Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What should parents of children with ADHD expect from their child?
experiencing ADHD should be held to the same expectations as their peers of the
same emotional developmental level. Assuming the child has no learning
disturbance, children with ADHD will have both academic strengths and weaknesses
like all non-ADHD classmates. Athletic ability will vary in a similar manner as
will social interaction; some children with ADHD are very outgoing while others
are more reserved. Children with ADHD are often noted to be emotionally delayed,
with some individuals having a delay in maturity of up to 30% when compared with
their peers. Thus, a 10-year-old student may behave like a 7-year-old; a
20-year-old young adult may respond more like a 14-year-old teenager.
What treatment options exist for a child with ADHD?
major components of treatment for children with attention deficit hyperactivity
disorder (ADHD) are behavioral therapy and medication.
Home and school
interventions: Parents can help their child's behavior with specific goals such
as (1) maintaining a daily schedule, (2) keeping distractions to a minimum, (3)
setting reasonable goals, (4) rewarding positive behavior, (5) using charts and
checklists to keep a child "on task," and (6) finding activities in which the
child will succeed (sports, hobbies). Children with ADHD may require adjustments
in the structure of their educational experience, including tutorial assistance
and the use of a resource room. Many children function well throughout the
entire school day with their peers. However, some patients with ADHD will
benefit from a "pull-out session" to complete tasks, review specific homework
assignments, and develop "management" skills necessary for higher education.
Extended time for class work/tests may be necessary as well as assignments
written on the board and preferential seating near the teacher. An IEP
(Individualized Educational Program) should be developed and reviewed
periodically with the parents. ADHD is considered a disability falling under
U.S. Public Law 101-476 (Individuals With Disabilities Education Act or IDEA).
As such, individuals with ADHD may qualify for "appropriate accommodations
within the regular classroom" within the public-school system. In addition, the
Americans With Disabilities Act (ADA) indicates that secular private schools may
be required to provide similar "appropriate accommodations" in their
Psychotherapy: ADHD coaching, a support group, or both can help teens feel
more normal and provide well-focused peer feedback and coping skills. Counselors
such as psychologists, child and adolescent psychiatrists,
behavioral/developmental pediatricians, clinical social workers, and advanced
practice nurses can be invaluable to both the children and families. Behavior
modification and family therapy are usually necessary for the best possible
The medications used to treat ADHD are psychoactive. This
means they affect the chemistry and the function of the brain.
are by far the most widely used medications in treating ADHD. When used
appropriately, approximately 80% of individuals with ADHD have a very good to
excellent response in reduction of symptoms. These medications stimulate and
increase activity of areas of the brain with neurotransmitter imbalances.
exact mechanism of how these drugs relieve symptoms in ADHD is unknown, but
these medicines are linked to increases in brain levels of the neurotransmitters
dopamine and norepinephrine. Low levels of these neurotransmitters are linked to
The most common adverse effects are short-term. They include reduction
of appetite, sleep disturbances, rebound (for example, agitation, anger,
lethargy as the last dose starts to wear off), and mild anxiety. Most
individuals who take psychostimulants for ADHD build up tolerance to adverse
effects within a few weeks.
Individuals with certain coexistent psychiatric disorders (for example,
psychosis, bipolar disorder, some disorders of anxiety or depression) are
particularly vulnerable to adverse effects if they do not receive appropriate
concurrent treatment for the coexistent condition.
The psychostimulants most
often used in ADHD include the following:
and amphetamine mixture (Adderall, Adderall XR, Vyvance)
is a newer nonstimulant used to treat ADHD. Less is known about its long-term
side effects. This drug has several benefits over stimulants, but its use may
also carry several negative aspects.
It is not a controlled substance and is
not considered a drug of potential abuse by the U.S. Food and Drug
Administration (FDA). Since it is not a controlled substance, pharmacies may
accept phone-requested medical refills.
It is usually taken only once a day for full 24-hour effectiveness.
It is much less likely than stimulants to disrupt eating or sleeping.
For some children, atomoxetine is not enough to control their
ADHD symptoms. Many other children do very well on this medicine alone.
Specialists treating individuals with ADHD have found Strattera seems to
best help improve the problems associated with a disruption in executive
function skills. Inattention and hyperactivity symptoms are less responsive.
When starting atomoxetine therapy, a gradually increasing
dosage schedule is recommended. It may take up to three weeks before full
therapeutic benefit is achieved. For this reason, patients may need to remain on
previously prescribed stimulant medication during the "build up" phase. In
addition, atomoxetine must be taken daily; short-term "medication
holidays" (for example, school vacations and weekends) will limit its efficacy.
Studies have indicated a higher than expected incidence of suicide ideation
during early treatment. This occurred in patients with pure ADHD as well as in
those patients with ADHD accompanied by other emotional disorders (for example,
depression, anxiety, bipolar disorder).
Some medications originally developed to
treat depression (antidepressants) also have important roles in treating some
individuals with ADHD. Since these medicines have been used for many years to
treat other mental-health conditions, their adverse effects are well understood.
an antidepressant that increases levels of neurotransmitters norepinephrine
and/or serotonin in the brain
(Wellbutrin): an antidepressant that increases levels of neurotransmitters in
the brain, especially dopamine
an antidepressant that increases levels of the neurotransmitter norepinephrine
in the brain
Other medicines that were
originally developed to treat high blood pressure (alpha agonists) may also be
useful in the treatment of those having ADHD. Again, due to widespread and
long-term use, their side effects are well known to doctors.
(Catapres): an a2 agonist that stimulates certain receptors in the brain stem.
The overall effect is to "turn down the volume" of hyperactive movement and
Guanfacine (Tenex, Intuniv): another alpha agonist with an effect similar
to that of clonidine. These medications are designed to be used in combination
with other medications listed above. They are not effective when taken as a
single and only medication.