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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10643
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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What is the best treatment for 13 years old boy with in attention

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What is the best treatment for 13 years old boy with in attention and anxiety

Dr. Z :

Hello I believe I can help you with your concern

Dr. Z :

I am sorry that this young child has been having issues with attention and anxiety, but that is good that you are trying to get him the best help possible

Dr. Z :

May I ask for how long has this child been on the Concerta for?

Customer: For two years but stopped this year because of side effects
Dr. Z :

Oh okay, what side effects exactly?

Customer: Loss of appetite and agitation after withdrawal
Dr. Z :

Okay, I am so sorry he had to experience that. Well there are non-stimulant medication designed to help with ADHD that may not produce those side effects. They are called Strattera or Intuniv. These medications are also designed to not increase anxiety as much

Dr. Z :

In addition, I would like to ask is this young child able to go to therapy at all, or would he be willing to use self-therapy books? Or even online therapy if that is something easier for you and him?

Customer: He is not hyperactive but only in attentive with specific math difficulties , will strattera help in that . He is not fluent in English and going to a therapist is possible.
Dr. Z :

Strattera is effective for the subtype of inattentive ADHD and should not have those side effects that you mentioned. A good type of therapy would be called Cognitive Behavioral Therapy (CBT) that can help manage his anxiety. I can provide you with some books with techniques so that you can teach him these techniques to help with his anxiety if you like

Customer: This would be great.. Please do and the other thing is the math difficulties if you have any suggestions or helpful website I would appreciate it a lot
Dr. Z :

What specific math difficulties is he having? Is it just inattention when it comes to math or possibly confusion when reading the numbers?

Dr. Z :

So here are some good books for the anxiety that may be able to help him

Dr. Z :

Also some individuals with ADHD also have a learning disability called Dyscalculia, which can cause specific math difficulties. A therapist that specializes in learning disabilities will be able to help him, but also this book contains great techniques to help him as well.

Dr. Z :

Also this is a good book to help manage the inattention difficulties associated with ADHD

Dr. Z :

I know you are in Saudia Arabia, so I was not sure which website would be best for you to get your books, but I wanted to at least provide you with the names of the books

Customer: Well the in attention makes it worse but he was diagnosed to have a comorbid math difficulties as a specific learning difficulty he doesn't grasp the math concept
Dr. Z :

The comorbidity does sound like Dyscalculia then and that book contains some good techniques to overcome this issue. Learning disabilities are very easily managed with techniques to help the child adjust and adapt

Customer: Thanks a lot for the great books. One more thing. His anxiety seems to dominates the picture and bothers him a lot. I was told once that the treatment of the anxiety alone might help the inattention.. Is that true
Dr. Z :

It is very possible, moderate to severe anxiety can cause attention issues and can cause him to be easily distracted. The CBT books on anxiety I gave can help with that, as can the Strattera. Stronger anti-anxiety medications would be the SSRI antidepressants (very good with anxiety) and also a benzodiazepine (e.g. Ativan, Xanxa, Klonopin) can be used for anti anxiety as well. But I would use the Strattera and the CBT techniques first and see how he reacts

Dr. Z :

This is a link for something called Progressive Muscle Relaxation that can help you create a long term calm by using muscle tension and release techniques; it can help manage his anxiety and is very similar to a style of meditation.

Customer: So what is the starting dose of strattera and how frequent is it used?
Dr. Z :

Does he have any medical problems concerning his liver or kidneys?

Customer: No
Dr. Z :

Okay well then the starting dose should be 40mg/day and can be gradually increased to a maximum of 100mg/day

Customer: Great.. He weighs 49 kg .. So this should be fine for his weight?
Customer: Not 49 am sorry it's 40
Customer: Any side effects I should watch for? And is it given once daily
Dr. Z :

Well for that weight, I would probably start on an initial dose of 30mg and not go higher than 60-70mg depending on the severity of his inattention difficulties

Dr. Z :

Some doctors want you to divide the doses and some will want it once a day, it really depends on who prescribes the medication, but here are a list of side effects for you

Dr. Z :

There are a lot on the list, but they typically do not happen very frequently and are manageable and usually there is less incidence of severe side effects when compared to the stimulant medication

Customer: Thank you very much dr.Z .. Last thing I would like to know if Omega 3 helps in this case and if yes is there any product name for omega 3 ?
Dr. Z :

Omega-3 (fish oil) helps with mood symptoms and may help with his anxiety to a degree. There are also no interaction effects with the medication and Omega-3. What do you mean by product name changes exactly?

Customer: We have many generic product for omega 3 In Saudi Arabia but non is for children . I was looking for something I can order from the net if available
Dr. Z :

Well I personally use Nordic naturals as I felt they have the best type of Omega-3 out there and they do have a Children's version as well

Dr. Z :

I found Nordic Naturals to have the purest form of Omega-3 and it what we use for patients as well

Customer: Thank you dr.z that was really helpful
Dr. Z :

Anytime, is there anything else I can assist you with?

Customer: No thank you
Dr. Z :

Well I wish you and him the best of luck with his anxiety and ADHD treatment. My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Customer: Thank you very much
Dr. Z :

You are most welcome :)

Dr. Z and other Mental Health Specialists are ready to help you

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