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Thursday, May 23, 2013
Attention Deficit Hyperactivity Disorder
ADHD and Anxiety
Hi, I live in Germany. My seven year old daughter has had an extremely rough year in the first grade. She suffered socially (as she did throughout preschool and kindergarten, having trouble making and keeping friends), had academic problems (daydreaming, figeting, short attention/concentration span, difficultly working independently, slow processing speed, trouble understanding math, problems taking tests), she has low self-esteem (I feel I am to blame here setting the standard so high and then getting loud when she would fail)and the last two years we have seen a lot of anxiety (worrying about a vulcano erupting, a tsunami coming, someone breaking into our house, traffic, being afraid of spiders, ants, slugs, the dark, etc). Further, she also exhibits a type of defiance often which I would attribute to ODD. After we noticed her problems concentrating in school we took her to a psychiatrist for a pysch eval. which took months to complete as we also had organic testing done and an done, etc. She is extremely creative, draws elaborate pictures, creates cartoons (books)with an ability well beyond her age, tells amazing stories, memorizes entire storybooks and movie dialogue verbatim. She is also bilingual and reads in both German and English. Yet, IQ/psychiatric testing noted she has a low normal IQ (90)(although the psychiatrist said before testing she thought she was gifted and after testing has said she believes the poor result was due to extreme distraction/concentration problems) and that she is very anxious about things and extremely angry, too. She told the shrink she felt like a weirdo an outsider, not good enough and often blames herself. Yikes. Well, then her classroom teacher went on maternity leave and she received a new teacher. Low and behold, her academics improved much over the last 3 months of school and in the summer vacation she does have friends/playmates over regularly (although she was still often the target AT school-if there was a need to pick on someone, it is always my daughter). Her new teacher reported that she works slowly but carefully and is usually correct, is still often distracted but not always and is doing much better academically. At any rate, now the shrink has determined that Ritalin will likely help her and we will begin with it in a week. (School will begin the week after) Long story short, I am going to speak with the shrink now about her axiety and I am wondering how the anxiety is usually treated when one also uses Ritalin. What meds are usually used and how effective are they? Could her anxiety symptoms get better without anxiety meds (that is just with Ritalin)? Will the anxiety/ADHD meds affect her ODD-like behavior as well? Or is the ODD behavior coming from her feelings of axiety? Thanks so much for your time. This was really something of a novelette. I apologize. A really concerned mom.
One of the things I enjoy most about writing for NetWellness is the constant reminder of how very much people care about their family members, friends, and even neighbors. Your love comes shining through.
Actually, your seven year old daughter's situation is not all that unusual. I have seen many girls like her over the years. Take a look at the website I have suggested below on women and girls with ADD. Nadeau and Quinn's book that is available on that site Understanding Girls with ADHD is superb.
Regarding your daughter's IQ---Her psychiatrist may well be right. The combination of ADD and anxiety, particularly if she has a slow processing speed (suggested, though not confirmed, by her teacher's comment on her working slowly but carefully) can be deadly for IQ testing. I have seen IQ tests change 25 points in persons with ADD who are on appropriate therapy and I would not be surprised if it could be higher in some, particularly if anxiety was helped.
Regarding her teacher---Periodically we at Affinity will try to go to the classroom and observe what is happening there. It can tell us wonders. However, we usually reserve that for after therapy if things are not going well. You were given a great lesson, as I believe you realize…environment has a huge amount to do with how anyone with ADD functions. Then again, I'd be willing to bet a number of other children in her class improved in their own problem areas when that teacher left, as well.
Regarding some of the social concerns---If she is going back to the same school I urge you to find out if they have any kind of bullying policy and, if not, if schools in your area have anything you can suggest they adopt. In the U. S. there is an excellent publication, Teaching Tolerance, that is for schools to use for free. They even have some free videos for teachers. It covers a variety of issues including bullying. They have many articles on line and I placed their URL below.
Finally, regarding her anxiety, defiance and Ritalin----If one is anxious because of one's ADD, and the ADD is helped significantly, the anxiety is helped significantly. If the behavior that you describe in your daughter (worrying about a volcanoes erupting, a tsunami coming, someone breaking into our house, traffic, being afraid of spiders, ants, slugs, the dark) is extreme, frequent and gets in the way of healthy functioning, a stimulant won't likely help that. There are medications that may help but there are also a variety of stress techniques that some counselors have used with young children. If your daughter's English is good and if she likes to listen to audio recordings, take a look at the URL I placed below, Health Journeys. They have a wide variety of CDs, tapes and MP3 downloads that can help children with stress and anxiety.
I tend to think of oppositional defiant disorder (ODD) as more of a symptom of other problems than a disorder on its own and I often see it improve greatly when anxiety and/or ADD improve with therapy. BUT MOST IMPORTANTLY, I only know a few hundred words about your daughter and all of those came without me ever seeing her or asking a question, so only take what I say as food for thought. It sounds like you are working with a psychiatrist who has recognized several important questions so far, so discuss all this with her soon.
I wish you and your daughter the best!
Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati