Dr. Haneen Jarrar explains to podcast host Maria Botros why, as a psychologist, she is very conservative when it comes to prescribing medication to people with ADHD or ADD.
I do not prefer giving medication to children before the age of 7 because the brain is still developing, says Dr. Haneen
Dr. Haneen: In some cases, medication can be helpful, which is why I’ll bring in a psychiatrist after we’ve tried therapy, and I’ve looked at the child’s adaptive functioning in all settings
I look at medication as an added value to my therapy plan, not as a replacement, says Dr. Haneen
Dr. Haneen: We know from scientific research that therapy changes the composition of the brain
Let’s say I have 50 ADHD cases, only 2 will require psychiatric medication, says Dr. Haneen
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I do not prefer giving medication to children before the age of 7 because the brain is still developing, says Dr. Haneen
Dr. Haneen: In some cases, medication can be helpful, which is why I’ll bring in a psychiatrist after we’ve tried therapy, and I’ve looked at the child’s adaptive functioning in all settings
I look at medication as an added value to my therapy plan, not as a replacement, says Dr. Haneen
Dr. Haneen: We know from scientific research that therapy changes the composition of the brain
Let’s say I have 50 ADHD cases, only 2 will require psychiatric medication, says Dr. Haneen
Read the full story here:
See more videos at https://gulfnews.com/videos
Read more Gulf News stories here: https://bit.ly/2HLJ2km
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00:00As a psychologist, I'm known to be very conservative with medication.
00:04I don't like, in general, medication before the age of seven,
00:08just because, like we said, the brain is still developing.
00:11Right.
00:12But medication can be really helpful in some cases,
00:14because in some cases I look at the functioning,
00:17I look at the adaptive functioning of the child,
00:20again, at home, school and social life.
00:30So, what are the assessments that you do with children,
00:38other than the MRI?
00:39I mean, we spoke about that,
00:40but what are some, like, practical assessments that you do?
00:43Like, when a child comes in, you know, and sees Dr. Hanine,
00:47what are certain things that you do to determine whether or not
00:50they have these difficulties?
00:52The MRI is only used for research.
00:55We never recommend MRI to detect ADHD or not.
00:59That's just, you know, research purposes.
01:01But there is a gold standard,
01:04and we take it from the people who have created the DSM.
01:08It's very Western-based, by the way.
01:10It's a whole other topic.
01:12But basically, what we need to do is we need to do an initial consultation.
01:17You take all the history of the child,
01:18and then there are what we call standardized assessments
01:21that are done for children,
01:23that will look specifically at the child's ability to focus,
01:26concentrate, impulsivity control.
01:29One of them is the WISC, which is the IQ test.
01:32Okay.
01:33The other one is called the WIAT,
01:34which is an educational test, for example.
01:37Then a school observation is done,
01:39where the child is observed in school,
01:41if they're younger than 12.
01:43You do a teacher interview.
01:45Lots of questionnaires.
01:46They're standardized questionnaires to see
01:48if the level of difficulty is within clinical significance.
01:53Because like you said, some kids are hyperactive,
01:55but that doesn't mean that there's anything.
01:57So you check if this hyperactivity,
02:00is it within clinical significance or not?
02:02The attention, is it within clinical significance or not?
02:04Is there anything else going on?
02:07And the child gets an interview as well.
02:09The child fills a questionnaire.
02:10You have a chat with the child and get their point of view.
02:14Then you write out a report,
02:15and you meet with the parents first and the school second.
02:18So the school is heavily involved in the whole process.
02:23And we're very lucky in Dubai.
02:24Schools are so open.
02:26There's so much training that goes into this.
02:29They're very involved.
02:30They're very willing to do whatever it takes.
02:34Any resources, they get on it.
02:36So I've been very, very lucky with all the schools
02:40that I've been working with,
02:42that they are very open to anything that needs to be done.
02:45Sometimes you feel like there might not be resources
02:48from the school itself.
02:50But in general, schools are very open
02:52to receiving this kind of information.
02:56That's great.
02:56I mean, it's good to have at least teachers that are receptive
02:59and that are willing to be part of the solution
03:01rather than making it worse.
