Ask The Specialist

Dear Panel,

Dear Specialist,
I am the grandmother of a twelve-year-old boy who was diagnosed with ADHD last year and has been taking ritalin. Since then we have seen an improvement, but recently his paediatrician has recommended his father [my son] and his mother to take him to a psychologist for some individual counseling. The boy does not want to go as he feels that he is no longer getting into trouble at school, and is managing his schoolwork better, so he doesn't see any point to it.

As both parents work, I have been taking him to the appointments, and I find that he is now resenting me. If I refuse to take him, it will be difficult for the parents to ensure that he attends. If I take him, I might ruin my relationship with him. How necessary do you think these appointments with a psychologist really are?
Torn Apart Nana

I do not see any particular necessity nor any benefit from seeing the psychologist. Actually it may become damaging for the child, and the psychologist him/herself might not want to continue the sessions.
Psychiatrist

Disordered attention causes complex difficulties on multiple levels. Any person with ADHD is likely to acquire multiple secondary problems involving academic weakness, social isolation or ostracism, but especially low self esteem. ADHD sufferers also become very disorganised, and learn to live in a state of mental and physical disorganisation.

Good psychological management will address all of these issues and give your grandson a firm basis to build on his strengths, and learn to manage his weaknesses. Medication will make it easier for him to learn these lessons but, by itself, is unsatisfactory treatment in many cases
General Practitioner 1

I would recommend that you and your grandson and his parents have a Family Meeting about the subject of your grandson seeing the psychologist.
Perhaps your son could start the ball rolling by saying how pleased everyone was with his progress since starting medication. Then a good technique is for each person at the meeting has 5 minutes to say what they feel or think without interruption from the others.

Then your son or daughter-in-law could explain why the paediatrician recommended he should see a psychologist even though he has responded well to medication.
If the paediatrician has not explained it well enough for a twelve year-old to understand, your son could perhaps use an analogy eg; Explain that if your grandson had asthma he would be treated with an inhaler ( I'm sure he has friends who have asthma). However to improve how well his lungs work, or to help when he does not have his inhaler to hand, or to be able to manage with less or no inhalers, [perhaps when he is older], then the doctor could recommend that he attend a special gym program or take up swimming. So increased physical fitness will add to the beneficial effects of the asthma inhalers.

Then it could be explained to your grandson that the psychologist will help him learn ways to manage his ADHD with or without medication, and he may learn ways to cope when he is unable to take his medication. He may learn strategies for those days that just turn out to be extra difficult. He may learn ways to manage when he is older if he does not want to take medication.

An important thing to remember is that when treating adolescents with ANY medical condition, including ADHD, it is essential to have their cooperation. You cannot, past a certain point, force an adolescent to go along with medication or psychological intervention.
A good strategy is to draw up a 'contract' between your grandson and his parents.

The terms could be something like this:

INFORMATION
SITES

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STUDY OF EARLY TV EXPOSURE EFFECTS.
http://www.helpforadd.com
/2004/may.htm

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DOWNLOADABLE FACT SHEET ABOUT CHILDREN AND TV.

Top 10 Tips for Parents about television.
http://www.youngmedia.org.au/pdf/ fact_sheets/08_01_top_ten_tips.pdf

BROWSE FACT SHEETS ON RELATED TOPICS

Advertising and violence on TV, the internet, video and computer games etc.

http://www.youngmedia.org.au/
mediachildren/08_strategies.htm

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BOOK FOR 6 -12 YEAR OLDS

The Survival Guide for Kids with ADD or ADHD by John F. Taylor.

http://psychcentral.com/lib/
2008/the-survival-guide-for-kids-with-add-or-adhd/

____________________________

BOOK
Learning to Slow Down and Pay Attention: A Book For Kids about ADHD, by Kathleen G. Nadeau and Ellen B.Dixon. Available through Amazon.com
http://www
.maginationpress.com/
441A149.html

____________________

AD/HD International Forum 2009
The ADHD Global Network and CHADD will be hosting this event at CHADD Conference, in Cleveland, Ohio, October 8-10, 2009.

http://198.106.60.73/6838/index.html
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The material provided by other websites is for information and not intended as advice. Any information provided by external websites should be discussed with your health care professional and should not replace their advice.

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your grandson agrees to attend six sessions with the psychologist, and after that, if he does not feel he is gaining any benefit from the sessions, then he can choose to stop going. This way, he will feel that he has a level of control over the situation.

It needs to be explained also, that you, as his Nana, are just trying to help. Then offer that you could both take the opportunity of these trips to the psychologist to have some special grandmother/grandson time together, and the two of you could plan some sort of activity following the sessions, such as having a special snack, or buying a special interest magazine or comic, or allowing some play time on the computer. [Avoid the mistake of making the rewards too big or complicated]. You will know what is likely to appeal to your grandson.

The aim is to turn the current situation into a WIN-WIN situation--- actually a Win/Win/Win solution for the parents/son/grandmother.

General Practitioner 2