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Oct. 17, 2022

Episode 69: Is Your Child Just Busy Or Is It ADHD with Dr. Walt Karniski

Does your child have difficulty focusing or paying attention? Are they hyperactive? And do you wonder if they may have ADHD? Today, we are talking to Dr. Walt Karniski, an ADHD expert and author for some answers. Listen in as he explains where ADHD comes from and helps us understand that the diagnosis doesn't mean that your kid is doomed. If you've ever wondered whether you or your child has ADHD, this episode will address some of those common questions. 

Walt Karniski is a Developmental Pediatrician. He trained at Boston Children’s Hospital, affiliated with Harvard Medical Center. He was the Director of the Division of Developmental Pediatrics at the University of South Florida, in Tampa, Florida for 15 years. He then opened a private practice and for 20 years, evaluated and treated children with ADHD, Autism, Anxiety, Learning Disabilities and other developmental difficulties. 

• [14:08] “The first question that I asked in my book is, is medication effective? Does it work? And there's actually three ways that we know that medication works and works extremely well.”
• [17:11] Dr. Karniski shares why there is compelling evidence that medication works.
• [19:54] “Many other people have been diagnosed with ADHD and they found ways to To make it a productive part of their lives…” 
• [26:54] Dr. Karniski explains, “as young as three years of age, we can distinguish that a child is having difficulty with hyperactivity, impulsivity, short attention span, distractibility…”

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DJ Stutz  0:13  
We think you should know that Imperfect Heroes podcast is a production of Little Hearts Academy USA.

You're listening to Episode 69 of Imperfect Heroes, Insights Into Parenting, the perfect podcast for imperfect parents looking to find joy in their experience of raising children in an imperfect world. And I'm your host DJ Stutz. Does your child have difficulty focusing or paying attention? Are they hyperactive? And do you wonder if they are maybe even you have ADHD? Maybe a friend or a teacher suggested the diagnosis, and now you don't know what to do? Today, we are talking to ADHD expert and author Dr. Walter Comiskey for some answers. He explains where ADHD comes from, why it used to be an advantage to have ADHD, and how for so many people, it is a challenge. He explains how ADHD isn't really a disease or based on actual pathology, but it is better perceived as being a maladaptive way of coping in today's complicated world. He also goes into detail about some of the medications that are available. And if you've ever wondered whether you or your child has ADHD, this episode will address some of those common questions. There's so much more to learn. So let's get started.

After tons of research, we know that gratitude is a key to psychological well being. Gratitude can make you happier, improve your relationships, and potentially even counteract depression and suicidal thoughts. But might the benefits of gratitude go beyond even that? Could gratitude be good for your physical health as well? Well, coming up on November 7th through 11th, I am hosting a five day gratitude challenge. Would you like the benefits of gratitude to be not just a part of your life, but a part of your children's lives as well, will come and be a part of us. And you can register at the website at Or just click on the link in the show notes. And it'll take you directly there. 

My kids, especially my boys, were super active kids, very big emotions, always wanting to test themselves and everyone around them. And it seemed that they just never stopped moving. When they got mad, they could be destructive and even violent. I went back to college when my youngest Christian was just a little guy. And the first class I took was a child psychology class. And that is when I went from being a history major to an early childhood major. And it was such a relief to realize that my kids were actually within the realms of normal. I also realized that different doesn't mean that they're not normal. And we may need to take a different approach or add some supports. But there are enough kiddos that are at some level of neuro divergence see that to call them not normal would just be wrong. Dr. Walt Karniskiki knows neuro divergence. And he explained that there are many more options than I was aware of. Let's listen in. 

Welcome, everybody. I'm so glad you chose to spend this time with us at Imperfect Heroes. And today we are talking about a subject that is near and dear to my heart. If you've been listening to me for very long, you know that among my five children, my youngest son is significantly ADHD. And so raising him, I'm just so thrilled we all survived to be quite honest. I have an expert in the field. It's going to help us understand a little more about treatments and things that we can do as a parent, and to help us understand that a diagnosis of that doesn't mean that your kid is doomed. And that's a big deal. So Dr. Walt Karniski. I am so pleased to have you here. Why don't you tell us a little bit about your background and what you have going on?

Dr. Walt Karniski  4:59  
Well Thank you, DJ, it's really wonderful to be here today, I met a developmental pediatrician I've been practicing for 40 years, in both university settings and private settings as well. During that 40 years, I've seen 1000s of children with developmental issues, learning disabilities, anxiety, ADHD, autism, cerebral palsy, and it has been my pleasure to watch children grow, and to develop the skills that they need to be successful on life despite those difficulties.

