11-Year-Old Girl with ADHD and Anxiety

HELP FOR 11-YEAR-OLD GIRL: Dr. Quinn Answers a Mother’s Questions

Dear Dr. Quinn:
This combination of coexisting conditions can sometimes be difficult to treat as stimulants often make the anxiety worse.

You may need to treat the anxiety first with a drug like Celexa or Effexor (both are SSRI antidepressants). Then you need to add a low dose of stimulant to treat the focusing, attention, and ODD problems.

We did find success with Effexor 150mg once a day. She is still having focusing problems and she has some authority problems. (She was also diagnosed with a smidge of ODD).

You have yet to treat your daughter’s ADHD and ODD. Ask your physician about a low dose of stimulant. Starting low and gradually increasing the dose usually allows for improvement of symptoms without side effects or making other symptoms worse.

She is being home-schooled this year since her school district would not, under IDEA or Section 504, help her is ANY capacity! She seems to like the home-schooling, but she is with me 24/7. She has told my husband that at times when I discipline her she wants to punch me in the face!

This response is not uncommon. Girls with AD/HD have a great deal of difficulty interacting with their mothers particularly. Mothers of girls with AD/HD tend to be hypercritical of their daughters and need to guard against this problem. Girls often exhibit these symptoms, but don’t have true ODD because the oppositional behaviors are only directed towards their mother and not towards others. We recommend that the mother/daughter pair receive some counseling to deal with this issue.

Her psychiatrist said it is possible that she is bi-polar. I attended your seminar last Feb. and you said that in most of these cases it is NOT bi-polar, but ADHD symptoms and hormones. You spoke about a three-medicine combination that you both found to be helpful for these girls. Is eleven too young to be dealing with hormones?

The three-medicine combination was a long-acting stimulant for ADHD symptoms and emotional reactivity, an SSRI for mood problems, and birth control pills to even out hormones, if the girl has been menstruating for a least a year. Eleven is not too young for hormones to be surging as most girls in the US menstruate at about 12 years. Your daughter is too young for oral contraceptives, but she can be medicated with the other two medications if needed to address her symptoms.

Bipolar disorder is also often seen with ADHD. Sometimes, it is not “is it either, but is it both.” You need to continue to discuss this with your psychiatrist. Question what symptoms he feels are related to AD/HD and which to the Bipolar diagnosis.

Do you have any suggestions? She had problems with Adderall and her appetite – she lost about 7 lbs. She still does not have a great appetite and the doctor doesn’t want to put her back on Adderall because of it. Any help or advice you can give would be greatly appreciated.

You might want to try a low dose of Concerta (18mg) and gradually increase this slowly to avoid side effects. Only 4% of children on Concerta reported appetite decrease.

Best wishes to you and your daughter. Hope this answers most of your questions.

Patricia O. Quinn, MD

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