Treating ADD When Emotional or Behavioral Problems Co-Exist

Dr. Alan Brandis Psychologist | Clinical Marietta, GA

Dr. Alan Brandis is a licensed psychologist practicing in Marietta, GA and Roswell, GA. Dr. Brandis specializes in the treatment of mental health problems, and helps people to cope with their emotional and relationship problems. As a psychologist, Dr. Brandis evaluates and treats patients through a variety of methods, most... more

Typical treatment for ADD is medication with stimulants such as Adderall (an amphetamine) or Concerta (a methylphenidate or Ritalin-type drug). Stimulants seem to work by correcting the low brain activity in the pre-frontal cortex, the area that manages the “executive functions” of concentration and focus, connecting cause and effect, and maintaining information in awareness so that it can be stored in memory. However, stimulants affect many areas of the nervous system, including any areas that are already over-activated, which can be causing some of the acting-out and oppositional behavior that has been problematic for adults who are dealing with that child.

Although the child is a candidate for a trial on stimulant medication, he or she should be observed closely if stimulants are used. Stimulants can create a “hyper-focus” condition in which the individual does better for a while, but over time the frequency and intensity of acting-out behavior can increase as anxiety or agitation is stimulated by the medication. Often, such a condition is “handled” by increasing the stimulant medication, re-creating the hyper-focus condition - with an inevitable increase in agitation or anxiety, or sometimes resulting in the "zombie" effect of dulling the child's emotions and personality.

If that cycle is observed, stimulant medication should be reduced or eliminated temporarily and a medication to improve emotional and behavioral regulation should be utilized. Once the mood and behavior is well-controlled, then the stimulant can probably be successfully re-introduced without the increase in anxiety or agitation.

Behavioral approaches are often a good idea, although they tend to be more effective once the brain chemistry is balanced appropriately and the child is more capable of responding to rewards and consequences with voluntary choices of behavior. Parents often feel that they have used rewards and consequences with little or no effect, but upon questioning we often determine that they have applied the approaches inconsistently or have used approaches that may not be optimal for that particular child. A review of the behavioral contingencies in the home is often helpful and gives the parents a sense of being able to affect their child in more positive ways.