03:04Is there any case, without mentioning too much
03:08and revealing their identity, of course,
03:10but is there a case that you would think is worth mentioning,
03:13like a child that came in maybe that spoke to you or a parent?
03:18Is there anything that came across
03:19that you felt like was fascinating
03:21or a case that required some extra attention?
03:26I mean, it's always, for me,
03:29it's always nice to see how the child can take this
03:34and turn it into a uniqueness for them.
03:37Okay.
03:38So you're going to know how many years
03:40I've been in practice from this story.
03:43This child came to me and he was diagnosed
03:46and he was really struggling in school.
03:49But then with a lot of support and a lot of therapy,
03:52he came to visit us years later.
03:54He was a very successful director.
03:57So he said to me, don't get me wrong, Coach Haneen,
04:00I still can't sit still.
04:02Okay.
04:03But now it's a good thing
04:06because I can be on set and then I can have meetings
04:10and then, you know, this energy is serving me well.
04:13Yes, I'm late to meetings
04:15and yes, I can't put things in writing
04:18and I have an assistant that has to follow me around
04:20because he's an ideator.
04:22He has lots of creative ideas
04:24because, subhanAllah, when one part of your brain
04:26is a little bit, has a little bit of a deficit,
04:29other parts of your brain are very active.
04:32So he is so creative.
04:34Like I've seen his movies.
04:35They're very, I'm like, how did he think of that?
04:38So he's taken this, whatever you want to call it,
04:43and he's focused on the good qualities.
04:47And this is, for me, this is what I hope to do
04:50is be able to support the child enough
04:52so that they can function in whatever school system,
04:56university if it's applicable,
04:58but then really zone in on what makes them unique,
05:01which can be something that only their brain has
05:06because their brain is wired in a completely different way.
05:10I love that and I think that gives hope
05:12to everyone listening.
05:13I mean, turning whatever it is that this child
05:16may have had as, you know, developed into an opportunity,
05:20into something great, into their success,
05:22potentially down the line, and just like your patient.
05:27So...
05:28Client.
05:28Client. I like that.
05:30I was going to say...
05:31Patient reinforces it from the medical model.
05:33Of course.
05:34That, you know, there's something wrong with my stomach.
05:37I fix it.
05:38But client is like you and I.
05:40Like a guest.
05:41A guest that's coming to visit.
05:42I'm not here to fix a problem.
05:44Yes.
05:46I'm here to help you grow into your potential,
05:48whatever that might be.
05:49Of course.
05:50No, I absolutely like that and I appreciate
05:52that you keep reinforcing that.
05:54Please continue to do that because I absolutely agree.
05:57And I think the key that you just mentioned is,
06:01you know, when someone is, let's say, deficient in one area,
06:05you find that in other areas,
06:08it's like their senses are heightened,
06:09their creativity is heightened.
06:11It's like they've overcompensated.
06:14They've been overcompensated in those other areas.
06:16So I absolutely agree.
06:17It doesn't make them less competent.
06:19It doesn't make them less special.
06:21It just makes them extra special,
06:23as you said in the very beginning,
06:24is that we don't isolate these people
06:26because some of these people have taken us to the moon
06:28and have developed new medicines in the medical field
06:31and whatnot.
06:32Now comes the difficult question or like the difficult...
06:36Oh, those were easy?
06:37No, those were...
06:38Okay.
06:39I don't mean easy in application.
06:41I mean, the difficult, you know,
06:43option that some parents try not to opt for,
06:47medical intervention and medication.
06:50When do you know that a child needs medical intervention
06:54or medication?
06:55And how do you introduce it to the parents?
06:59As a psychologist,
07:00I'm known to be very conservative with medication.
07:05I don't like, in general, medication before the age of seven
07:09just because, like we said, the brain is still developing.
07:11Right.
07:12But medication can be really helpful in some cases
07:15because in some cases, I look at the functioning, okay?
07:18I look at the adaptive functioning of the child,
07:20again, at home, school, and social life.
07:24If the home is breaking down,
07:26there's so much fighting and an argument
07:30and relationships are breaking
07:31and even the parents are fighting
07:32and sibling dynamics are falling down.
07:35School is suffering.
07:36He's not doing well in school.
07:38So, doesn't have friends, is going into depression,
07:41doesn't sleep at night.