DJ Stutz  5:35  
That is so important. And thank you, for all you do. I'm sure you've touched so many lives. It's not just the kids that are affected, but it's the family members. It's the classroom, its friends, it just really is a broad spectrum of people that are involved with kids, whether they're with a neurodiversity or not, there's just this huge dome of people around them. So I'm wondering,

Dr. Walt Karniski  6:04  
in order to address that, can I just tell you a little story. This is taken care of and presented in my book as well. In that one day, I saw a new patient, this is about five or six years ago, saw a new patient, the mother was sitting in a chair opposite on the other side of my desk. And the child of a seven year old boy was sitting in a chair playing on his mother's phone playing a video game. I started asking her questions about why what she was hearing what she was concerned about. And I noticed that she was kind of answering the questions appropriately, but it seemed like she was getting ready to cry. I stopped and asked her another question. And at that point, she didn't say anything, she reached into her purse, and took out a notebook and handed it to me, this notebook was a calendar that she could fill out and then sent to the teacher, the teacher would fill, write a note and then send it back to her. And that way they could communicate about how her son was doing in school, I have to tell you that when I started reading through that book, I started getting tears myself, because I began to very quickly realize how this disorder affects not only the teacher, not only the parents, not only the other children in the classroom, but the child himself or herself as well. People seem to forget that the kids are aware of the difficulties that they're having, despite the fact that they might want to deny it. They're significantly aware of it. And so what I did in the book was I copied about 10 of those pages into the book, and then commented on what the mother and the teacher were talking about back and forth. And it really is a beautiful way of understanding what ADHD is, rather than listening to a doctor say, well, criteria say you must meet six have criteria. And so this really points out how ADHD affects all aspects of their lives and the lives around them.

DJ Stutz  8:10  
That is so true. And you're right, the kids are aware. And I think they start labeling. And I don't like to call it a self label, because these are labels that are imposed on these kids. And they choose to accept them, that they're the troublemaker that they can't sit still. They don't listen, they're aggravating their friends or they're doing this on purpose. They know better, you know, kind of thing. Yeah. And it does affect them.

Dr. Walt Karniski  8:44  
Absolutely. I also printed a letter in the book that came from one of the kids that I saw as well. He had gotten in trouble because he told the teacher to shut up. And then the next day he came in with a letter that he had written to his teacher. His parents did not ask him to write the letter. The teacher did not ask them to write the letter. He wrote it completely on his own. And he handed it to the teacher and went back to his desk. He should read it and she broke down into tears. In the letter, he said, Dear Mrs. Miller, I'm so sorry that I told you to shut up yesterday. Sometimes things just blurt out of my mouth that I don't seem to have any control over it. I can be the best kid in your classroom. But please give me another chance.

DJ Stutz  9:29  
Yeah, that breaks your heart. Absolutely. Bless their hearts. Yeah. And I remember with my son, it was really interesting. When he had teachers that really understood him, what he was going through how to work with him. He would shine he would excel. He would do great. But very often he also had teachers who just didn't know how to manage him and his ex As an energy, that nervous energy that gets up, I remember in sixth grade, which is a little older than the kids that we usually target with the podcast. But in sixth grade, he had an English teacher. And she was very hard on him. So he had have that nervous bouncing his knees or tapping his finger on the desk. He didn't even realize he was doing it, but it drove her insane. And we wound up going through the system principal, I was the PTA president at the school. Thank heavens, because that gave me access to maybe some extra conversations. But absolutely, yeah. It turned out that the assistant principal that we were talking to, he's ADHD as well. And so he understood, she refused to accept his homework because his date wasn't as in the right place on the page kind of a thing. And so she did a lot of damage to his self esteem to his, you know, now on the other end, he had a math teacher, that was, again, very high strung, I think, but just couldn't deal with Christians, little ticks and stuff. We got him moved from a developmental math class, to an honors class. And when I was talking to the principal, she's, that's the only class that has room available. I said, he's gonna fail this developmental class. It's so either fails developmental, or he fails in the honors class. And she put this is a really good teacher, he wound up with the highest grade in the class and the honors class. Because she understood him, she got him she knew how to help him manage the need to move and how to bring it around and understand what she was teaching. And so it really does have a huge effect on how people react to the child. It could be a teacher, it could be a parent, it could be a friend's parent, a coach, whatever. But how they react to the child really has a lot to do with how they perform, doesn't it?

Dr. Walt Karniski  12:07  
Yep, absolutely. You said it very loud and clear. Yeah.

