Dawn Kamilah Brown, M.D. is a diplomate of the American Board of Psychiatry and Neurology and the American Board of Medical Specialties as a board-certified physician in both child & adolescent psychiatry and general/adult psychiatry. She is the owner, CEO and sole practitioner at ADHD Wellness Center and has 2 private practice locations in the Woodlands, Texas and Houston, Texas. She was most recently awarded as a “Top Psychiatrist” by the International Association of HealthCare Professionals and the 2015 Best of Spring, Texas Award in the Psychiatrist category.
Dr. Brown diligently provides her patients and their families with competent and compassionate care, which highlights her extensive knowledge of clinical psychiatry. Dr. Brown established The ADHD Wellness Center after discovering there were very few community and medical resources to support the ADHD community. Although her focus involves the medication treatment of ADHD and its co-morbidities, she also believes in order to have optimal control of the disorder, ADHD coaching, effective Parent Management Training, and other forms of behavior management are equally important. Additionally, she is an advocate of innovative resources for positive parenting and healthy family relationships and her passion extends within her public speaking role, promoting awareness and education about mental health conditions.
Dr. Brown is actively involved in local and national organizations and has presented at both the local and national level on many topics in child psychiatry. She has participated in several community mental and medical health awareness projects and helped establish a child and adolescent clinic to provide convenient and affordable access to primary pediatric mental health care services for children and teenagers in a medically under-served area of Houston.
Dr. Brown is originally from Flint, Michigan. She graduated with honors from Xavier University of Louisiana and received a B.S. degree in Biology Pre-Medicine. She earned her Doctorate and completed her residency in General Psychiatry at Saint Louis University School of Medicine. Dr. Brown furthered her education by completing a fellowship in Child & Adolescent Psychiatry at the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine.
Dr. Brown is very close with her family and enjoys valuable time with her friends. She has the goal of establishing a mental health consulting group with her brother, Donald, who is in his last year of Psychiatry Residency Training. She is the pet owner of 2 teacup yorkies, Django and Gucci. She sings on her church’s praise team and Unity Choir. She enjoys shopping, bowling and is an avid sports fan.
Dr. Brown answers your questions about ADHD here:
How do colleges help assist with ADHD students?
It is important for students and their caregivers to meet with their school’s academic counselor to ensure that they have the appropriate support available during their tenure at college. This may include: implementing 504 accommodations for their courses (i.e. access for more time on exams, positioning their place in the lecture rooms where it is less distracting and/or they may be closer to the professor, taking 5 min breaks during 50 minutes or more lectures and labs, possibly suggesting other ways to evaluate students during exams, i.e. oral exams); enrolling in ADHD coaching from their school’s academic adviser office; and working with the colleges to schedule core curricular classes towards the beginning of the day and not at the end.
It is also important for colleges to provide proper training for their professors and educational staff to assist students. They should be well-informed about those students who have ADHD and be trained to become clinically aware so that they may have appropriate discussions with students about their concerns and know when to refer students to the appropriate collegiate staff members for further evaluation.
What chemical is deficient during ADHD? Is there a natural food that helps produce this chemical?
There is definitive evidence that there is a chemical imbalance in the brain of those living with ADHD. Chemicals like dopamine, serotonin, norepinephrine, and adrenaline are found to be insufficiently produced in ADHD brains. Studies have found that these individuals have deficiencies in the way the brain deals with dopamine, an amino acid involved in the regulation of movement/activity, thoughts, feels and behaviors.
Dopamine is the key chemical responsible for the “reward system” in our brain- you know, the feeling you get after conquering a major accomplishment. These deficits in the brain’s reward system may help explain clinical symptoms of ADHD, including inattention and reduced motivation, as well as the risks for complications such as substance abuse (i.e. cannabis/marijuana, alcohol, tobacco, unadvised use of stimulant and non-stimulant medication and obesity among ADHD patients.) Studies also suggest that patients who abuse drugs or overeat may be unintentionally attempting to compensate for a deficient reward system by boosting their dopamine levels.
Understanding how the insufficient production of dopamine in the dopamine system contributes to ADHD and finding ways to improve the functioning of the reward system could help mitigate the troubling risks and consequences in the ADHD patient population.
What side effects have we identified from ADHD drug treatment?
