Advances in the Management of Complex ADHD in Pediatric Patients - Episode 11
Theresa Cerulli, MD: Any quick tips before we wrap up with my next question? Any quick tips before we move on to, for families in a situation with COVID-19 [coronavirus disease 2019] now, remote learning and addressing ADHD [attention deficit hyperactivity disorder] symptoms?
Frank Lopez, MD: One of the things I’ve done in the last couple of months is instead of going every 3 to 4 months between visits, I’m actually doing 2 months between visits. Instead of making them longer visits, like 45- or 50- minute visits, I’ll do like 15- and 20-minute visits, and it gives me an opportunity to provide remediation, reminding them of their structure, the need for the appropriate support and location. That has been helpful, and it’s really the groundwork for telehealth for these individuals.
The other thing I’ve seen is a lot of sadness in terms of the parents. That’s playing a role, and that is leading to depression in the parents, which will affect the child. It’s an opportunity for me to talk to the parents—not just see the child, but to see the whole family and support them. It’s important. They’re saying we’re all in this together. We are, and we’re in it together throughout this entire piece and beyond.
The other option for clinicians is that there are quite a few telehealth programs that have an otoscope. Now, mind you, my first training is pediatrics. I am a neurodevelopmental pediatrician, and you are a child psychiatrist. So I do a lot more of an exam with the kids when they come in. Then again, I’m OCD [obsessive compulsive disorder] when it comes to getting data like that. But at the end of the day, I would suggest that they look at the different telehealth programs, because some of them even have otoscopes available and heart rate monitors available as part of what they send the parent when you sign up. I think the cost is something like $50 for the entire duration, where they get the otoscope and a heart rate and blood pressure monitor that plugs into and you can see on your computer. However, the telehealth program for us would be high end. Nonetheless, it’s something to consider. If the parent wants to learn how to do their own blood pressures, go for it. Structure.
Theresa Cerulli, MD: Structure, right, you took the words out of my mouth. Structure is your best friend.
Frank Lopez, MD: Yes, it is. Absolutely. Structure, consistency, compliance, and supportive statements of good tidings of hope that this is not something negative.
Theresa Cerulli, MD: Frank, it’s such an important message: the positive reinforcement. On that note, what advice do you have for clinicians on explaining ADHD to parents and children, to promote their understanding of this disease state and adherence to the therapy?
Frank Lopez, MD: Knowing you, I think I would say it in unison. You’re not mentally ill because you have a diagnosis of ADHD. Yes, you have a neurobiological disorder that requires support. Treated, the outcomes are much better obviously than untreated. The hope is that when you talk to the parent and to the child, in my mind, what I do is I take a little chair, and I sit at the same height as the child stands, so that he, she and I are on the same eye level. I try to do the same thing mentally with the parent. We can all be up here and describe the signs, the symptoms, the expectations. But the typical parent, it’s going to go like this. The idea is to bring it down. Bring it down so you are on an equal footing with not only the parent but also the child. Don’t leave the child out. The child is critical. They are the patient, and they’re the key to not only their improvement but the family’s improvement and eventually social acceptance of the child and the family. To me, that’s the biggest piece.
Theresa Cerulli, MD: Yeah, absolutely. Beautifully said. It’s such a collaborative process. It is a team approach, and the parent and child are both such an important part of this team, in addition to us as the prescribing clinicians.
Frank Lopez, MD: Yes. It’s well put when they say it takes a village. It really does.
Theresa Cerulli, MD: I would like to leave with certainly a message of hope for the clinicians who are listening. There has been such an evolution in our understanding of ADHD over the years. This is not the parents’ fault. It’s an underlying neurobiological, highly genetic condition that’s also highly treatable.
Frank Lopez, MD: Absolutely.
Theresa Cerulli, MD: It was the reason I chose within neuropsychiatry, when I was doing my fellowship, to specialize in ADHD as my area of interest. It was because it was so rewarding to work with these patients. The treatment interventions we’ve had—they work, right? The combined pharmacological and nonpharmacological treatments lead to good outcomes when you can educate and support the families and having access and follow-through. A message of hope is that it’s really very rewarding. Thank you so much for listening to this discussion because it’s important, and you really can bring this to your patient families.
In closing, thank you for this insightful discussion. Thank you to our audience for watching this HCPLive® presentation. We hope you found this Peers & Perspectives® discussion to be useful and informative.
Transcript Edited for Clarity