometimes things like movement or tick related disorders that can show up. So in those cases, you likely want to have the aid of either a child and adolescent psychiatrist or a developmental behavioral pediatrician who’s kind of a more specialized pediatrician for any realm of these like developmental or behavioral disorders that can show up. In particular if you happen to have a child with the emotional difficulties from anxiety or depression or big explosive behaviors, I think you’re most likely well suited with a psychiatrist. And usually the pediatrician can give you a set of referrals. You can also look online to see who is around you. Definitely feel free to kind of get one or multiple consultations to find somebody who is experienced and who feels like they can manage these issues together.
There are also all these other support specialists as well, so it’s also helpful to ask your general practitioner and your main parent coach or therapist to say, who else is needed? Do I need an occupational therapist for fine motor difficulties or other motor and physical difficulties? Do I need a speech and language pathologist to really help support my child in these other areas of learning and speech difficulties? These are the kinds of things that you can also add on. Um, and then finally, there are certain kinds of behavioral therapists that Liberty had mentioned called executive skills trainers who can also support your child, especially in the older adolescent age range, when they’re really transitioning from being in school to being a young adult and they are really going to kind of have to do a final push and learn all the skills of independence that can be helpful for them.
Cindy Lopez:
Well, Liberty and Bayan, you’ve given us so much to think about, and I’m wondering, what final advice would you like to give to our listeners?
Liberty Hebron, LPCC:
Well one, feel free to re-listen to this at any point or rewind, right? And just, I think that’s telling of the final advice I want to give is to take it slow. I know it feels like all of this is happening at once and that there are so many things to target, so many challenges that are happening, and it feels like all of it needs to be addressed right now. And slowing down is probably going to save you the frustration, being able to address something very intentionally. As Bayan mentioned it earlier, of like picking one behavior for example at a time. That’s so, so important because we can get exhausted trying to extinguish everything that’s in front of us. And what we really need to do is just one thing at a time. ADHD is something that’s gonna be with your kiddo throughout their development. It is brain-based, as was mentioned, and so as much as their brain is going to develop and change, sure there’s neuroplasticity, but it’s something that’s gonna be chronic. And so if we kind of get overwhelmed from the onset, it’s gonna be a longer journey as opposed to taking our time to really come to understand our kiddo’s needs and what we can do to address them in the moment and slow down along that way.
Dr. Bayan Jalalizadeh:
Because ADHD is often a chronic issue, it may be a long road ahead, and it’s normal to have frustrations and questions and even see all the inconsistencies along the way and want to pull your hair out. For parents or supporters of a loved one with ADHD, we can remember to be patient with ourselves and our loved one as well. We want to take care of ourselves so that we can help take care of them, and we also really wanna pay attention to all those beautiful moments of life and to be present with our loved one with who they are now at their developmental level and with all of their amazing attributes. I think sometimes we can get lost in trying to support as much as we can, and we can accidentally send the message that our child needs to be somebody other than who they are. And I think that can sometimes be, you know, an accidental misstep. And again, as Liberty says, if we can slow down, that can be something that can help us really appreciate this long road that there is hope, and we can come a long way towards understanding really how to help these kiddos thrive, not just survive.
Cindy Lopez:
I love ending on that note of hope. Thank you Liberty and Bayan again for your time. And to our listeners, thank you for listening in, and we will share some of the specific resources that both Bayan and Liberty have mentioned in our show notes and in our resources list. If you’re interested in finding help please contact us at chconline.org. You can contact our care team, careteam@chconline.org. We have opportunities for therapy for a child for medication management, all those kinds of things that you might need, behavioral therapy for someone with ADHD. So thank you all again.
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