As aforementioned, there are 2 main classes of medications that are used in the management of ADHD: stimulants and non-stimulants. These classes can be used alone or as adjunctive management (used together at relatively lower doses.) The most common side effects reported from both classes include: appetite suppression, insomnia, headache, nausea, vomiting, stomach queasiness, growth delay (seen in boys when on the first year of medication, but studies reveal they typically “catch up” during their second and third years of treatment), rebound irritability (when the medications wear off), tic exacerbation (meaning, that these medications do not actually cause tics, but may make them appear more apparent and frequent), and moodiness.
To get an accurate picture of side effects, your child’s baseline should be established before he/she starts taking the medication. For instance, some kids with ADHD have a hard time falling asleep to begin with. Some kids with ADHD are very picky eaters before they start medication. Identifying these pre-existing problems helps avoid blaming the medicine for problems that were already there. Getting the right dosage is important for minimizing side effects. Also consider that some children respond differently to those two groups of medications.
The least common side effects would be elevated blood pressure and/or heart rate. Nonetheless, before a medical provider starts a child on medication, they should take a careful cardiac history. Suicide can also be a rare side effect. Studies reveal that the stimulant class of medications can be used in smaller doses as adjunctive treatment with anti-depressants with a person who has a difficult to treat depression or is at risk for suicidal tendencies, when carefully monitored and preferably in a safe environment (i.e. hospital).
How young can a child be diagnosed with ADHD?
The criteria for diagnosis was re-established from age 6 to now age 12. In other words, in order to establish the diagnosis, the history should suggest that kids exhibited symptoms before the age of 12. The same criteria goes for adults. It is best diagnosed early on, so that management can begin right away and untreated ADHD not further interfere with a child’s functioning at home, school and in social groups.
I have seen children as young as 3 years old diagnosed with ADHD. Although this is a very young age, these children also had significant risk factors and exhibit severe symptoms which helped established the diagnosis. I personally see patients aged 5-65 and have established a diagnosis as young as 5 years old. Finally, I often do not make the diagnosis during the first or even second evaluation. It is important to obtain adequate history and complete thorough evaluations before the diagnosis is determined.
My 6-year-old was recently diagnosed and has started taking Adderall. She is going up to 10 MG next week. How do you know when the dosage is right?
Great question! Taking the correct medication is important, so that the child does not experience unwanted or intolerable side effects, but so is taking a dose that is safe based on a child’s weight and metabolism. All of these factors, along with a decreased risk of side effects determines the therapeutic dose value of the medication. It can also be frustrating when managing children since they grow so fast. I explain to the caretakers of my patients that the medication dose often “grows” with the kiddo and to a certain dose/level, where they can maintain that dose for a period of time until they have to change again.
It is usually when they become adults, when medication can be lowered due to our body’s metabolic changes. Not only does the body change but there are also psychological (body development, maturity) and social changes (increased school and workloads regarding the amount and complexity), as an example.
This is why I stress the importance for my patient population to maintain their quarterly appointments (every 3 months/4 times a year) to complete re-evaluations and determine if a medication change or dose is needed due to these factors, which considering psychological and social stressors that are managed with the help of behavior modifications.
Information given by caretakers, teachers and MOST importantly, children help to make the appropriate change, if needed. At times, the change may be made on a “trial and error” circumstance, to evaluate if it has been helpful.
Is not turning in assignments or being late a symptom of ADHD? My child has issues with this.
Possibly! However, all children may encounter this, as this is very common behavior of all individuals (including adults!). It can be challenging for parents to distinguish between ADHD and typical childhood behavior. The key distinction for individuals with ADHD is that these behaviors are much more persistent, intense and severe.
In addition, if you suspect your child is showing signs of ADHD, as yourself these questions: 1) Is my child full of energy, or is he/she actively causing persistent problems at home, school and in relationships? 2) Is my child pleasantly talkative, or is his/her excessive talking becoming uncontrollable or disruptive? 3) Does my child have occasional difficulty completing homework and chores, or does he/she need constant monitoring and supervision? 4) Does these behaviors in my child occur only occasionally, or do these behaviors significantly impact their daily functioning?
Always consult your child’s personal pediatrician or mental health provider and discuss the concerns you have and your answers to these 4 questions.
I am a 59-year-old Black man and I suffer from ADHD and I am on several medications including medication for short term memory. What is the best medication to treat ADHD? I really have a hard time staying focused.
