Concentration - Meds or other advice please

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Hi everyone

My daughter's behaviour has come on leaps and bounds in recent weeks/months. She's now relatively easy to parent and it's great. We had her parents night last week and the teachers said that she was doing very well, she tries very hard and is just lovely and enthusiastic. They know she has difficulties with concentration, so she has a desk in the corner of the classroom, which she can go to, if she's feeling overwhelmed and she gets stickers, for completing her tasks.

Now, that I'm seeing clearly, I realise that the only major issue she has at school is concentration. It's just this that's holding her back from being in the top groups, instead of the middle. I know this is going to frustrate her in time, because she's a really smart wee girl. The Rs are easy for her, so long as she can stay focused, but that's the issue. I'm wondering what your opinions are on how to deal with this specifically. She is sort of like a child with ADHD (and she may well have this too, but I'm uncertain).

Has anyone found any methods that I should consider, before I seriously consider trying out some sort of medication or asking for an ADHD assessment?

Thanks

I would go for the ADHD assessment -- it's basically a questionaire for the parents and teacher, plus an appointment where you talk to the doctor about your child's history and your concerns. I prefer to work with a developmental pediatrician, someone knowledgable about both ASD and ADHD.

I had a hard time accepting that ADHD really is diagnosed by questionaire, and that medication IS the primary, first-line treatment. Russell Barkley, one of the top ADHD researchers in the country, says that 10 years ago they used to recommend trying behavioral treatments first, but the research showed that the majority of patients ended up on medication anyway after those treatments failed. So now the recommendation is medication first. On addforum.com I saw story after story from parents who tried "everything else first" and once they tried medication, wished they had gone to it sooner.

OT might be worth trying if you have a strong feeling that her inability to concentrate is primarily due to sensory issues. It sounds like they're already using accomodations in her classroom, so I don't know how much further you can take that. DS saw a sensory-integration OT weekly for nine months, and when I saw the hoops she was jumping through to get him to write for 2 minutes I asked her opinion about trying medication. She said it might really help him, but never would have volunteered this if I hadn't asked.

We've found medication to be extremely helpful for concentration and perseveration, but much less so for aggression. Our star-shaped peg just doesn't fit in the public school's round hole, and medication can't fix that. But if the issue were primarily concentration, medication would go a long way.

There is a free three hour lecture by Russell Barkley on youtube called "Essential Ideas for Parents". Well worth watching as you do your research.

We are pretty sure my daughter is ADD - not ADHD, just ADD. What I call jumpy brain. Never formally assessed, but pretty obvious to anyone who knows her.

We kept that information to ourselves since she was getting by OK in school, and I did not want to have medication pushed on us, so instead she talked with some adults (like my sister) to find out strategies they use to stay focused. Honestly, I'm not entirely sure all the things she eventually worked out for herself, but by the time she started middle school she pretty much had it figured out and is now a top student acheiving to her intellectual ability.

One of the weird things she does is to listen to music or watch TV while doing homework. Apparently dividing her focus helps her stay focused. She does allow herself extra time to get things done just in case; that is another strategy. And we give gentle reminders about things like bed time because she'll totally forget that

What I liked about our approach is that it is life long, no worrying about when it wears off, like you have with medication. When a child is falling behind I would consider medication, but when a child is keeping up but not working to their potential, I think you have some room to let them figure it out. Depends on how bad the problem is, no doubt, and also how self-aware the child is, but it is sounding to me like your daughter might be more like mine: it's a hinderance, but not a boulder in the path.

Now, my daughter is not AS like my son, "just" ADD, so you will have to think about if your daughter has room to work on this skill in addition to everything else she has to work on, and that could change things. But remember that ADD medication does, apparently, lose effectiveness over time so you want to target its use to when most needed. JHMO.

I've done a lot of reading on ADHD and medication, and have not found anything that says medication loses effectiveness over time. If this were the case, I would expect to see reference to it by Russell Barkley. I have seen some annecdotes over at addforum.com, where a particular medication stopped working for a particular child, and it took some trial and error to find the right med and dosage, but it doesn't seem to be a common occurance.

Barkley does say that research shows medications to be less effective for the truly inattentive type. A lot of kids that lack hyperactivity are diagnosed as inattentive, but there is a subset of those kids who are dreamy, spacey, and low energy, and for them the current medications aren't as effective.