DJ Stutz  12:13  
Well, thank you. So I hear and this is now because my son, he's about 35 now. And he's a police officer, and doing very well loves the work. But I know that when he was little man, I was ADHD. They're just busy boys. He's a busy boy. He's just, you know, boys have energy. And so I was kind of in my own denial, that ADHD was really even a thing. And it kind of had to be shoved down my throat for me to really accept it, then talking to a pediatric neurologist and getting more information. What do you say to people who think, you know, I hear comedians, my dad knew how to deal with my ADHD. You had a belt. And I straightened up. And I'm like,

Dr. Walt Karniski  13:03  
Well, when I hear parents talk like that, I remember, I diagnosed ADHD in a at a nine year old boy and started treating him both medication he did really well with the medication. But after about the fifth or sixth visit, the mother and father came in. And the father said, you know, I've been noticing I have some of the same symptoms of ADHD. And we talked about that, and and I said, Well, maybe you want to talk to your doctor about going on medication. He said, Oh, I've done just fine without medication. And at that point, his wife, sitting right next to him, rolled her eyes off a few times stirred her head and said, I don't know about that. But and so I think it it is a disorder that affects every aspect of children's and adults lives as well.

DJ Stutz  13:53  
What you just brought up medication. So there's a lot of pros and cons that we hear and that the medication is dangerous to the kids and blah. So can you help clear up some of that?

Dr. Walt Karniski  14:08  
Sure. The first question that I asked in my book is, is medication effective? Does it work? And there's actually three ways that we know that medication works and works extremely well. The first way is to look at the research that is published every year across the world on the topic of Attention Deficit Hyperactivity Disorder. There's approximately 350 research studies published every year. These are not opinion pieces. They're combined research studies, in almost every one of those studies point to how effective the medications are in a classroom, in the job setting, in a marriage. And all of those studies that 350 studies indicate that medication as a very positive effect on children's learning, their ability to get along with their peers, their grades. So that's one of the ways that we know that medication is effective. The second way is by looking at what happens when children are diagnosed with ADHD and then grow up to be adults, we find that those children are much more likely to have educational difficulties. Now, that's not surprising. We know that ADHD expresses itself in school. But children with ADHD are more likely to receive more lower grades, they're eight times more likely to be retained or expelled in school. But when children grow up, they continue to have difficulty as adults and especially in employment. It's been determined that children who have ADHD as adults change jobs more frequently, they're less likely to be happy with their jobs, they're more likely to have poor job performance. And they often make less money than somebody else doing that same job. Matter of fact, one study showed that there was a $10,000 difference, after controlling for all other factors, a $10,000 difference in what ADHD adults made versus non ADHD adults. But here's the most surprising thing about that. When these children are seen as adults, if they continue to take medication as adults, they have far less of the problems that I just enumerated. So for example, children who have ADHD are two to six times more likely to be in a car accident. But if they take their medication, they're 38% less likely to have a car accident. So what it shows is that every one of these areas, the fact that ADHD adults are more likely to be remarried, they're more likely to get divorced, they're more likely to have a child out of wedlock, they're more likely to abuse substances that were likely to smoke earlier at youth alcohol earlier. In yet, if you look at the same people when they're taking their medication, they are no different from the group of people who don't have ADHD. That, to me is compelling evidence that the medication works. The third way that medication works is by looking at brain scans. And a number of studies about 10 years ago started looking at the brains of children with ADHD. And they found that children with ADHD had three areas of the brain that were smaller than children who did not have ADHD. Those three I won't enumerate those areas. But those three areas were the three areas that are most important in learning and retaining memories in organizing children's approach to learning and towards what is called executive function is well, here's the surprising thing. It was interesting to find that there was three areas of the brain that were smaller in children with ADHD, but it didn't occur consistently enough. He used as a diagnostic tool. But what we did find is we waited 10 years to those children became young adults. And they were brought back into the research lab and rescanned again, this time, what they found was in the adults now, who had not taken ADHD medication that children, those areas of the brain were still smaller. Wow. But in those adults that had continued on medication or took medication as a child, they found that when they scan their brains as adults, those areas were now normal size are they compared normally to other people who don't have ADHD. This began to to suggest it doesn't prove it. But it has been done to suggest that the medication actually changed his brain structure to reverse some of the underlying problems of ADHD. So those three areas or those three methods of looking at ADHD have revealed to us that medication has a very strong impact on the overall lifespan of people with that.

DJ Stutz  19:15  
That really is surprising and amazing. So we're looking at this isn't something that we expect our kids to outgrow. They will learn to manage it. Correct.

Dr. Walt Karniski  19:30  
Some people not only learn to manage it, but they use their ADHD to boost them along. You know, Michael Phelps, the Olympic swimmer, had ADHD and his mother was trying to find something where he could use up his energy and she came across swimming. And of course we know how he's used his energy and in that setting, many other people have been diagnosed with ADHD and they found ways to To make it a productive part of their lives, but sometimes that requires marrying the right person, marrying the woman, or the spouse who's going to be organized and remember to pay the bills on time and get the access to the accountant on time. What we have found is that children with ADHD who grow up continue to have the same difficulties, but some of them are able to use that productively. If they have a wife that attempts into the details, an executive secretary, that remote reminds him more to be for his meetings. And then those those people can do extremely well. And even better sometimes than people without ADHD. The problem is we force children to live a very specific kind of life when they're in school, we don't change the way we teach the children based on how they learn, we expect them to learn how we teach. As a result, we don't give them the freedom that adults have to choose their job, an adult is going to with ADHD is not going to do well on an assembly line, picking out objects that need to be returned and fixed, he's not going to be able to pay attention to that very well. But an adult with ADHD can do well as an athlete, they can do well as a sales consultant, something that has to do with working with other people, clinicians, therapists, as well are working with other people and ADHD, to enhance their abilities as well.

DJ Stutz  21:36  
Yeah, and I think that's what my son's finding in his vocation as police officer, is that working with people that interaction, I wonder sometimes too, because I had it explained to me with him by the pediatric neurologist was that we have all of this input around us, there's posters, there's the air conditioning, that that the the noise that comes from there, other people close, and we're able to kind of funnel it down so that we're only processing the information that is important to the task at hand, or what we're doing, where the way he explained it to me is, instead of a funnel, they have just a cylinder. And so they're not able to funnel out those things that are not necessary to the task.

Dr. Walt Karniski  22:30  
I think that's a big problem. You know, I've had parents tell me, when I made the diagnosis of ADHD, they would look at me and say, There's no way that he can have ADHD, play a video game for three hours, without interruption. And I see that very frequently in children with ADHD. But what I think is happening with video games, is they are getting distracted just as frequently as they get distracted when they're doing their math problem. But because the video game changes immediately, they're distracted away from their distraction back to the video game. So exactly right, right. And so every second, they may be distracted by somebody walking by them in the room, or by the air conditioner coming on, or by the cat running across his legs. But then suddenly, the screen changes and somebody attacks your character on the screen, and you have to jump back into the screen, you're distracted from your distractions. I see that all the time as well.

DJ Stutz  23:31  
That's so do you think that things like video games are productive for these kids? are? Are they a hindered to them?

Dr. Walt Karniski  23:41  
Well, the fact that they can watch the video games for an hour is a plus. But what they're gaining from that is another question. And I think that's a whole topic of discussion, we could do an entire podcast on whether video games are helpful or not. So I think kids nowadays need to be exposed to the video games, because they're not going to be able to avoid it in their lives. But they need to be taught how to put limits on how much time they spend playing video games. And I don't mean that you put the limits on them. They need to be taught how to put the limits on themselves.

DJ Stutz  24:20  
Now there's the trick, isn't it?

Dr. Walt Karniski  24:22  
And that is a trick. That's absolutely right. That's not an easy task. But that's the task that is before us.

DJ Stutz  24:29  
Do you have any ideas on how a parent could try to help their kids establish that?

Dr. Walt Karniski  24:35  
Well, let me go back to the issue of medication for a second. You know, I've had parents frequently say, okay, maybe he does have ADHD, but can we try counseling first? Can we try behavior management? Can we try executive function training? Can we try biofeedback? In other words, they try many different non medication ways of treating the ADHD. Again, the research studies so that on a short term basis, some of those interventions are helpful and productive. But on a long term basis, they're not. Because what the brains job is, is to take that information and to compartmentalize it in the brain so that the, that child has access to that information, read his life, and if they've been taught how to attend, and how to focus, and how to learn, they need to be able to access that. And what we found is that children who attempt those non medication strategies don't seem to be able to learn the strategies until they are on medication. And the medication kind of opens the door allows them to walk through to get the therapy that it's on the other side.

DJ Stutz  25:46  
So we're looking at these things working in tandem. Yes. So I see kids coming in as young as three, four with these diagnosis of ADHD. I also hear other experts say, that's way too young. We can't No, three and four year old five year old kids are just kind of off the wall. Anyway, that's the nature of the beast. So what are your thoughts there?

