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Why Is My ADHD Child on So Many Medications? How to Prevent the Drug Cascade with Dr. Kate Trapani · Raising ADHD: Real Talk For Parents & Educators

0:00
Apryl: Kids being put on multiple psychiatric drugs, the side effects of being treated with more medication instead of being addressed, and families feeling like they're on a treadmill they can't get off of.
0:12
Apryl: Here's the thing: those situations are preventable, and prevention starts with you, the parent, knowing what questions to ask, what red flags to watch for, and who to turn to when something doesn't feel right.
0:25
Apryl: That's what this episode is about.
0:27
Apryl: This is not medication is scary, but rather here's how to be your child's best advocate in the medication conversation.
0:35
Apryl: Welcome to Raising ADHD, the podcast for parents and teachers raising ADHD kids.
0:41
Apryl: If you've ever felt frustrated, overwhelmed, or just unsure what to do next, you're not alone.
0:47
Apryl: I'm April Bradford, a former teacher and ADHD mom, and alongside my husband, Dr.
0:53
Apryl: Brian Bradford, a child and adolescent psychiatrist, we're here to give you the clarity, strategies, and support you've been looking for.
1:01
Apryl: Every week we break down the misconceptions, answer your biggest questions, and share real tools you can use right away at home and in the classroom.
1:10
Apryl: So if you're ready to feel more confident and less overwhelmed, you're in the right place.
1:15
Apryl: Hey there, welcome back to Raising ADHD.
1:18
Apryl: My name is April Bradford, former teacher, wife and mom to ADHDers.
1:22
Apryl: If you're returning, welcome, friend.
1:24
Apryl: We're so happy to have you.
1:25
Apryl: And here with me is Dr.
1:27
Apryl: Brian Bradford, child and adolescent psychiatrist.
1:31
Brian: Hey, April.
1:32
Apryl: Okay, we have something brand new to the podcast.
1:36
Apryl: We've never done this and we're very excited.
1:38
Apryl: We have another doctor with us today.
1:41
Apryl: Her name is Dr.
1:42
Apryl: Kate Tropony.
1:44
Apryl: Welcome, Kate.
1:45
Apryl: Hey guys.
1:47
Apryl: Thanks for having me.
1:48
Apryl: Yes, we're so excited to have you.
1:50
Apryl: Brian, do you actually want to introduce Dr.
1:52
Brian: Tropani is currently a PGY2 resident, which means she's in her second year of residency.
1:59
Brian: So she's finished all of undergrad.
2:01
Brian: She's finished all of medical school.
2:03
Brian: She's taken all the all the step boards and has earned the title doctor and is now at the hospital training just like they do in Scrubs.
2:13
Brian: She's a second year resident here in Nashville, Tennessee.
2:17
Brian: And she has her first year was already spent in the hospital doing like schizophrenia, stuff like this with adults.
2:25
Brian: And now she's in her second year and gets to work with kids.
2:28
Brian: So she's already had a few rotations on the adolescent unit.
2:31
Brian: So she's she's starting to become very well versed with kids and is and is well on her way to doing a child fellowship, which starts her fourth year.
2:42
Apryl: Kate, do you want to introduce yourself or tell us a little bit about how you got into psychiatry specifically?
2:51
Kate Trapani: Yeah.
2:51
Kate Trapani: So, you know, going into medical school, I was interested in behavior for the most part.
3:00
Kate Trapani: And I thought that was going to lead me to pediatrics.
3:03
Kate Trapani: However, it feels as if psychiatry kind of chose me.
3:08
Kate Trapani: And as soon as I did my psychiatry rotation, I really, I really fell in love.
3:13
Kate Trapani: Um and then I think I had some great mentors in the field of child psychiatry.
3:19
Kate Trapani: We're going to medical school at the University of Tennessee.
3:23
Kate Trapani: And I think they're the ones who really kind of lit the fire inside of me to pursue child psychiatry.
3:31
Apryl: Thank you for being on with us today.
3:32
Apryl: There was a recent article published by the Wall Street Journal that talked about kids, essentially, overall, the article was kids who start ADHD medication young end up on multiple psychiatric drugs within just a few years.