This can be determined with the help of a specialty provider, like a psychiatrist. We are clinically trained to evaluate and determine WHY a person has memory difficulties and distinguish problems with memory to other disorders or medical problems that may result in memory difficulties and/or deficits (i.e. depression, anxiety, substance-induced disorders, dementia, thyroid dysfunction, vitamin deficiencies, etc.)
It is important to discuss your concern with your doctor who may refer you to a specialty provider. What is helpful to providers is if you can make a detailed list of your concerns, noting what symptoms are occurring, the timing and duration of their occurrence, are there any triggers, what helps to relieve the symptoms or make them worse. Also, inform your doctor or specialty provider of current and past medical illness and medications. With your help, they should be able to assist you in evaluating, diagnosing and managing the medical problems that are impacting your functioning and livelihood.
Be warned: There are companies who advertise “natural supplements” that can help with memory and focus. Many individuals and their families take these ritualistically, believing they are “safe” because they are recognized as being “natural.” However, they may not informed or lack the knowledge or understanding that the majority of these products have NOT been studied for what they are promoted to help manage AND therefore, NOT approved by the Food and Drug Administration (FDA.)
There are only a few medical food supplements like Vayarin that is used in children to assist with focus improvement that have been studied and approved by the FDA. I encourage you to discuss everything that goes into your body, including your diet/food sources with your doctor. This also helps them to determine possible drug interactions that may be causing symptoms that appear to be related to memory difficulties or deficits.
What’s the difference between ADD and ADHD In children and adults?
Attention-Deficit/Hyperactivity Disorder (ADHD) is described as an ongoing pattern of inattention and/or hyperactivity that occurs in a variety of day-to-day settings. Symptoms are broken up into 2 categories, the first being symptoms of inattention: trouble keeping track of things and with staying organized, challenges with listening and retaining information, difficulties with sustaining attention, failing to complete tasks, making careless mistakes, becoming easily distracted, procrastinating, forgetfulness. The second category, being hyperactive/impulsive, could present with symptoms characterized by: excessive fidgetiness and restlessness, excessive talking and talking over others, blurting out, impulsive reactions, difficulties awaiting one’s turn, acts if driven by motor.
Previously, the inattentive form of ADHD (which did not involve hyperactivity and impulsivity) was called Attention-Deficit Disorder or “ADD,” however recently, the terminology has changed to “ADHD, predominately inattentive presentation,” and children and adults with those symptoms have been included under the “ADHD umbrella.” The term “ADD” is no longer used.
“ADHD” presents with similar features in children and adults; the major differences being actual age, developmental age and what the daily interactions and tasks an individual encounters. Children tend to have the combination of symptoms, referred to as the “Combined Type” of ADHD, where they are observed to have challenges with inattention, hyperactivity and impulsivity, whereas adults can also have combined ADHD symptoms, but more commonly, present with inattentive concerns, but within the home, work environment and in social groups and settings. There are other factors that may accompany ADHD include: boredom, problems with emotional regulation, poor self-image, lack of motivation, depression, anxiety, relationship conflicts and health problems, to name a few.
Why are doctors pushing medicine instead of changing a child’s diet?
As a Double-Board Certified Child, Adolescent and Adult Psychiatrist, I work with individuals of all ages, cultural/ethnic backgrounds as well as with their family members. It is my professional opinion that both medication management and the behavior management for ADHD is equally important. Furthermore, the ‘action” of taking medication is an example of a behavior management task! Medication management is important because of the biological and genetic factors related to ADHD. There are chemical (and structural) differences within the ADHD brain compared with that of a non-ADHD brain.
It is important to understand the biological basis in order to understand and be open to medication management and understanding its need. In short, studies show that there are brain chemicals that are typically produced LESS in the ADHD brain in comparison to the non-ADHD brain, which affect an individual’s executive functioning (planning, organizing, concentration, memory, motivation and effort, learning from mistakes, impulse control, social skills, activity levels, etc.)
With ADHD, having LESS of these brain chemicals can lead a person to have problems with these executive functioning skills. Medications (i.e. stimulants and non-stimulants) are important because they produce what is missing. When an individual with ADHD takes their medication daily (considering that they are taking a safe and therapeutic medication regimen determined by their doctor,) their executive functioning skills can be optimal, where they experience significant improvements in their school or work performance and productivity as well as their self esteem and confidence.