To the OP, I'm sorry if I jumped to the ADHD conclusion too quickly. Does your daughter have trouble concentrating at home? Is she impulsive? You might also consider trying some of the strategies in Smart But Scattered.

Add me to that list. I was vehemently opposed to meds and at first would not even consider it because I was certain there was something else that could be done.

While I am glad we tried other things, I wish I wouldn't have been so pigheadedly stubborn about meds. Looking back, we should have started them about 6 months before we did and those last 6 months were brutal (mostly for my son).

Adderall helped greatly with response inhibition and focus. Eliminated his hyperactivity (which I was pigheadedly fixated on being a sensory issue and not related to ADHD. Turns out yes, he has sensory issues, but his hyperactivity really was straightforward hyperactivity due to ADHD). Even he could see how much better he did with his meds.

Have you tried any diet modifications to see if she is responding to food/additive sensitivities? This is the only other thing I have ever heard of really working, but it only works if your kid is sensitive to something. Turns out, my son wasn't. But that doesn't mean it couldn't hold true for your daughter. My daughter had food sensitivities when she was little that made her autistic symptoms way worse. So it's possible. I think Feingold diet is the most common one that helps, but there may be more now because my research in that area is years old now.

There are several tests of attention, not just questionnaires. A good psychologist will use them in an evaluation for ADHD.

Zette- I just wanted to say that I love the fact that your peg is star-shaped!

Thanks everyone for your posts. Sorry I never posted sooner. I started to feel really unwell soon after I posted (probably a virus), collected my daughter from school, then I went to bed, until noon today. Since then, I've been prioritising my replies, as I'm not 100% yet.

My daughter is hyperactive at times. When I was unwell last night, my husband was trying to get her to complete her homework. We have a wooden floor and I could hear her jumping off her seat and running up and down the living room. It almost sounded like she was doing this after each word she wrote. She's not nearly as hyperactive as she used to be and this is not a typical evening (it used to be), but she's definitely more hyper than her peers, by a long shot and always has been.

As for diet, we've found that a low dairy diet does help a lot with the hyperactivity and we try to keep her to this. But no diet modifications have ever seemed to help to maintain her concentration.

We can't seem to divide her focus, whch would help if we could. She can't walk and talk at the same time. She can't eat and watch TV at the same time. We've found that for homework, she has to be doing that and nothing else.

I'll take a look at 'Smart But Scattered' and 'Essential Ideas for Parents'. Thanks very much, for those pointers. I think we're going to have to be looking into further assessments for this. I have similar issues and I know it has held me back and caused me a lot of frustration. I really don't want this for her.

Thanks again, everyone.

My youngest son is on Vyvanse and it's helped him a lot. He will flat out tell you that he has trouble concentrating or focusing without it. He just can't make himself do it unless he's on the med.

I don't know how it is where you live, but here, I just told the doctor I wanted to try it with him and he said ok. Some places make you get them evaluated for ADHD and all, but others just try the med out if you want to. If it works, then it works. If it doesn't then it doesn't.

I really like Vyvanse because he's pretty sensitive to the "buzz feeling" of those meds and always has been. He cannot stand the "speedy buzz" feeling that some of the other ones give him. It works for 15 hours straight, he can eat and sleep on it. I give it to him at about 530 or 6 in the morning and he goes right back to sleep. It doesn't start working for about 3 hours and it's just a help for him, not an overwhelming nervous jittery thing like even the lowest mg Adderall was.

We have tried other ones and he could always feel the "speed" feeling from it, even without the actual "tweaking" that a person who isn't ADHD gets if they take ADHD meds. He would feel the increased heart rate, and that would freak him out, or would have a slight shakiness and that would freak him out, etc. He feels nothing with these, except is able to concentrate.

My oldest was on Ritalin for a while when he was in grammar school, and while it really helped his concentration, he lost a lot of weight, had a terrible time sleeping, etc.

Thanks for that. My daughter's not under the care of a paediatrician. At her autism assessment, which was done by specialist speech and language therapists, she was signed off for further treatment, etc. We have to go to our GP and ask for a referral to the relevant department at the hospital, if we feel she needs it - this is possibly going to happen, with regards to the concentration problem. I'm not sure if that dept will then want her properly assessed for ADHD (and I'm not sure of the process here, for that) or if they'll prescribe something, in the hope that it might help. I'm going to try out the other methods suggested first. I'm not against meds, but I'd really like to be certain that I've done all I can before try them.