3:49
Apryl: And they're usually on two to like four, five, six psychiatric medications.
3:54
Apryl: And so we're going to kind of talk about what happens, why does this happen, what you can do as a parent, those kind of things.
4:01
Apryl: So to start off, can you guys tell us?
4:04
Apryl: And we have two doctors here, so you have a second opinion.
4:07
Apryl: It's not just Brian's opinion here.
4:09
Apryl: We have two.
4:09
Apryl: Um, to start off, why does this happen?
4:12
Apryl: Is this normal?
4:14
Apryl: Was this just a few cases?
4:17
Apryl: How come do these kids end up on multiple medications?
4:21
Speaker 2: Yeah, I think there's a lot of factors that contribute to kind of the we call it polypharmacy or children being on multiple medications for really the same purpose, which I don't think is exactly what this article was saying.
4:38
Speaker 2: I think it talks about how ADHD meds are often kind of the initial gate to then starting of other psychiatric medications.
4:47
Speaker 2: Which, you know, I have mixed feelings about.
4:53
Speaker 2: I think generally, I'd say, I won't speak for you, Dr.
4:58
Speaker 2: Bradford, but I would say that we're both very pro as few medications as possible, you know, best quality of life on as few medications as possible.
5:06
Speaker 2: Um at the same time, though, I think in the case of ADHD, medications really are so effective.
5:14
Speaker 2: I think it's wrong to say, or too black and white to say that, you know, you should avoid medicating your child with ADHD because it will then lead to this extreme polypharmacy.
5:31
Speaker 3: Yeah.
5:32
Brian: Yeah.
5:32
Brian: I would also say, I mean, part of the reason ADHD is implicated in with this is it's very I want to say like easy and safe to treat relatively to compared to other psychiatric things.
5:45
Brian: And so when you first go to the doctor and it's like they see this kid's acting up in class, this kid's anxious, this kid's depressed, this kid's traumatized, this kid's got ADHD, this kid's got like they see 20 things, they're like, start with ADHD.
6:00
Brian: I know that one.
6:01
Brian: Like that's the the most common one.
6:03
Brian: That's easy.
6:04
Brian: Let's start there.
6:05
Brian: And then the kid comes back and a year later and it's like or a few months later and it's like, sweet, that actually helped with the ADHD.
6:12
Brian: It didn't help with all the other stuff.
6:14
Brian: What else is going on?
6:15
Brian: And so then they're like actually treating other things.
6:19
Brian: And so ADHD meds, I think, get thrown under the bus for that.
6:23
Brian: The other thing is that there is a lot of comorbidities with ADHD.
6:28
Brian: ADHD kids are more anxious.
6:30
Brian: We know this.
6:31
Brian: They they get in trouble more often.
6:33
Brian: They have a harder time sleeping, like neurobiologically.
6:36
Brian: And I mean, right or wrong, we can kind of discuss, but we once once you've started one medication, it's like, well, they're on meds now.
6:45
Brian: I mean, what the heck, what's what's the difference in throwing on a sleeping med too, because they're having trouble sleeping?
6:49
Brian: Well, they're still a little anxious.
6:50
Brian: I mean, we're already on meds.
6:51
Brian: Why not another one for anxiety?
6:53
Brian: And it kind of just starts this drug cascade where the first one's very difficult.
6:58
Brian: It's like it answers, is my child on meds or is my child not on meds?
7:02
Speaker 2: I do think often ADHD may be one of the first diagnoses noticed, but I do think the article did a good job of touching on how very frequently ADHD can look like PTSD or post-traumatic stress disorder.
7:19
Speaker 2: I think, you know, looking at that differential is very important as providers.
7:26
Brian: Yeah, that's that's a question on the the DSM for depression is inattention.
7:33
Brian: And we know that anxious people don't pay attention as well.
7:36
Brian: We know that tired people don't pay attention as well.
7:38
Brian: It's so easy to like say, oh, everybody has ADHD.
7:42
Brian: Well, not everybody has ADHD.
7:44
Brian: There's a lot of different things.