Regarding diet, this is a behavior modification change that includes eating balanced meals (and exercise!). There have been many studies that conclude it is best for an individual with ADHD to include protein (the brain’s best fuel source vs sugar) in their diet like fish, chicken, peanut butter, almonds/nuts, protein shakes and bars and rid their diet of excessive sugars (and their substitutes), food additives (i.e. foods with coloring/dyes), and substances like alcohol.
Therefore, medication and diet are equally important to manage ADHD and I encourage physicians to promote both over medication alone.
Why do we as Americans have more dye in our foods then foreign countries is that a contributor to ADHD?
Interesting question! Dye is “attractive/appealing” to the eye, which increases the likelihood that when it is added to a food source, you are going to eat it, remember how it tastes and talk about it, so others can partake! It is important to mention that The Food and Drug Administration (FDA) is responsible for regulating all color additives to ensure that these color additives are safe to eat, contain only approved ingredients and are accurately labeled.
Color additives are used in foods for many reasons: 1) to enhance food colors that occur naturally 2) to correct the natural variations in food color; 3) to offset color loss due to exposure to light, temperature variances, air, moisture and storage conditions; and 4) to provide color to colorless and “fun” foods. Without color additives, pop (as we call it in the Midwestern states) or sodas wouldn’t be brown, margarine wouldn’t be yellow and mint ice cream wouldn’t be green. Color additives are now recognized as an important part of practically all processed foods we eat.
Can you refer me to a clinic in my area?
If you have medical insurance, I would recommend contacting an insurance agent, requesting a referral list of mental health providers who are paneled with your insurance, in your area. I also encourage individuals to start with their primary care physician and ask them for a direct referral. Other resources: www.psychologytoday.com that has a directory of a number of mental health professionals (psychiatrists, psychologists, therapists) nationwide; your local physician referral service/ Board of Mental Health (877) 210-8513.
Can you outgrow ADHD? Or do you have to take medication forever once diagnosed?
This is one of my favorite MYTHS that I love to talk about! The studies show that it is possible for the disorder to not affect 33% of the child population that have been diagnosed into adulthood. However, these same studies conclude that at least 66% of these children will live with ADHD for the remainder of their lives. My professional opinion- is that the disorder is lifelong for ALL who are diagnosed with ADHD.
I believe individuals find ways of using healthy coping strategies to manage it, as well as compensate for their deficits. At time, this can turn into “over-compensating” and lead to stress and anxiety or depression. To help determine if the condition will continue to affect an individual’s life, I personally advise my patients to maintain quarterly appointments with me so that I can complete a thorough evaluation that consists of medication and behavior management.
As a child, adolescent and adult psychiatrist, I see individuals of all ages and cultural and ethnic backgrounds who manage their ADHD differently. Very few are managed with behavior management alone. When medications are apart of their management, it is important for them to take their medication daily, as ADHD doesn’t come on or shut off ‘like a light switch.’ The disorder does not go away and therefore, important to take daily, and likely, for the rest of their lives. Studies show that the combination management of medication and behavior modifications OR medication management alone are best at managing ADHD, than behavior management alone.
What is the test to diagnose ADHD?
Although there have been advances in medicine to better diagnose and manage ADHD, there is not a single test currently available to diagnose ADHD. This disorder is not determined by blood work or imaging, although these can be helpful to determine the associated factors linked to the disorder (i.e. vitamin D deficiency, structural brain changes.) Diagnosing ADHD can be challenging and should be established by a clinically trained mental health professional. ADHD is diagnosed by using subjective evaluations and objective evaluations.
Underlying medical causes and other factors that may present or look like ADHD, also have to be ruled out. It is important that your mental health physician/provider obtains a thorough medical history from the individual being evaluated and their guardian (if warranted). It is extremely helpful if other caregivers, teachers, tutors, coaches, counselors are involved by providing their opinions (subjective) as well as complete measurements/rating scales that includes objective questions for them to answer.
For adults and children, there are online questionnaires that are also given by primary care physicians and mental health professionals to evaluate for the risks of having ADHD, however they do not provide enough information to help establish the disorder. A clinically trained mental health provider may institute “standard of care” testing instruments/exams which are likely clinically recognized by the Food and Drug Administration (FDA) that are typically 30-60 mins long.
These exams are specifically designed to evaluate an individual’s’ attention, processing speed, impulse control to help objectively determine the probability of an individual having ADHD. All assessments are both REQUIRED to establish the diagnosis.
