Question: My son,age 7, has been diagnosed with ADHD thru various neuro physc. tests including “Quotient” exam. He struggles in school and home to focus. He basically can’t complete any school assingment without 1/1 help for redirection etc.

I currently have him in cranio sacral therapy in hopes that midline and coordination therapy will help him. (he cant military crawl, crab crawl etc.) He will also starts vision therapy soon for a tracking problem.

I have a family history of hypothyroid My son shows no outward signs of it,, weight gain etc. But I have heard that it can cause ADHD symptoms in children. Is it worth it to have him checked?

If his thyroid levels come back normal, would anyone do a trial medication for him? My levels were normal despite numerous debilitating symptoms of hypo. Also, I cut my thyroid meds in half during the summer months as I recognize my needs changing. Then my hypo symptoms come back with a vengeance during winter months. I notice that my son has more difficulties in the winter and is moody. He has frequent skin problems (extremely dry, rashes, bumps etc) all winter.

I am cautious about ADHD meds. and I want to be certain there is no other underlying problems before I subject such a young child to them, but I worry I am looking at too many aspects when trying to help him.

Dr. Anne Fenton: You raise some interesting questions.  First, let me say that there is some research supporting the existence of “subclinical hypothyroidism”.  This is a condition in which some of the symptoms of hypothyroidism occur, but blood levels of thyroid hormone fall within normal range.

In the absence of lab data supporting clinical intervention, it would be quite risky to treat the condition with thyroid hormone.  The side effects of thryoid hormone supplement can be quite serious, sometimes even life threatening in and of themselves.  For example, excessive thyroid hormone therapy has been known to produce symptoms of tachycardia (rapid heart rate), high blood pressure, stroke, arrhythmias (irregular heart rate), hyperexcitability, hyperactivity, and even mania and psychosis.  So it is highly doubtful that you would find a pediatrician or pediatric endocrinologist who would treat your son for hypothyroidism without hard data.

In addition, given that your son has been diagnosed with ADHD, (attention deficit disorder with hyperactivity) and not ADD (attention deficit disorder without hyperactivity), it is unlikely that a low thyroid hormone level is the cause.  In hypothyroidism, people are sluggish, not hyperactive, and have attentional issues due to slowed brain function rather than due to distractability from external stimuli.

In terms of the relative risks of thyroid hormone supplement vs standard ADHD medication, it can be far less risky to offer him a trial of a short acting ADD medicine such as Ritalin or Adderall.  First, these medications are out of the system within hours.  They work quickly.  As soon as 20 to 30 minutes after taking them, a person can experience a noticeable improvement in their ADHD symptoms.  With thyroid hormone supplement, a person often does not experience the results of the trial for several weeks, and it takes up to 3 months of daily dosing to stabilize on any particular dose, and sometimes even longer to achieve observable results.

When I see a child with an ADHD diagnosis, I often recommend starting with a low dose of one of these medicines.  I look at it as a test dose, to see whether the medication will be helpful, and also to minimize the possible side effects.  The goal is to achieve the minimum optimal dose which will relieve the child’s symptoms so that he can function as well as possible without interference from side effects.  Typical side effects are appetite decrease and difficulty sleeping (if the medicine is taken after 4PM).  However, since these medicines primarily help children to focus at school, they are seldom needed beyond school or homework hours.  Therefore, they are out of the system by bedtime.

In addition, thyroid hormone has to be administered every day, whereas ADHD medicines can be given only on days they are needed, like school days.  Often, children do not take the ADHD medicines on weekends, holidays, summer vacation, etc. unless they need them for other symptoms associated with ADHD, such as reckless behaviors, oppositional behavior, defiance, or aggression, all of which can be symptoms of ADHD related impulse control issues.

In regard to your treatments that do not involve mediation trials, there are other programs that have been used with some success to “re-train” the ADHD brain.  Two software products that come to mind are “Cog-med” and “Fast-Forward”.  Suggested reading includes Doidge’s book called “The Brain that Changes Itself”.

All in all, the most effective, efficient, and reliable treatment for ADHD to date, in my opinion, remains Ritalin, Adderall, and their time released forms which offer up to about 10 hours rather than 3-4 hours of benefit per dose. That is not to say that medication and non-medication treatments are mutually exclusive.  I see many patients who employ a number of modalities simultaneously, depending on the nature of the condition, age, and other factors.  The school your son attends should also be involved in offering whatever academic modifications may be most helpful.