7:45
Apryl: One thing that I took away from the article is that a lot of these kids that were on multiple medications were being treated by number one, multiple different providers.
8:00
Apryl: And a lot of times they were more nurse practitioners or um physician assistants and not psychiatrists.
8:13
Apryl: Do you guys see that in the hospital?
8:17
Apryl: Like kids coming in and they've never seen a psychiatrist, but they're on an entire list of medication.
8:25
Brian: So yes.
8:26
Brian: And I I think part of the issue though with this is in general in the community, there's a lot more nurse practitioners that are accessible.
8:34
Brian: It's it's there's not enough child psychiatrists, we know this.
8:38
Brian: And they're very hard to get an appointment with, so there could be just some bias there of we see this because that's who they're able to see, period.
8:49
Speaker 2: Right.
8:50
Speaker 2: And then oftentimes it becomes a they see whoever is available.
8:55
Speaker 2: So they may not even be seeing the same nurse practitioner when they come back for a return visit.
9:02
Apryl: Yeah, that makes a lot of sense.
9:04
Apryl: I I've I have friends who are literally like they've reached out to me like from out of state, like, hey, can your husband help me?
9:13
Apryl: We've tried to see, we've reached out to every single psychiatrist, psychologist, whatever, and we can't get into anyone.
9:21
Apryl: And so that makes sense that they would be like, whoever we can see, whenever we can see them, we're that's who we're seeing.
9:28
Brian: Yeah, they're booked out forever.
9:30
Brian: I will say, I mean, this is this is personal bias, obviously.
9:33
Brian: But child psychiatrists are awesome.
9:36
Brian: Uh if you get a chance to see a child psychiatrist, it's you're you're seeing somebody with like the utmost training.
9:45
Brian: Like there's there's really not much more you can you can go past that for treating a child with ADHD.
9:51
Brian: There's a few more specialties though, like a behavioral pediatrician that also has like right there at the top of top of the game on treating ADHD.
10:04
Brian: A lot of pediatrics are actually pretty good at ADHD.
10:08
Brian: I wouldn't really put that a tier below.
10:11
Brian: Um so if you can if you could get in to see one of those, that's great.
10:16
Brian: Just on how our medical system's set up, that may not be an option.
10:21
Brian: And it doesn't necessarily mean that you're gonna get second-rate care uh below that.
10:26
Brian: ADHD for for a lot of patients is relatively simple.
10:29
Brian: You just need to be a good advocate.
10:32
Brian: And if something seems off, go see somebody else.
10:36
Brian: Going to see a child psychiatrist and going to see just whatever local, the first person you can do to prescribe medicines, that you may actually be getting the same, the same medication, the same treatment.
10:48
Brian: It may not make a difference.
10:50
Apryl: Okay, so that actually brings us to a really good point where you said knowing how to advocate for your child when they are being prescribed.
11:01
Apryl: So let's talk about that.
11:03
Apryl: What can parents do when, say, you know, they go to the doctor, they have been on ADHD medication, now the doctor's recommending something else, or their child is on multiple medications and the doc and the parent is worried about it.
11:21
Speaker 3: What can parents do?
11:23
Speaker 3: I think one of the best things is to not be afraid to ask questions.
11:31
Speaker 2: You know, ask questions of the doctor, clarify what we're treating, um, you know, clarify why we've added a certain medication, why we can't, why can't we consider stopping it?
11:45
Speaker 2: You know, I think those are all valid questions for a parent to ask in in a mental health appointment, you know, whether it's with a nurse practitioner or a child psychiatrist.
11:57
Brian: If you go into the doctor and they're like, hey, we need another medication, it's okay to just say, hold up, why are we adding in this next medication?
12:05
Brian: Everybody's on the same team.
12:07
Brian: The doctor's on the same team, the parents on the same team, the child themselves are on the same team, and they should have their own voice.
12:14
Brian: It's okay to question that.
12:16
Brian: It uh like there's this like uh, I don't know, stipulation, whatever, in the just in society of, oh, the doctor's always right.
12:25
Brian: You know, you can't can't question the doctor.
12:27
Brian: The doctor doesn't know every single thing about the situation.