Dr. Walt Karniski  26:10  
Well, you know, in another part of my life, my wife and I own a preschool, she runs the preschool, and we have about 110 120 students in the school at any given time. It's amazing, because every year, there seems to be one or two or three children that are having difficulties with distractibility, staying in their seat, not listening to the teacher running around the room. And each year, it really is up to the teacher to determine whether they can intervene with those behaviors and help those children learn or whether they need to get some outside help. And so I think over time, the preschool teachers in the school directors have learned how to distinguish that so as young as three years of age, we can distinguish that a child is having difficulty with hyperactivity, impulsivity, short attention span, distractibility. Now, having said that, I will admit that most clinicians, most psychiatrists, most neurologists, and Most pediatricians are uncomfortable starting medication and a child under five years of age, if there's a reason for them to be uncomfortable, because the research shows that the medications are just as effective and four year old kids, they are in six year olds, that the research shows that the children learn better, and are better prepared for life if they start on medication early rather than later. So yes, it is true that clinicians are hesitant about starting medication, they'll try other things first, or they'll look at a non stimulant medication. So a medication that is not in the same group as adderall or ritalin or Vyvanse, or those medications, but look at another medication that generally is not as effective, but also doesn't cause some of the same side effects that we talked about that in the book, how do you decide which medication to use? How many medications do you know, that are used to treat ADHD?

DJ Stutz  28:10  
Wow, I'm thinking of our Ritalin, Adderall. Gosh, I think there's like four or five that I can. They're not coming to my brain right now.

Dr. Walt Karniski  28:23  
But it's about four well, but do you know, do you know how many medications have been approved for the treatment of ADHD by the FDA 4646 medication. Now, here's the crazy thing. About 36 of those medications are stimulants. And we can talk about what it stimulates. But, but those are the most effective medications for treating ADHD. But those 36 medications represent really only two different generic chemical substance, methylphenidate and amphetamine. And the differences to make 42 brand name medication are in how the medications are prepared. So Methylphenidate is the main ingredient in Ritalin. It lasts about three and a half to four hours. So Ritalin is one brand name medication, but Ritalin Sr, is sustained reliefs and lasts five to six hours. Ritalin XR, is the long acting Ritalin and left eight to nine hours they try to is a skin patch that delivers that same medication into the body through the skin, so nobody has to worry about swallowing it. There's liquid preparations, there's oral preparations, there's orally dissolving pills. So each one of those different preparations gets a different brand name and allows the pharmaceutical company charge 10 times as much for that medication. But we find that in the process of the pharmaceutical companies making more money, they've given us a big gift. And that is more specific ways of treating children's ADHD. If you need a medication that lasts only seven hours And then we have and if you need one that lasts 14 hours, we have it. If you need some variability than the skin patches are incredibly excellent for that situation. So you can put a skin patch on begins to take effect in an hour, and it wears off an hour to two hours after you take it off. So college students love they try to because when you put the skin patch on on a Tuesday, they may be done with their classes by noon, and they can take their skin patch off. But on Thursdays, they know they have a test every Friday morning. So they're going to study till three o'clock in the morning, they'll leaves the patch on till three o'clock in the morning and get to they can get 15 hours out of it one day, in three years to six hours out of it the next day. So the pharmaceutical companies have given us a gift in all of these different preparations that allow us different ways of managing. But we need to also understand that sometimes we can get duped into using an expensive brand name medication with a generic medication at 1/10 of the cost will do exactly the same thing. And that's one of the things I spend quite a bit of time in the book talking about how to avoid those errors.

DJ Stutz  31:16  
Yeah, I had no idea about that. And I'm sure a lot of those have been developed since my son graduated from high school a year or two ago. So. So what about though I've heard that it can affect their heart, it can affect their growth? What are you hearing about those concerns?

Dr. Walt Karniski  31:40  
Every medication has some side effects, even the aspirin that you can take, it has side effects on the stomach as well. So every one of the medications we deal with has medications. But what I can categorically say is that none of the side effects are long lasting, they do not last beyond the time that children are on medication. And none of the side effects are serious. So people have talked about the cardiac side effects. Blood pressure will go up slightly on on the stimulant medication but on the order of five, five or so points. And you have to understand that exercising will actually make your heart rate go up by 20 points. So is that a good thing or bad thing? We don't really know. There's no evidence that children have any permanent cardiac defects from these medications. And there's no evidence that they have any more serious problems than a mildly elevated elevated heart rate and mildly elevated blood pressure, then the interesting thing is, is that that is oftentimes a dose related response, so that decreasing the dose or switching to another medication will often change those side effects or decrease the side sometimes significantly.

DJ Stutz  32:55  
That's good to know. So then also, we think about these kids are very physical, do they have an increased need to be outside running longer? Or when they're getting really hyped up? Do we just need to take them outside and let them work it out?

Dr. Walt Karniski  33:16  
Again, I can't help but tell a story about the children that I've seen. I saw 111 year old boy who were diagnosed with ADHD started on medication and the mother brought him back for the first follow up visit after he'd been on medication. And I said, well, that has Michael doing and she said, Well, it's cool. He's doing great. His grades are all A's. His teacher says he's the most attentive child in the classroom. He's getting along better with the other children. But at home, I think he's depressed. And I looked at her depressed. Why do you think that? Well, Dr. It used to be before he started on this medication, he would come home, he would run in the door, he would jump on the couch, he would knock over the lamp, he would pull the cast tail. But now he dropped his bookbag on the floor and he goes to his room and he reads for two hours. And so I said am Why do you think he's pressed? And she said it. She looked at me like I was mad. She said, Well, Doctor, I just told you that he dropped his books on the floor. It goes to his room and breathes for two hours. And I said yes. But if he had been that way all his life as the young child, if he had enjoyed reading and would read two hours a day, would you have been concerned? And she said well, no, of course not. I'm concerned because it's such a change. And I said to her yes. What you're seeing is what Michael would have been like if he hadn't been born with ADHD. And there's nothing wrong with the behaviors that you're seeing and he's not depressed. I mean, I did a whole evaluation with him. I spent a half hour talking to him to make sure that he was not truly depressed. But in reality, parents see that quietness that somberness, that ability to take things more seriously. They see it as the negative behavior, when in reality is to positive behavior.

DJ Stutz  35:17  
So talking about that time at home and stuff. So I was told that if there's no school, there's no medication. And so during summer break, he wasn't on the medication or spring break, or on the weekends, no medication. Does that sound right?

Dr. Walt Karniski  35:37  
It sounds like the most ludicrous thing I can imagine. I am strongly against medication vacations, as they're called, as I would venture to say that what children learn in school is important, it's important to know that the Constitution was signed in 1776 by all of these powerful men and how our country was formed. But in reality, what we learn on a weekend by playing with our friend, by trying to get on with the children is just as important, if not more important to success in life. And so I would say that what children do on the weekends, or after school, and or during the summer, is just as critical as what they do in school. And so that medication should be used that in children, who are adolescents, and above 16 years of age and driving, as I mentioned earlier, they're three to six times more likely to be in a car accident, but less likely to be in a car accident if they take medication. So they need to be on their medication throughout the day, whenever they're throughout the weekend, throughout the summer. And especially when they're driving, which means teenagers, they should be honest, sometimes the second dose to get the medication to extend into the afternoon or early evening.

DJ Stutz  37:00  
Okay. And one other thing. And this might be one of the myths that goes around with families and parents. So if if they've had their medication for most of the day, and it's wearing off the afternoon, but you don't want to give them another dose, because for whatever reason, but giving them a caffeinated drink would be an extra boost that was useful. What do you think

Dr. Walt Karniski  37:33  
caffeinated beverages do seem to help children with ADHD, but very minimally, and not enough really to make a difference? I think you'd have to drink about a half a gallon of coffee, to be able to really make the same difference, just the medications. And I would venture to say there's more side effects from half a gallon of coffee than there are from the medications.

DJ Stutz  37:57  
Interesting. Okay. So gosh, so much like key information. So let's say you've got a little kid maybe in kindergarten, or pre K or whatever. And the teacher is saying, Wow, Susie is all over the place. Have you thought about having her assessed or Kim assessed as with ADHD? What kind of questions are important for parents to ask?

Dr. Walt Karniski  38:23  
For the parents to ask? Well, I think some of the important questions are first, to ask how you make the diagnosis. If the doctor makes the diagnosis, by a comprehensive history, by taking information from the teacher, from psychologists to the site, child has seen that I think that you're seeing somebody who is well versed in how to address ADHD. So I think the first thing to do is ask the doctor how he or she makes the diagnosis that can lead I would ask the doctor, how many of the medications they're aware of and how they choose one medication over another. And I think that that will give you an understanding of what goes through the doctor's mind about how to manage those, those behaviors as well. I think the the, the other thing, is, I think there's something that you can do to take information back to the doctor. And that is, if your child has been on other medications before you come to see this doctor, so you're seeing their specialist, you should write down what you saw when the child was on that medication. What were the benefits? What were the side effects? How long did it last? If you're concerned about side effects, talk to your doctor about it but understand that there are four important time periods that when those side effects occur if the doctor knows when those side effects are occurring, he or she can make appropriate modifications in the dose and most fourth time through the following. The first is before medication is taken. But what is the child look like when he's not on medication? So for instance, if we're talking about irritability, and the parents are concerned that the child is irritable for medication, ask the question, was that child irritable before he started on medication. Second time period is important is the period when medication starting to take effect. Third time period is when it reaches a peak effect. Because at those times, the medication might be the most effective. But you might be also seen side effects at that point because the medication is higher at a higher level in the bloodstream. And then finally, when the medication wears off, can also cause significant side effects. So irritability is common in children, as the medication wears off, the child might have had a wonderful day in school, but his medication where it's off at 330, destined by the time he gets home from school, and the parents see nothing but irritability. The teacher sees a perfectly compliant, happy, alert, well, learning child and the parents see irritability. So again, being able to give them medication on the weekend and say, Oh, we gave them medication on the weekend. And he's suddenly got very attentive at 10 o'clock in the morning. And then at four o'clock in the afternoon, he got irritable, but he wasn't irritable anytime, during throughout the day, with just those observations, putting it in the time context of those four time periods, will give you your position, much of the information he or she needs to make an appropriate choice of medication.

DJ Stutz  41:31  
Got it? Wow, so many great things to learn and to know. And if you feel like a medication, either is having some other side effects or is losing effectiveness. I wonder like if they go through puberty or growth spurt, does that change the effectiveness of the medication?

Dr. Walt Karniski  41:56  
It does in a way that you probably can't anticipate, and that is that I've seen children who were on site, 27 milligrams, Concerta, and they were on the medication for two or three years and it was working fantastic. But all of a sudden, it starts being less effective. I think the first thing we do is look at the child's weight, and how much weight has been gained over the years. So I had a child who was on 27 milligrams. And he had doubled his weights in this time that he had been on that notes. So now he was weighed twice as much, but getting the same dose of medication. And then lo and behold, the medication was about half as effective. All we had to do is increase the dose so that he was on the same amount of medication per body weight. And he began to get the same effect that he had previously. So I think it is important to monitor weight, appetite and sleep. But for different reasons than you might expect. Usually we can alter the side effects these medications by being well aware of what the problems are. And I think that children should be told that they need to tell us what the side effects are, what they don't like about the medication and and it sometimes was a job for me to convince a 14 year old and I was going to take into account her feelings about the medication. One time I saw a 12 year old girl made the diagnosis of ADHD, started her on medication and asked her to come back in three weeks. They never came back. The parents didn't bring her back. Five years later, I was sitting in my office and in walks. Michelle, this same girl is just seven years later. She's now 19 years old, a freshman at Florida State University. And I said what do you what are you doing here? And I haven't seen you for seven years. What happened back then he said, well, like your current SE. I'm an adult now. And I think I need to talk to you about medication. My parents don't agree. But I'm an adult and I can make my own decisions. So we started talking and I asked her what, what happened back when we started doing that medication. And she said, Dr. Comiskey when you started that medication. I hated you. I hated the way it made me feel. And I said, Well, how did it make you feel? And she said, Well, actually, I didn't really feel that different. But my friends told me I was different. It said I wasn't as much fun to be around. I used to be the life of the party. And I used to laugh and giggle about everything. But they said I wasn't as much fun to be around. So we started her back on medication. She came back three weeks later without her parents. This time she came in. I said how's the medication working? And she said, Great. I got all A's. I'm spending half the time doing my homework and still getting it done with all A's. And I'm doing really well. I said well, what's happening with your friends? And she said, Well, Dr. chronicity that That's the weird part. My friends tell me that when I take my medication, I'm not so easily distracted, I listen better. I attend to what they're saying. And then I comment on what they're saying. And they say, I'm just a much better friend when I'm on my medication. So what changed for Michelle? Between 19 years of age and 12 years of age? What was different between the 12 year old Michelle and the 19 year old? Michelle? Well, the answer is nothing. Nothing was different, she responded to the medication in the same way. In both circumstances, the difference was the expectations of her friends. They expected her to be the life of the party at 12 years of age, they expected her to be a serious listener, and a good friend did 19 years of age, and yet the medication was doing the same thing. So I think that that's an important lesson to keep in mind that we need to take into account how the kids feel about the medication themselves. And it's not an easy job sometimes to convince them that we're really listening, that it is important to listen to them and then make a change in the medication. When they say there's something about the medication they don't like, I can't accept the statement. I just don't like the way it makes me feel without them telling me, it makes me feel irritable, or it makes me feel revved up. Or it makes me feel angry or depressed. I need to know how it makes me feel. Don't just tell me, I don't like the way it makes me feel. Right, because I can't do anything with him. Right. But if I can convince the child to trust me, and to trust what we're saying about the medications, then I can tailor my treatment specific for that child with the minimal side effects and the maximum maximum benefit.

DJ Stutz  46:46  
That's so key, I think is listening to the child and asking the right questions to get a little deeper. So Dr. Comiskey, how would our parents find out more about you about your book?