07:42If all of these three areas are functioning
07:45and I have been trying therapy for a year with a child,
07:49I then bring in a psychiatrist,
07:51but not any psychiatrist.
07:52I have a few that I trust
07:54and the reason why I trust those few
07:57is because I like the way they work.
07:58They're also very conservative.
08:00They start the medication off at very low doses.
08:03They always look at side effects
08:04because medication can be a plus for us.
08:07They give us, it's a good side,
08:09there are good applications for medications,
08:12but then there are side effects.
08:14So, what you try to do
08:15is that the positive things with medication
08:18outweigh the side effects.
08:20Once the side effects become so severe,
08:22you need to increase the dose,
08:23decrease the dose, change the medication.
08:25There are so many different medications
08:26that suit children, don't suit children.
08:29So, I'm always very conservative
08:31and I take it as an addition to my therapy plan
08:34and not the basis of therapy.
08:37I do not recommend for anyone
08:40to only base their entire treatment plan on medication.
08:44This is a big no-no for me
08:46just because medications are drugs.
08:49So, it's like coffee.
08:50So, if you take your cup of coffee,
08:52you will get energetic,
08:53but you won't change your muscles.
08:55The muscles in your body are the same.
08:57If you go to the gym
08:58and you change your muscles in your body
09:00and you get coffee, then that's great.
09:02So, this is exactly what medication does.
09:04It comes in, it gives you energy to focus,
09:07but then when it's out of your system,
09:09your brain hasn't changed.
09:10The neural connections in your brain,
09:13the frontal lobe that we talked about in your brain
09:16is not changed.
09:17But we know from research and from science
09:20that therapy changes the composition of the brain.
09:23Just like when you go to the gym,
09:24you can build muscle,
09:25just like that in therapy,
09:27you will build new neural connections.
09:29So, we will get a child where in the MRI scanner,
09:33it's green and blue,
09:36and then after two, three years of therapy,
09:38it's firing orange.
09:39So, you see that there's a shift.
09:41That doesn't happen with medication.
09:44And so, I'm a true believer in therapy, therapy, therapy first.
09:48And then, of course, medication in some cases is a must.
09:51If the functioning is falling down,
09:55then yes, I need medications.
09:57But let's say I have 50 cases of ADHD,
10:00two of these cases only will require psychiatric medication.
10:04The rest, they're on therapy, interventions,
10:07changes in environment, parenting, planning, that's it.
10:12Not 50, we start off with medication and see how,
10:16and definitely not under the age of seven.
10:18I don't like medication for under seven
10:19just because the brain is changing.
10:21And medication changes the composition of brain
10:25unless, of course, it's a severe case.
10:27Then yes, under seven might be helpful.
10:30Medication might be helpful.
10:32And there are a lot of people that have bad experiences
10:37with therapy and so tend to go to medication
10:41as a fast kind of result-oriented kind of solution.
10:48But I always opt for therapy first,
10:50as a priority, medication second.
10:52I love it.
10:53I love that you said that they go hand-in-hand.
10:56Do not replace the medication,
10:58don't replace the therapy, sorry, with the medication,
11:00or vice versa.
11:01I mean, in some cases, you said, it is necessary.
11:05There are children that do require
11:08that medical intervention.
11:09They need the psychiatrist to come and assess
11:13and to give them that medicine.
11:14So, and as you said, some people have had
11:18really bad experiences with, you know, therapy,
11:21so they resort to the medication right away and vice versa,
11:24which is why I was asking that question,
11:28is because some parents have had bad experiences
11:31with these medications.
11:32And even though their child might need it severe,
11:36like they desperately need that medicine,
11:38they won't give it to their children.
11:40So what do you do in those cases?
11:41Like, how would you advise the parents?
11:44How do you explain to them the side effects?
11:46What are some of the side effects?
11:47And how do you at least reassure them that,
11:51you know, this is the right step for your child?
11:54Whenever there's a huge block with parents,
11:57I always try to understand the anxieties
12:00or the worries underneath that.
12:01And they're always very founded reservations.
12:05Oh, I read about this medication.
12:07This is antipsychotic medication.
12:08How am I going to give it to my child?