12:31
Brian: So usually they're going off, okay, we need this treated now.
12:36
Brian: Let's do this.
12:37
Brian: And it's okay to say, actually, in our life, we don't need that treated right now.
12:41
Brian: We've we've got things handled.
12:43
Brian: Like we could we can make a few changes and and avoid this extra medication or whatever.
12:49
Brian: I know like like working with some of the patients that I've had in the past where I've started to add more medications, it was oftentimes it would it would come in and would be like, hey, I'm feeling very depressed.
13:04
Brian: Great, let's start an antidepressant and work through this, and then they'd come back a few months later and be like, Great, this is working out really well.
13:11
Brian: Now if I could just get this anxiety under control.
13:13
Brian: Okay, now let's let's work on the anxiety.
13:15
Brian: And then come back a few months later, you know, I've this all this stuff's working really well, but I'm also having nightmares.
13:21
Brian: Okay, well let's let's do some nightmare medication then too.
13:25
Brian: And then pretty soon, like you had this cascade of we're trying to treat symptom after symptom after symptom.
13:30
Brian: When in reality, from the very get-go, we should have taken a step back and been like, wait a minute, this is PTSD.
13:36
Brian: You don't actually have depression, you don't actually have like a generalized anxiety, you don't actually have you know all these other symptoms, which you've got is something that needs treatment with on a whole different ballgame with uh different therapy, with uh you know, maybe a different medication and and you missed it the f in the first place.
13:58
Apryl: Yeah, that goes back to what Kate was saying, what the article you know did talk about that.
14:04
Apryl: Is this ADHD or is this trauma?
14:07
Apryl: So how do you then this is me as a mom thinking this and I'm seeing my kid go through all of this medication, how do I say, like, hold up, are we treating the correct thing?
14:24
Apryl: If we're trying to treat all these symptoms and now we have multiple medications, is that how how do I do that as a mom?
14:32
Speaker 2: Yeah, I mean, I think kind of the story that you were describing, Dr.
14:36
Speaker 2: Bradford, of constantly adding medications for new problems gets to the fact of, you know, initially what we should have been asking is what is the why behind this behavior?
14:50
Speaker 2: Um, what is the underlying cause of the suffering?
14:57
Speaker 2: Right.
14:58
Speaker 2: Um, and I think when we ask that question, we get to a more more accurate diagnosis, as opposed to kind of just looking at clusters of symptoms and then deciding which which diagnosis they fit under best.
15:13
Brian: Yeah, I will also say having a longer appointment, or if you if you go to an appointment, you're like, I'm not quite comfortable yet with medication, let's have another appointment.
15:23
Brian: Things like this are okay.
15:25
Brian: If if you're having these, like, you know, a five-minute appointment of hey, I've got depression.
15:29
Brian: Here that here's your depression bed.
15:31
Brian: That's where you can't get to the underlying the whys and things like this.
15:35
Brian: And it's also where you're more likely to get a missed diagnosis.
15:39
Brian: So if you could have longer appointments, I think it's worth advocating for.
15:43
Apryl: How does a parent do that?
15:44
Brian: Ask up front.
15:45
Brian: Yeah.
15:45
Brian: When you call, be like, hey, you know, am I gonna be given a five-minute time slot or like a 30-minute time slot?
15:52
Brian: Can I can I request a 40-minute time slot?
15:54
Brian: Sometimes like you might have like a larger copay or something like this for you know a larger question billing code, basically.
16:02
Speaker 2: But the initial evaluation appointment is is so important.
16:06
Speaker 2: Because I think that's when you know we as psychiatrists try to make the most accurate diagnosis and then create, you know, a treatment plan from there.
16:18
Speaker 2: The flop appointments, you know, are kind of check-ins to see if we are sticking to that treatment plan.
16:26
Speaker 2: Is it working effectively?
16:27
Speaker 2: Is it not?
16:28
Speaker 2: I think too often we kind of stick to the diagnosis that we make on that first evaluation and have trouble seeing, you know, the gray.
16:39
Speaker 2: Could it be something else?
16:40
Speaker 2: I think that's something that you know I definitely want to try to foster as I get more experience in the field.
