Saturday, November 28, 2015

Will ADHD medications help?

I have a 7 year old son who is struggling with the same issues you discuss on your blog. I am a mental health professional and work with kids but it is difficult when it is my own child. We have him on a medication trial with concerta 18mg but it only seems to make him tired. He is in therapy but it is not really helping. Would straterra help. What do you suggest?

Hi, You mention two medications that can  be used for attention deficit disorder (ADHD).  If your child has ADHD, then your doctor may try either of those medications. Most doctors will try a stimulant like Concerta first.  Concerta is a time released form of ritalin.  More research has been done on stimulant medication for ADHD than any other class of medications, and stimulants have the highest percentage of positive results: from 70 to 90 per cent effective in reducing symptoms of ADHD.  The other medication you mentioned Strattera is sometimes used for ADHD, especially when a child has side effects to stimulant mediation.  However, I have not found it to be as effective in treating symptoms of ADHD.  

It is important to add that these medicines are not typically used for anger overload.  There is no research that I am aware of that they are helpful in the absence of ADHD.  If your child has anger overload issues and ADHD, then ADHD medicines may help your child self-regulate, i.e. become less impulsive.  And if your child is less impulsive, he may be able to pause and think more often when he is frustrated.  So you may then see some reduction in anger overload.  Still, it is unlikely that anger overload will disappear, and I would recommend you also work on the strategies in my anger overload manuals.  These cognitive behavioral strategies have been found to help reduce anger overload in a number of research studies of children.

Take care, David Gottlieb, Ph.D.

Wednesday, November 4, 2015

Will children outgrow anger overload?

So I have been reading your blog and plan on reading your books soon.  It sounds like my 6 year old could be any one of the kids mentioned in the blog.  I was wondering what the over all outlook for these kids are?  Do they ever "grow out of this"?  What can I expect when my child is a young adult in college or at 25?

Hi, You ask a good question.  I can't tell you exactly what will happen for any individual child, but overall studies, looking at groups of children, show that there are significant changes when children learn cognitive behavioral strategies, like those I present in my anger overload manuals.  The studies compared using these strategies with groups that did not receive therapeutic intervention, and the studies found that the group of children taught to use the strategies handled their anger better.  

What hasn't been studied yet is seeing what happens to these children over many years, in other words, a longitudinal study.  Do the children maintain their gains over a long time period, and what percentage are still having anger overload many years later?  We do know that the brain keeps maturing throughout childhood and early adulthood, and we do know that practice using these strategies is beneficial over the short term for most children, so we believe that most children will continue to improve as they get older.  

Questions still to be answered by future research:  Some adults have anger management issues.  Did these adults receive help as children?  Is there something about their biological or emotional development that interfered with their learning better self control?  We know that adults with anger problems do have subtle differences in parts of their brain.  But we don't know how this happened. Were there other life events that impacted them in a negative way?  For example, we know that if there are serious mood problems or drinking problems, there often are anger problems as well.  But more research still needs to be done.

Hope this brief overview is helpful, Dr. Dave Gottlieb