Dr. Walt Karniski  46:58  
The book is available through Amazon and Barnes and Noble. The book is entitled, ADHD medication, does it work? And is it safe? ADHD medication does it work is it safe, was published only about two months ago. And it really would appreciate if parents would look it up and at least scan through the book and see some of the information that we've talked about today.

DJ Stutz  47:24  
The link on the show notes,

Dr. Walt Karniski  47:26  
let me excuse I'm sorry for interrupting you. But I also have a website, ADHD medication And in on that website, we have a summary of each of the chapters. We also have a list of other podcasts that we've done, and you can listen to those there. And finally, there's a medication selector that allows you to put in information, and then to find out what medication meet those criteria. So if you want a long acting, liquid preparation of medication, that is the methylphenidate medication, it'll show you which medications meet that criteria. Wow,

DJ Stutz  48:04  
that's a great resource. We'll get that information on the show notes for sure. Um, before we go, I have my one last question. I ask all of my guests the same question at the end. How would you define a successful parent?

Dr. Walt Karniski  48:22  
I think a successful parent is the parent who listens to their child. And I don't mean, listen to find mistakes that he's made to offer corrections, but simply to listen. If you start that early on, you're more likely to be able to listen to your child at 14 and 15, as well, as opposed to if they've never been listened to before. Why do you expect that they're going to listen to you at 14 either? So I think a good a good parent is a parent who listens to his or her child.

DJ Stutz  48:59  
I love that. And I agree. That's a great aspect. Well, Dr. Karniski, thanks so much for spending this time with us and giving us so much great and informative information so that we can meet the needs of our kids. And as they succeed and they calm down, we're certainly to calm down a little bit ourselves and find some stress relief there as well.

Dr. Walt Karniski  49:27  
Absolutely. You hit the nail on the head with that explanation.

DJ Stutz  49:31  
Thank you. Well, Doctor, I think we'll be able to talk again in the future and good luck in all these important endeavors that you have going on. Thanks for taking care of our kids.

Dr. Walt Karniski  49:42  
Thank you. I appreciate it. It really enjoyed talking to you today. Remember, listen to the kids.

DJ Stutz  49:52  
Okay, let's recap. Number one. ADHD is not the end of the world. Number two, there's been A lot of research that has been done on the effectiveness of ADHD medications. Number three study shows that adults who are medicated while children do as well as adults who never had ADHD. And number four, some individuals have been able to use ADHD to their benefit, and to the benefit of those that are around them. Number five kids and adults with ADHD benefit from having someone that can help them stay organized. Speaking from experience, organization is not their strong suit. There are 46 different medications that are authorized by the FDA to treat ADHD. And so this diversity gives us a lot of flexibility in meeting the various needs that kids and adults have. And number seven, be aware that generic medications can give the very same benefit at up to 1/10 of the cost. So if you are interested in finding Dr. Karnan, ski, all the contact info is there in the show notes. parent teacher conferences are already here in some areas, and I'm here to help. Have you ever left a parent teacher conference thinking, Well, that was a waste of time? Or is this your very first conference with your first child or your only child, there are things that you can do to prepare, so that you are using your time wisely. And I have a workshop for you that I have cut down to $10 from my usual 20. And when you're done, you're going to walk into the conference with confidence and knowing just what to ask and what to share. And then you're going to walk out of the conference thinking I'm so glad I went. So that link is also in the show notes. It's so beneficial to go check those show notes out, you know, and while you're there, you can always leave a five star rating and give us a review. 

So next week is episode 70. And the magical thing about the number 70 Is that it ends in a zero. And that means Bailey Olsen is back. This time we are sharing experiences and ideas about managing those times when our kids just totally lose it. So until next time, let's find joy in parenting.

Transcribed by

Walt KarniskiProfile Photo

Walt Karniski


Walt Karniski is a Developmental Pediatrician. He trained at Boston Children’s Hospital, affiliated with Harvard Medical Center. He was the Director of the Division of Developmental Pediatrics at the University of South Florida, in Tampa, Florida for 15 years. He then opened a private practice and for 20 years, evaluated and treated children with ADHD, Autism, Anxiety, Learning Disabilities and other developmental difficulties. During that time, he developed and operated three private schools for children with ADHD, Anxiety and Learning Disabilities. Over the 40 years he has been practicing, he has evaluated and treated close to 10,000 children. He been the director of a child abuse program and a program for enhancing development in children born premature. He has also conducted numerous studies of brain activity in children. He has approached each child as a unique individual, with distinctive strengths and weaknesses, where the diagnosis does not matter as much as understanding the specific needs of each child.