16:50
Brian: I think also just with psychiatrists not getting married to this diagnosis.
16:53
Brian: So if it's, hey, I was diagnosed with you know such and such as at age 12, I must still have it.
17:01
Brian: Like the diagnosis list can change.
17:03
Brian: Like we could be wrong, we could be, you know, it can it doesn't need to be this like set in concrete thing.
17:10
Apryl: When you get a patient that comes into the hospital with this list of medications, what do you guys do?
17:16
Speaker 2: So one of the places that I like to start is really just asking the kid, how did we get here?
17:24
Speaker 2: How did we get to this inpatient hospitalization?
17:30
Speaker 2: Because so often there's been these traumatic, you know, very serious events that led up to this hospitalization.
17:38
Speaker 2: And I think you know, understanding what led to the requirement of this severe, you know, intervention is really helpful.
17:47
Speaker 2: Um, and sometimes really that's all we do on the inpatient side is we figure out how do we get here, how can we prevent this from happening again?
17:58
Speaker 2: And how can we get the child on the right track, on the initial track that will then be continued outpatient.
18:05
Speaker 2: I think oftentimes I will almost try to ignore it when I go to evaluate the child and then you know, formulate a diagnostic impression is what we call it.
18:19
Speaker 2: Oftentimes what that looks like is Dr.
18:22
Speaker 2: Bradford and I arguing about all the possible things that it could be, why it's this, why it's not that.
18:28
Speaker 2: Um, and then looking, you know, at the medication list after that with a good picture of the child and thinking, you know, what what are we treating?
18:39
Speaker 2: What do we need?
18:41
Speaker 2: What is causing side effects?
18:43
Speaker 2: What can go?
18:44
Speaker 2: I think evaluating each medication as you go down the list is super important.
18:48
Brian: Yeah, I would concur.
18:49
Brian: It's uh like when somebody comes in with a with a long list of medications, like one of our first goals is how can we simplify this down so that we're just on the very most effective things and that we're gonna give this the child the best chance at life?
19:08
Brian: And that includes like the lowest side effects, the least the least long-term side effects, the least side effects now, the the best chance at compliance if somebody's on something like three, four times a day, it's like what if they weren't on a three, four times a day medication?
19:22
Brian: And is it possible to get them down to ideally just one, or maybe even most ideally zero?
19:29
Apryl: If a parent has concerns about their child's current treatment, how do they go about respectfully advocating for a second opinion?
19:40
Brian: I mean, I just asked Kate.
19:42
Apryl: These guys are in a very lucky and unique situation, I would say.
19:47
Brian: Yeah, I mean, we're essentially coworkers because we're we're co-treating patients together.
19:51
Brian: Uh but that's all the residents.
19:54
Brian: I know when I was in residency, it was like constantly going to other residents.
19:57
Brian: Now that I'm attending, it's constantly going to the residents and and asking for second opinions.
20:04
Brian: I don't get parents asking for a second opinion very often, and I actually think that's a shame.
20:09
Brian: I think that it should be asked more often.
20:12
Brian: There's there is a barrier in child psychiatry that it's so hard to get to see a child psychiatrist that the thought of asking for a sec or getting a second opinion with another child psychiatrist is almost like fantasy.
20:23
Brian: Like, how's that possible?
20:25
Speaker 2: I think also, you know, asking as a parent, asking the psychiatrist what their thought process was.
20:34
Speaker 2: I think that sounds straightforward, but I feel like it's it's not done.
20:39
Speaker 2: I don't remember being asked that, you know.
20:41
Speaker 2: Like a parent asking me, how did you reach that diagnosis?
20:46
Speaker 2: I think so often we just say it and then the parent will accept it as fact, which can be dangerous for sure.
20:56
unknown: Yep.
20:56
Apryl: Yeah, that's true.
20:57
Apryl: That I mean it is.
20:58
Apryl: It's like, oh, the doctor said it.
21:00
Apryl: It's true.
21:01
Brian: I think another way that you could also ask a second opinion.
21:04
Brian: I mean, you you can't just straight up ask and be like, hey, can I do my follow-up with a colleague or with somebody else in your office?