12:10What if my child can't sleep?
12:11What if my child can't eat?
12:13Am I changing my, am I a bad parent
12:16for putting my child on medication?
12:18Is this medication going to, what if I don't like it?
12:21So if you force it and you say,
12:23as the doctor, you have to,
12:26then that's not the way to go.
12:28But if you have an honest and open conversation,
12:30at the end of the day,
12:31parents will do what's best for their children,
12:33if they know, but they know that
12:35their children are their responsibility.
12:37If they mess up, it's on them.
12:39So they can't risk it.
12:40They can't be like, oh, let's give them medication.
12:42And then a part of them always feels,
12:44am I doing it for me?
12:45Am I being the selfish parent that just wants to relax?
12:48There's a lot of reservations.
12:50The right psychiatrist will talk you through all this
12:54and will do something called psychoeducation,
12:57talk to you about the different types of medications,
12:59what are the side effects.
13:01Some of the side effects are lack of sleep
13:04or lack of appetite.
13:05Some medications increase appetite.
13:08Some medications create anxiety,
13:10which is not helpful.
13:11Yeah.
13:12So there are different side effects
13:14for different medications,
13:15according to what the psychiatrist thinks is best for you.
13:19Okay.
13:19So this is actually the perfect segue
13:21to the shift in our conversation,
13:24which is attention difficulties in adults.
13:29And I think I've seen with friends
13:33and some of my peers
13:35that there was a resistance to some of these medications
13:38because of their personal experience
13:40as children who were diagnosed with ADHD or ADD
13:44and had to be put on meds
13:45and how awful it made them feel.
13:48And I know for a fact that some of them didn't get therapy
13:52and they were just on meds
13:54and they were, you know,
13:56resorting to dealing with this difficulty
14:00based on coping mechanisms by their parents.
14:03I mean, not by a professional.
14:05So, I mean, these are all things
14:08we're going to discuss in this next part.
14:10But first off,
14:11have you seen an increase in the number of diagnosed adults?
14:15I know that you work with children,
14:18specifically, but have you seen or heard
14:20that there is an increase in the number of diagnosed adults
14:24with, you know, attention difficulties?
14:26Definitely.
14:28I think if I'm remembering statistics correctly,
14:32there's a 200% increase in developmental disorders,
14:37anxiety disorders, depression disorders since COVID.
14:40In adults?
14:41In adults and in children.
14:42And this is because of a lot of factors.
14:47One of them is because now it's information
14:51is so accessible to everyone.
14:52So people know, people are self-diagnosing now online.
14:56So people know what these effects are,
14:59what the symptoms are,
15:01and they're very easy to say,
15:02I want to get diagnosed.
15:04So this has increased the number,
15:07the increase in screen time and in technology,
15:11less time in nature, less movement,
15:13less interaction with the sun.
15:15What can I look out for as an adult?
15:16So we know with kids that it's the executive function,
15:20executive function issues.
15:21Yeah.
15:22Is it the same for adults as well?
15:24Same thing as an adult.
15:25So if you're an adult that struggles with timeline,
15:29deadline, managing your time, impulsivity control.
15:33Now impulsivity control in adults is different than children.
15:35Right.
15:36If you're impulsive as an adult,
15:37you're like, you shop till you are broke.
15:40Or if you smoke, you smoke till your lungs collapse.
15:44Or if you drink, you drink until you're, you know.
15:48So it's like, I cannot control my impulses.
15:50I cannot control the things that I like.
15:52If you like chocolate, you will eat chocolate until you,
15:55like first thing in the morning,
15:56and then you can't control your impulses.
15:59Yeah.
16:00You might have difficulties in social life.
16:03So you have a lot of fallouts with friends.
16:06And that's because it's a combination of social skills,
16:11confidence issues, impulsivity control,
16:13time management, planning an organization
16:16might be difficult for you.
16:18It might be difficult for you to focus
16:20on non-preferred activities.
16:22Sorry, the last thing that I forgot to mention
16:23is emotional regulation.
16:25Okay.
16:25So you might find that regulating your emotions
16:29might be very difficult for you,
16:31more than what, you know, seems to be normal or acceptable.
16:36Right, quote-unquote normal, obviously, yeah.