It's scary that you mentioned sleep problems with Ritalin. My daughter takes ages to get off to sleep anyway and, if she's taken a particularly long time to get off to sleep, it shows in her concentration. So, if she had side effects like that, it would totally defeat their purpose.

I was much like your daughter at her age. I nearly failed 2nd grade for the reason that I have AS, ADHD and dyscalculia, despite being well above average intelligence.

I have never been on medication because after investigating and talking to lots of others who were - it did not seem the way for me to go.

Those on SSRI and ADHD medication report that it interferes with other things - I recall many saying that especially with ADHD meds, it does make them less hyper and implusive but also makes them feel rather zombie like. They may find things less distracting, but they no longer have the ability to intensely focus the way they used to either, and some say it kills their creativity. I have heard similar things about SSRI's - people say they take away the "lows" but they also take away the "highs", leaving them feeling numb or just meh much of the time. (if this happen to her she won't be able to tell you so because of her age)

What has helped for me has been the following:

- One particular behaviour thing that has helped has been working with my brain rather than against it. I have the ability to concerntrate for about 20 minutes at a time - after that I need a 5 minute break, then repeat. And a 20 minute break every 1.5 hours or so. Our brains can only focus intensely for 20 minutes at a time before they start devoting attention to other things anyway - so rather than fight that, I work with it. I get more done that way. If I don't do that - I might get in a good 20 minutes or even 30, but after that it crashes and I'm back to being inattentive, unable to focus and hyper again and am unable to focus again. If I ignore that limit - I pay for it later.

- Diet. It's been mentioned that she reacts to diary - I react to more than just that. Even simple things like what and how much I have for breakfast (especially protein/carb/fat ratio - and the sources you get them from) and how often I have snacks, and what they are, affect it. Once my blood sugar drops too much it's impossible to focus.

- Exercise. Being hyper, I need at least 3 hours of physical activity a day, plus during breaks I tend to use them for that on top of it. She's not likely to be as hyper as I am (mine's pretty bad) but she will probably need at least 1 hour, plus extra on breaks if she wants or needs to.

- Nutrition.
This one is something I've been exploring and experimenting with lately, with some really great results. It also makes sense with my past history. If your get the correct nutrients, you start producing the right amounts of brain chemicals (especially neurotransmitters) and they balance themselves the way they are supposed to, and it makes focusing much easier. It's made a lot of the ADHD and AS symptoms easier to deal with - of course it doesn't get rid of them, but they are less in intensity and therefore have less impact on my life - especially my sleeping issues, I;m not an insommniac anymore.

Drugs can have the effect of stopping us from producing neurotransmitters, or producting too little or too much of them over time - and that would make the issue more difficult to deal with, not less. It would mean certain parts of the brain would be overactive or underactive, and would have a difficult time changing that after being on them for an length of time (especially since she is still growing and her brain is still developing) - which is why you are supposed to come off SSRI's and ADHD meds slowly.

In the end that was why I decided against medication. I don't mind taking the nutrition route - but it's not for everyone, it requires more effort and attention. Medication is the much easier route (although whether it is better is debatable).

Last edited by Kjas on 23 Nov 2012, 7:34 am, edited 2 times in total.

You might need to try different meds and different dosages to get it right if you do decide to take the med route. My son was on Adderall and it did not effect his sleep at all. It did decrease his appetite, but that was actually a welcome side effect since he tends to be chubby because he overeats due to sensory issues. And eventually as his body adjusted, he settled at a "normal" weight. What I did notice with the Adderall is when his dose was too high, his affect would flatten and he'd seem....dull?...don't know if I'd say zombie-like, but I lost the exuberant fun kid I had. However, that was remedied by changing his dose. On the right dose, I like to say he was "more him" than unmedicated. He was still exuberant, funny, and spirited, only in doses that normal people could handle because he lost his intrusiveness which made his bubbly personality a bit much to take at times.