21:11
Brian: I trust you, but I also want just a second opinion, and then after that we'll go back to follow-ups with with you.
21:18
Brian: Uh you could also get a second opinion from other professionals like your therapist and just say, you know, we're we're right now diagnosed ADHD.
21:29
Brian: Are you seeing ADHD?
21:30
Brian: Uh the school teacher can actually be a a pretty good advocate for ADHD and just can say, like, what are you guys treating there?
21:39
Speaker 5: There's nothing there, or yeah, you're pretty inattentive, but I think you're actually helping.
21:44
Brian: Uh yeah, like there's other sources.
21:47
Brian: In a in a hundred percent ideal world, you would say, Hey, I would like a second opinion, and they would be able to pull up a list of local child psychiatrists or similar in the immediate vicinity they could get in a reasonable time frame, but it's honestly it's it's logistics.
22:05
Brian: It's not like fear of offending the psychiatrist that's preventing that.
22:08
Speaker 4: Mm-hmm.
22:09
Apryl: So you could do a second so okay, I took my child to a psychiatrist or child psychiatrist, and now they have a pediatrician's appointment and I'm like, hey, this is what's they're on, this is what's going on.
22:23
Apryl: Can you give me a second opinion?
22:24
Apryl: I could do that as well, right?
22:26
Brian: Yeah.
22:26
Brian: A pediatrician can diagnose almost everything and they're pretty good at the vast majority of them.
22:32
Brian: Like if a pediatrician called me and was like, are you sure they have ADHD?
22:35
Brian: I would, I would question myself.
22:36
Brian: I wouldn't be like, no, I'm the child psychiatrist, bro.
22:39
Brian: Like, what are you, what are you doing?
22:40
Brian: You're the pediatrician.
22:41
Brian: Do you not, you know, stay in your lane.
22:42
Brian: No, their lane is, is my lane.
22:44
Brian: We're doing the same thing.
22:46
Brian: And we're all we're all just trying to treat the kid.
22:49
Brian: Like I'm more worried about making sure this kid gets the best outcome than I am about my ego.
22:57
Brian: By far.
22:59
Brian: And I don't know that I've met a doctor who doesn't think that I thought was a good doctor.
23:04
Brian: Not sure I've never met one that actually doesn't wouldn't wouldn't agree with that, but they're probably out there.
23:11
Speaker 2: The pediatrician you know has watched the kid grow up so often.
23:15
Speaker 2: True.
23:15
Speaker 2: Yeah.
23:15
Speaker 2: I mean they're the one that they go to when they have an ear infection.
23:20
Speaker 2: They also have their their annual checkup.
23:23
Speaker 2: I think frequently that person, the pediatrician, has more data points than the child psychiatrist.
23:29
Apryl: Yeah that's a really good definitely carries weight.
23:34
Apryl: Yeah.
23:35
Apryl: Yeah that's really good.
23:37
Brian: Also pediatricians are awesome people like they're there to hang out with kids.
23:41
Speaker 5: They're not there to pat the rego and they know a lot about ADHD this is not a this is not a mystery diagnosis to go to your pediatrician like I would love it if they were like I'm gonna ask my pediatrician please do.
23:58
Apryl: And if and here's my here's my phone number tell the pediatrician to call me if he has questions okay so speaking of doctors and talking to them if a parent is starting the medication conversation with their child's doctor what are the three to five questions they should absolutely ask.
24:17
Brian: So a parent starting medications this is like day one like you know what?
24:22
Apryl: They're coming in yes and they're like okay we're thinking about medication and they're they have questions for you.
24:28
Speaker 2: What would you say are going to be the most helpful I want Kate to go first though and then then I'll follow up um well the first thing that comes to my mind is we need to make a list of what behaviors we are trying to target and have a goal for the medication.
24:44
Speaker 2: I think every time that we start a medication with no clear goal it then becomes well how do we ever discontinue that?
24:53
Speaker 2: How do we know when to increase the dose decrease the dose or stop it altogether?
24:59
Apryl: That's really good.
25:00
Apryl: I like that one a lot.