16:38And does that lead to burnout or other mental health,
16:41you know, implications?
16:42Anxiety is comorbid with ADHD in adults,
16:45anxiety and depression, because also as an adult,
16:48if you're always being told that,
16:51you can see that you're not doing very well in social life,
16:54not succeeding very well in your career, home life,
16:58you're always having fights with parents.
17:00So this will affect your self-esteem.
17:02And when self-esteem takes a hit,
17:04anxiety is always on the rise.
17:06So anxiety and depression are always comorbid with ADHD.
17:10A lot of the times, actually,
17:11people come to us for the anxiety,
17:14for the secondary issue.
17:15Yeah.
17:16And we dig deeper and we find there's ADHD
17:18and that's why you have anxiety.
17:19So we can't only help you with your anxiety
17:22if we don't help with the ADHD as well.
17:24What's your advice for adults
17:27who might be considering therapy,
17:29you know, in the long run,
17:32but just can't take that step?
17:34You know, they're dealing with their own challenges
17:37on their own.
17:38They find it difficult to open up to someone
17:40and they don't know what to expect.
17:42And then, you know, it's the back-to-school season.
17:44What's your advice for parents,
17:46you know, going into school,
17:47especially with their kids,
17:48you know, going into a new grade,
17:50you know, a new classroom,
17:52maybe a new school.
17:54How can you ease that process for children?
17:56So when you want to go into therapy,
17:59there is a lot of stigma associated with starting therapy.
18:03A lot of people feel like,
18:05but there's nothing wrong with me.
18:06I don't need therapy.
18:08Or when people hear that I'm in therapy,
18:09they're like, what?
18:10You're a therapist and you're in therapy?
18:12I'm like, yeah, just like a personal trainer.
18:15You wouldn't trust a personal trainer
18:17who doesn't have a fit body, right?
18:19Yeah.
18:19Just like that.
18:20It's the same thing.
18:21So therapy for me is not,
18:24it's not something that you do
18:26because there's something wrong with you.
18:28It's something that you do
18:29because you want to get better at something.
18:31It's something that you do to grow.
18:34Back-to-school can be nerve-wracking
18:36for kids, teenagers, even for parents.
18:40So usually what I advise is to prepare yourself beforehand.
18:43For example, two weeks before,
18:47try to get back into some sort of routine,
18:49especially with sleeping.
18:51Try to half an hour earlier each day
18:54to get back to the same amount of sleeping hours,
18:58to get back to the same amount of screen time
18:59because I know that screen time gets out of hand
19:01during summer vacation.
19:02Yeah.
19:03Prepare your kids.
19:05Talk to them about school.
19:06If there's a new class,
19:08tell them there's a new class.
19:09If there are pictures that they can see,
19:11show them the pictures.
19:12Show them the pictures of their new classmates,
19:15of the teachers.
19:17Our school does an amazing thing
19:18where they meet the school teacher before.
19:21Today, for example,
19:22we had a meeting with a school teacher.
19:23Everyone in class,
19:25and they saw the school teacher assistant
19:27in their classroom.
19:28Oh, that's nice.
19:28Virtually.
19:29Okay.
19:29New students who are completely new to the school
19:31come in one day
19:32and have a tour of the classroom of the school
19:36to prepare you for what's coming
19:37because if you see something,
19:39it's so much more relaxing for you
19:41rather than it's a new day.
19:43I don't know where to go.
19:44This is part of the worry that you get.
19:47I like to read social stories to my kids
19:49about school
19:50and how might I feel about school
19:54and excitement and worry
19:55and what might make me feel worried.
19:58And then embrace that the first week
20:00is going to be like that.
20:01It's normal.
20:02It's going to be chaos.
20:03You're going to be emotional.
20:04You're going to feel worried.
20:05You might not sleep very well the first day.
20:07It's normal.
20:08Human emotions are supposed to be up and down.
20:10We're not supposed to be happy
20:12and controlled the whole time.
20:13That's toxic positivity.
20:15So embrace it
20:16because very soon we're going to be
20:19very tired of the routine,
20:20the monotony.
20:22So that's going to be the first maybe week
20:24is going to be a little bit out of sorts
20:27but then hopefully everything will settle in.