I really hated putting him on meds. I hated it the whole time he was on them. But there is no doubt in my mind that it was the right thing to do and if I had to do it all again, I would have done it earlier. I share that because I didn't realize how rotten I would feel about doing the right thing for my son. I think I would have handled it better if someone would have said "you might never feel 'good' about it, but that doesn't mean you aren't doing the right thing."

I might share one thing with you that helped me. We started him on meds during Christmas break and we didn't tell his teachers we had done anything different. I wanted to see if they noticed, so I would know for sure that it was really helping and not just my imagination. Within a short period of time of returning to school, his teachers were saying that he seemed like a new kid. To have confirmation from people who knew him well, but did not know he was on meds really helped me know for sure that it was worth it.

Good luck.

SSRI's and stimulant ADHD meds are very different. There is no need to come off stimulant ADHD meds slowly -- they are out of the system in 4 hours for the instant release, or 12 hours for the long acting. The things I've read indicate that stimulant ADHD meds do not make any persistant changes to brain structure or function. SSRI's are known to blunt the highs and lows of emotions, even at the right dose to help depression. Adults who find stimulants helpful don't describe anything similar. The ones who are on a dose or med that isn't working for them talk more about being "edgy" or having a crash in mood.

I needed loud music in the background when I did homework as a kid - it gave me only one thing to screen out, rather than every. single. little. tiny. distraction.

One thing to think about - I have zero opinion on whether this is an acronym-applicable situation, I'm not a doctor and I don't know your daughter. However, from my memory of being in school: I was ALREADY concentrating to my fullest - staying upright in my chair (I work best in a kind of lounging position on a couch) screening out all the ambient noise, worrying about all the social cues I was missing, etc., etc.

I have no idea whether meds would have helped me or not - they weren't available when I was a kid and I doubt my parents would have allowed them (they were of the opinion that I "just wasn't applying myself.") However, while I probably was one of those distracted-appearing kids who was always looking out the window ("daydreaming" they called it.) I was working as hard as I absolutely possibly could with everything I had.

With my own son, I try hard to make sure we do a lot of the educating at home in ways that work for him: watching science videos, doing craft and cooking projects that involve math skills, creating stories. I figure at school, he's learning other stuff (all the list I mentioned) and that's OK, but trying to get him to do both things there is impossible.

Ritalin worked horrible for me. Didn't make me any better at anything. It oddly made me more impulsive. My month on an SSRI made me feel weird, too. Ritalin just was "bleh" though. Maybe an amphetamine based one would be better for me, but Ritalin was a no go. For me, I have NVLD, so it probably means my right brain hemisphere is messed up in some way. But I have a very like, hyper verbal thought process, and Ritalin sorta shut it down, but that made things I wanted it for, like driving, worse, because I'd have to think with the nonexistent nonverbal part. That said, I LOVE caffeine. Caffeine makes everything better for me, except for sleeping. Disrupts sleep.

But, I'd say try just giving your kid a cup of coffee. It'd be safer than Ritalin. If you're concerned about coffee stunting growth, you should be very concerned about Ritalin doing it. I knew a kid on Ritalin from elementary school, he was quite skinny, but still taller than me in elementary school. I saw him again, you know, 10 years later, ridiculously skinny now. Probably like 110lbs, and slightly shorter than me now. His family is all big (not fat, but good sized) people, his brother was bigger, too, but he ended up very small, no doubt due to his meds. As far as what dose, though, who knows. I've heard of kids getting 50mg and stuff. 20 for me made my pulse 100, my blood pressure 150/90, when my normal waking is 70 pulse, 115/70-60s blood pressure. Even 10 would get my pulse to almost 100, and raise the blood pressure (but BP was still within safe ranges most of the time.) So try coffee and see wtf happens if you need to give your kids stimulants.

Diet and exercise is very important. I have no doubt that I managed to do well in elementary school due to having steady exercise and a good diet. I'd have salad every meal, probably 70% of my food was organic, and I'd get half a dose of good quality adult mulitivitamins, along with fish oil (in the 90s before fish oil got cool.) I'd swim like 3 days a week at least. My emotional issues sorta coincided with my diet change (divorce), and I got fat, too.

When you're on them long term - actually there is.

Most studies where they get those stats from have only been from people who have been on them a short time or just starting them. The very few long term studies that have been done indicate the opposite. However since taking them off medication makes them markedly worse - meds are still considered preferable.