25:01
Speaker 2: I think that we need to counsel the parent on realistic expectations for what the medication can help with.
25:10
Speaker 2: And then how can therapy augment that medication we're working on parent-child interaction as well.
25:20
Brian: Mm-hmm That's I think the biggest thing that people miss out on is setting that goal right up front of we need medication, but we need medication because of this people come in and they're like I've got the ADHD diagnosis clearly I must need medications.
25:38
Brian: Wait, do you like what what is the the thing that we're trying to get the medication to do because there's many different medications and it's possible that you don't even need medication.
25:48
Brian: It's possible that your diagnosis is not dysfunctional enough or disruptive enough or the medications the way they would benefit you is not in favor of doing medications.
25:59
Brian: So setting a goal of my child's having a difficult time paying attention in school he's socially falling behind he's not getting his homework done and like some of these goals that can say okay sounds like the biggest thing is school.
26:16
Brian: If we can get school handled that would be good and paying attention school's where it's at great this is a crystal clear uh stimulant case versus you know he's he's anxious constantly he doesn't want to go to school he's he's nervous to to be at school he doesn't want to leave home well that's a whole different thing that that looks completely different than and the stimulant would maybe make that worse with the anxiety may make it worse or you're missing the target and you're not using the right therapy to begin with.
26:45
Brian: So setting a clear goal that's got to be like number one by a long ways.
26:50
Brian: Other like good things you could ask though is how long am I going to be on this medication?
26:56
Brian: Because that can be very different.
26:58
Brian: And what do I do about side effects if I get you know we usually talk like the first common side effects and what kind of side effects mean that I need to stop this medication and come back and see you versus what kind of medicate or side effects can we just kind of power through and daily go away or whatever.
27:19
Brian: Dose timing like if I miss a dose what should I do?
27:24
Brian: Because some of these like long acting stimulants like a 12 hour stimulant if you miss your morning dose and it's like oh shoot it's after school now should I give it a they're not going to sleep all night the the biggest is is setting a clear goal.
27:40
Apryl: That's super interesting because when our daughter got diagnosed there was no talk of goals or I mean Yeah it's it's kind of a missed thing.
27:50
Brian: Like it's especially like in outpatient and the I guess like less specialized you are, you end up having like quicker appointments so like FamilyMed will have a lot of appointments in a day and it it ends up being like okay you've got ADHD here's the medication.
28:08
Brian: And most of the time it's the right choice but you didn't set the goal up front of what we're actually trying to tackle where if you're able to have like a half hour, 45 minute or a you know heaven forbid, like an hour appointment, you can set these goals and just say, okay, here's going to be our goal and here's how we're gonna track it and here's what we're gonna do to try and reach that goal.
28:29
Brian: And here's how much meds we're gonna potentially need to get to that goal or here's how much therapy.
28:36
Speaker 2: And I think with the medications particularly the stimulants a concern that a lot of people have or a fear is that their child will become addicted to the medication.
28:47
Speaker 2: I think that's you know before I got more education I think that's something that I even thought of and you know the research research shows that children who are medicated are less likely to develop addiction as compared to ADHD kids who are not medicated.
29:04
Apryl: Yes that's a huge I think that's one reason my parents are so afraid to medicate is because I think I don't know where that myth started.
29:14
Apryl: I guess because it has like the word methylphenidate in it.
29:17
Apryl: I don't know like but that is definitely like a very common believed myth yeah the amphetamine too yeah where it definitely has a lot of fear.
29:30
Apryl: Yep.
29:31
Apryl: Yeah okay I love that I think that's super helpful and practical for parents to be able to do with at a doctor's appointment.
29:40
Brian: All right Kate one super psychiatry tip that you have for parents that you're like man I just wish parents would ask this or do this when when we're working with them good question.
29:51
Apryl: Or maybe here's one too you can answer either one or both what do you find is the most shocking like information about ADHD that you've learned being in the psychiatry field that you didn't realize before you were in this field?
30:12
Speaker 2: I think what I wish parents would ask the most is how can I incorporate positive feedback into my parenting and helping my child with their diagnosis?
