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Using medications to improve behavior and enhance learning is both an art and a science; it requires close communication between everyone who works with the child. The dosage, frequency, and schedule for giving stimulant medications vary greatly from child to child. Here are some general guidelines.
1. Working out the right dose requires establishing whether the drug works, and what, if any, are the side effects. The usual dosage ranges from .3 to .8 mg/kg depending upon body weight. Your doctor will probably begin with a dosage of .3 mg/kg (a 5- to 10-mg pill in the morning) and, based on your charting and reporting, and that of the teachers, increase or decrease the morning dose, add a second late morning or early afternoon dose, or decide that your child either doesn't need or doesn't respond to that particular medication. Your doctor may increase the medication by 5 mg weekly until either the desired beneficial effect or undesirable side effects occur. If one stimulant medication does not work or is not tolerated by your child, your doctor may try another. This trial phase may take as long as six weeks. The second phase is monitoring the long- term dosing schedule, which may include increased doses during stressful situations and drug holidays when there is no school.
2. Some A.D.D. specialists feel that some children, and their parents, are "placebo responders," which means they respond to the power of suggestion and get better with just about any therapy, or with a placebo (pretend) pill. For these children, a placebo trial may be useful. Some A.D.D. specialists recommend this first. Your pharmacist can make a look-alike placebo pill.
Don't start the medication simultaneously with a major change, such as a move, a family upset, or a change of school. To gauge whether or not the drug is necessary, first give your child a chance to adjust to his new environment. On the other hand, if you know by past experience that your child falls apart during major changes, beginning the medication just before the event may help. It will, however, be more difficult to evaluate the results.
3. Give the first dose of medication on a Saturday morning or at the beginning of a school vacation, so you have an opportunity to observe the effects firsthand before the next school day.
4. To minimize the appetite-decreasing effects of stimulants, try giving the morning dose after breakfast or just before the child leaves for school, so it is likely to take effect by the time the child's class begins. A few children may absorb Ritalin better on an empty stomach. This may, however, diminish their appetite.
5. The most noticeable effects occur around one to two hours after the medication is given. If your child is required to be at his best behavior or peak performance at a certain time, you can time the giving of the dose accordingly.
6. For medications given at school, give the child a reminder, such as a watch with an alarm that beeps at the dosage time.
7. Consult your doctor about drug holidays, weekends, school holidays, or school vacations, when you can skip the medication, or at least use a lower dose.
8. To avoid sleep disturbances, give the late afternoon dose earlier, lower the dose, or omit that dose entirely.
9. Some children do better if the second pill is given after the morning recess; otherwise, the last class of the morning is an academic disaster. If safety is a factor in the hyperactive, impulsive child who walks (or rather runs) home from school, a third pill may be given after the afternoon recess.
10. If your child experiences a rebound effect when the medication wears off, try "piggy-backing." Give the next dose before the previous dose has worn off, usually three hours after the previous dose instead of four.
11. Resist the temptation to increase or decrease the dose if the child is having a particularly bad day. First, explore other causes unrelated to the effects of the drug that may have triggered his sudden change of behavior.
12. If your child's appetite is diminished as a result of the medication, encourage her to eat large meals at the times of the day when the effects of the medication are wearing off. Offer your child nutritious foods frequently throughout the day.
HOW TO EVALUATE IF THE MEDICATION IS WORKING
After an agreed upon time by you and your doctor, and with the help of the following medication effectiveness chart, note your observations: Is the medication helping, hindering, or having no effect? Don't be surprised if the teacher's assessment on the effectiveness chart is different than yours. Remember, the teacher is observing your child's behavior and learning when the medication's influence is at its peak, but parents see their child mostly when the effects of the drug are wearing off. Your observations of the medication's effects are more accurate on weekends and holidays. According to the doctor's instructions, report your findings either by phone or in a follow-up office visit. Remember, the primary goal of drug therapy, or any therapy is not to eliminate problems, but to make them more manageable. Be sure the medication is actually improving your child's behavior and/or learning, not just making him more convenient to have around.
THE A.D.D.-Q/MM (To Monitor Medication effectiveness) Instructions:
1. Teacher or parent fills in this questionnaire according to who is with the child.2. Complete questionnaire 2 hours after every drug dose - usually at 10 am, 2 p.m. and 6 p.m.
3. Do this for 2 days before starting medication and each day during the drug trial.
. .Name:____________________ Age:_____ Date: __________Medication: ____________ Dose: _______ Time: __________Time chart was filled out: _________________QUESTIONS: (check '?' appropriate column if any example is true)Never or very rarelySome-timesA great dealAlmost always
1. The child has difficulty paying attention to things other people want him to do.
2. The child seems to be day dreaming, almost "spaced out", drifting into her own little world, oblivious to what's going on and not paying attention to instructions.
3. The child doesn't pay attention to details and often makes careless mistakes in schoolwork.
4. The child has difficulty following routines, such as getting ready for school, bringing homework home, getting ready for bed.
5. The child needs a lot of supervision to complete assignments (school work, chores), which require sustained attention.
6. The child fails to think before acting, does not think through what he is about to do or say; leaps without looking.
7. The child has difficulty waiting for a turn, (for example, interrupts others, blurts out answers before a question is completed.)
8. The child has difficulty waiting in line, sharing, and cooperating.
9. The child has difficulty waiting for rewards, delaying gratification. (She wants the toy, to go biking, and so on, NOW!)
10. The child's schoolwork, keeping things together, time-management, personal functioning, seems very disorganized.
11. The child over-reacts to seemingly little things.
12. The child has difficulty adjusting to sudden changes in routines.
13. The child's activity level is inappropriate for the situation (e.g., has difficulty sitting still in class, church, during meals).
14. The child shows motor restlessness, fidgeting, squirming.
15. The child seems always on the go as if driven by a motor.
16. The child seems sluggish, lethargic and unmotivated,
TOTAL SCORE for each column:
.SCORE: (the total number of checks for each column multiplied by 0, 1, 2, and 3 respectively.)
x 0 = 0x 1= x 2= x 3 =Total
From: The A.D.D Book by Dr. William Sears and Dr. Lynda Thompson
STIMULANT MEDICATION FACTS 1. Ritalin (Methylphenidate)
2. Dexedrine (dextroamphetamine)
3. Cylert (magnesium pemoline)