Reader’s Question

I just read your article about ADHD. I found many great ideas in how to understand and work with my children, but I have a few things I would like to ask you.

I have 3 boys (almost 12, almost 10 and 5 and a half). The first one has ADD (inattentive type) and tends to be very oppositional. He has never responded to any of the regular medications, so we give him 5HTP to even out his disposition. The second one has ADHD with the hyperactivity being the largest problem. He is on Ritalin, having just changed over from Adderall. The 5-year-old does not show any of the early signs that the other two displayed at his age. We don’t think he has another variation of ADD, but we won’t be sure until his 2nd or 3rd grade teacher tell us that he is doing “whatever”. I am just waiting for another bomb to drop.

We have not found any support in our community for this as a family. The Academic Support Team at the kids’ school has been fantastic in helping them individually with their academic issues. We have a great MD who has been really supportive with the medications and keeping an eye on their health.

Our problem, as I see it, is that our family is never on an even keel. We are constantly trying to keep the peace in the house. Our oldest sees that he is not worth much and has told us that he thinks of how to kill himself sometimes. I have an appointment for him to see a child psychologist this afternoon. My real question is:

We have tried to deal with each of them individually so much that we are a splintered family. How can we become one coherent family with goals, and activities that we do together instead of just always solving problems?

It is wearing out all of us to be in this constant state of upheaval. Homework time is a mess, chores have just become something that I can’t fight about any more so I end up doing everything in all of MY spare time, and I am becoming bitter about it.

Our Clinical Psychologist’s Reply

You’re moving in the right direction. Once each child is stable, we then focus on making the family environment stable. Some suggestions:

• The oldest son is having difficulties. The referral to a psychologist is appropriate. I’m concerned about using 5HTP, which may actually create more problems than it solves. As a youth with “Inattentive” ADHD and signs of depression, we may want to look at medications that do double duty such as the Serotonin Norepinephrine Reuptake Inhibitors. Return to your physician to explore other options, especially in view of his comments about killing himself.
• You’ll need to move from being a firefighter to a fire chief. As a firefighter, you are instantly reacting to individual children and their individual crisis — sometimes several in an hour — spending all your time putting out the behavioral fires of the children. As a fire chief, you are taking the “big picture” view and assigning your resources to deal with the situation. As an example, the assignment of individual chores on a schedule will not work in your family. Instead, as the fire chief you announce after dinner “I need everyone’s help for 45 minutes — NOW.” Assign chores immediately and supervise their work.
• You’re probably experiencing what I call “Homework Turmoil”. After school you have two sons who will be out of control and very ill-tempered and distractible. The oldest son’s inattentiveness is basically untreated (5HTP has no effect on that symptom) and the ADHD son’s medications are dropping out of the effective range. During this after-school transition period, some experts recommend using a soda or other mildly stimulating drink to help with homework. Your pediatrician may have some recommendations.
• Use this family and team approach with many activities. Enlist the help of the children with preparing for dinner, leaving the home, etc. This not only provides purposeful activity, but assures the children that they are contributing to the family.
• Visit many of the ADHD related websites on the Internet. Many offer suggestions for improving family life and organization.