30:23
Speaker 2: Because so often with children who are struggling child or parents will resort to really punishment as the primary form of how they shape their child's behavior.
30:37
Speaker 2: Whereas I think that you know punishment's really only effective if it's paired with positive reinforcement praise.
30:44
Apryl: Mm-hmm That's such a good point.
30:47
Apryl: And and like all the research shows and I mean this is with every kid but ADHD especially they thrive off of the positive and they hear so much negative that that's a really really good one.
31:02
Brian: I wish that parents would ask when they're when they're on the phone call just saying hey is there something just maybe one or two things that you think I could do or change or implement that that would help my child I think uh I think it's I think it's always like hard to tell parents like you're you need to change this or you're the problem.
31:26
Brian: Well yeah it's you it's not them I mean sometimes they're the problem but a lot of the times there is just like a few things and it's hard to just say you know you need to do this and this and this.
31:41
Brian: Like it feels like there's this barrier there of parents not realizing that they're part of that and need to make a few changes.
31:53
Speaker 3: Yeah and I think the family aspect is one of the things that helped me fall in love with with child psychiatry is that you are dealing with you know a system right child and the parents and how can you help all those parties work work together.
32:12
Brian: Yeah getting everyone on the same team and I mean because it really is like the environment how they're treated what systems are in place at home all of those things come together to make the child successful yeah it's exactly it's what makes child psychiatry cool is that there is so many different aspects where some of these things like other parts of medicine are like here's the here's the problem you've caught this bug here's the antibiotic and good luck.
32:45
Brian: And it's kind of just like plug and play where this is there's so many different factors going into it and so many different symptoms and sometimes the symptoms aren't created by the things that we think they are.
32:55
Brian: Yeah it allows for creativity so that if you want to be really good and you can dive deep you can you can be really good.
33:08
Brian: Like it's infinitely deep as to how good you could be all right back to your other question.
33:13
Apryl: You had one more question and then it was the um oh symptoms of ADHD most shocking yeah like but you didn't know about ADHD until you got into psychiatry oh jeez I think it's the trauma that children with ADHD experience just from the fact that they have ADHD I think I remember Dr.
33:45
Speaker 2: Bradford when you mentioned to me the number of times that children with ADHD are yelled at um or or punished and how that can really be traumatic for a kid and create a really negative negative self-concept for them moving forward which is in itself a trauma created really from the diagnosis of ADHD.
34:13
Apryl: Mm-hmm yeah or the undiagnosis you know like I mean this happens right if they're not diagnosed too if you they have ADHD they're just constantly stop that don't do that.
34:23
Apryl: You're driving me crazy you're annoying that's all they hear.
34:26
Brian: Yeah it's weird because if it was like any other diagnosis like schizophrenia or or let's say diabetes your blood sugar's off you're a bad person like over and over and over I mean it's it's almost ridiculous to think about but ADHD kids are being punished for a medical diagnosis not for like true like intrinsic morals.
34:51
Speaker 3: Yeah right because people think that they should be able to help it that they should be able to behave which is really sad.
34:59
Apryl: That's that's a really good one the trauma.
35:01
Brian: I would say like socially the ADHD kids struggle and I don't think I realized it growing up but once I hit psychiatry I was like oh these kids are really struggling to maintain to to start relationships, maintain relationships.
35:16
Speaker 5: Mm-hmm and like these ADHD symptoms are just like they make it really hard to keep friends.
35:24
Apryl: Yeah sad very sad.
35:27
Brian: Luckily I get a new sh a new batch of resins every year.
35:30
Apryl: So my friends as soon as they get sick of me they graduate Kate's like my year's almost up yes Kate thank you so much for being here with us today it was a pleasure to have you and we will see you guys next week.
35:51
Brian: Thanks for having me guys thanks see you guys thanks so much for joining us for today's conversation on raising ADHD remember raising ADHD kids doesn't have to feel overwhelming.
36:02
Brian: Small shifts can make a big difference.
36:04
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36:14
Brian: And don't forget to join us next week for more real talk, practical tips and encouragement.
36:18
Brian: Until then you've got this and we've got your back