What age should you get your kid tested for ADHD?
If you suspect that your son and/or daughter has ADHD, I would recommend seeking assistance immediately; the sooner, the better. I see kids as young as 5, since this is a common age where they begin pre-school / group activities and there are “certain expectations” that are considered amongst teachers and caretakers regarding a child’s academic and social performance. However, I do not diagnose every child (or adult) that walks into my office with ADHD, even if I alone, a teacher or family member suspects it.
For every individual, I complete a thorough evaluation that includes subjective and objective measures to assist in determining the diagnosis. If it is decided that it is best to include medication therapy with a child, I am very conservative with my management, meaning, I use the least dose and amount of medication that is safe and effective with controlling the disorder. It is also important to rule out other factors that may look like ADHD like. learning disorders, other neurological deficits, underlying medical causes, societal pressures and stressors, etc. A behavior management modification plan for home and school are also discussed to best support the child, ensuring that we are positioning him to “win!”
How do I begin to help my son? He has each symptom you mentioned.
I would strongly advise you to first consult with his pediatrician and express your concerns. Teachers/tutors/coaches/counselors input are also important and should be relayed to your son’s pediatrician. Pediatricians should also provide caretakers with the ‘objective measures/rating scales” that I have discussed above to accurately help with establishing the diagnosis. Pediatricians will likely obtain a blood sample to rule out underlying medical factors that may exacerbate your child’s clinical presentation, or in other words, add more severity to the clinical features of ADHD. Many pediatricians may refer you to specialty providers for ADHD, like a child psychiatrist or child psychologist, who can also establish the diagnosis and begin management.
I realize caregivers can feel helpless while this process takes place. I recommend that you talk with your child, encouraging him that he is no different than anyone else; he just may be dealing with a brain disorder that can be easily managed with the right treatment. Ensure that he is safe and you are working with professionals to seek help on how you and others can be of a greater help to him.
Help him to develop his individual strengths; structure his environment and stick to routines; provide him with proper nutrition, cutting out as much junk food as possible, actively stay on top of his academics, getting him extra help if necessary, encourage him to exercise and/or become involved in group sports; and for YOU, discuss behavioral management techniques with a professional to help with parenting a child with ADHD. It is not YOUR fault. There is NOTHING you could have done differently. This is a genetically-linked disorder that WILL likely occur regardless of the support and love you provide for your son.
What meds are required for this disease and do people become dependent on them?
The stimulant medication group are the first-line class of agents that are used in the proper management of ADHD; first line, meaning they come highly recommended for individuals who have ADHD. They are at the “top” of the medication chain with how effective they are with controlling ADHD symptoms; they have a range of duration effects (depending on the stimulant medication chosen); they are in and out of the system and can be discontinued abruptly, without significant withdrawal symptoms (although I personally recommend daily adherence, since ADHD is a disorder that does not go away over the weekends or during the holidays.) They work very well for an individual with ADHD if they are taking their medication regimen as directed by their physician.
There are also non-stimulant medications that are just as effective as stimulants, but work differently in the body. These medications MUST be taken daily in order to be effective for assisting in maintaining ADHD symptom control. They also may take a longer time for individuals to notice a difference upon their start, for ADHD management.
There have been many studies conducted which conclude that individuals with ADHD are NOT at risk of dependence or becoming “addictive” to medication if they are taking their medications properly. As aforementioned, there is a biological factor that has shown different chemical and structural changes with individuals who have ADHD. Often, the chemical difference is the lack of required chemicals that are needed to not have the disorder.
So, the medication replaces what the individual’s brain is not making enough (of.) Therefore, you can imagine that for an individual who does not have ADHD, this changes the story. They are likely producing enough of these chemicals to begin with and if they were to take unadvised ADHD symptom control medications, without a doctor’s authorization, they are simply “over-producing” what their brain is already making enough of. One of these chemicals is called dopamine. The over-stimulation of dopamine can cause euphoria, hyper-focus, jitteriness, excessive activity and speech. Some individuals may enjoy this feeling, which leads to addictions.
You can connect with Dr. Brown here:
Official Website: www.adhdwellnesscenter.com
On Twitter @ADHDWellness
On Facebook: http://www.facebook.com/adhdwellnesscenter
On Instagram: @adhdwellnesscenter
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