With around one in 50 adults diagnosed with cancer each year, many people are faced with the difficult task of sharing the news of their diagnosis with their loved ones. Parents with cancer may be most worried about telling their children.

It’s best to give children factual and age-appropriate information, so children don’t create their own explanations or blame themselves. Over time, supportive family relationships and open communication help children adjust to their parent’s diagnosis and treatment.

It’s natural to feel you don’t have the skills or knowledge to talk with your children about cancer. But preparing for the conversation can improve your confidence.

Preparing for the conversation

Choose a suitable time and location in a place where your children feel comfortable. Turn off distractions such as screens and phones.

For teenagers, who can find face-to-face conversations confronting, think about talking while you are going for a walk.

Consider if you will tell all children at once or separately. Will you be the only adult present, or will having another adult close to your child be helpful? Another adult might give your children a person they can talk to later, especially to answer questions they might be worried about asking you.

Finally, plan what to do after the conversation, like doing an activity with them that they enjoy. Older children and teenagers might want some time alone to digest the news, but you can suggest things you know they like to do to relax.

Also consider what you might need to support yourself.

Preparing the words

Parents might be worried about the best words or language to use to make sure the explanations are at a level their child understands. Make a plan for what you will say and take notes to stay on track.

The toughest part is likely to be saying to your children that you have cancer. It can help to practise saying those words out aloud.

Ask family and friends for their feedback on what you want to say. Make use of guides by the Cancer Council, which provide age-appropriate wording for explaining medical terms like “cancer”, “chemotherapy” and “tumour”.

Having the conversation

Being open, honest and factual is important. Consider the balance between being too vague, and providing too much information. The amount and type of information you give will be based on their age and previous experiences with illness.

Remember, if things don’t go as planned, you can always try again later.

Start by telling your children the news in a few short sentences, describing what you know about the diagnosis in language suitable for their age. Generally, this information will include the name of the cancer, the area of the body affected and what will be involved in treatment.

Let them know what to expect in the coming weeks and months. Balance hope with reality. For example:

The doctors will do everything they can to help me get well. But, it is going to be a long road and the treatments will make me quite sick.

Check what your child knows about cancer. Young children may not know much about cancer, while primary school-aged children are starting to understand that it is a serious illness. Young children may worry about becoming unwell themselves, or other loved ones becoming sick.

Older children and teenagers may have experiences with cancer through other family members, friends at school or social media.

This process allows you to correct any misconceptions and provides opportunities for them to ask questions. Regardless of their level of knowledge, it is important to reassure them that the cancer is not their fault.

Ask them if there is anything they want to know or say. Talk to them about what will stay the same as well as what may change. For example:

You can still do gymnastics, but sometimes Kate’s mum will have to pick you up if I am having treatment.

If you can’t answer their questions, be OK with saying “I’m not sure”, or “I will try to find out”.

Finally, tell children you love them and offer them comfort.

How might they respond?

Be prepared for a range of different responses. Some might be distressed and cry, others might be angry, and some might not seem upset at all. This might be due to shock, or a sign they need time to process the news. It also might mean they are trying to be brave because they don’t want to upset you.

Children’s reactions will change over time as they come to terms with the news and process the information. They might seem like they are happy and coping well, then be teary and clingy, or angry and irritable.

Older children and teenagers may ask if they can tell their friends and family about what is happening. It may be useful to come together as a family to discuss how to inform friends and family.

What’s next?

Consider the conversation the first of many ongoing discussions. Let children know they can talk to you and ask questions.

Resources might also help; for example, The Cancer Council’s app for children and teenagers and Redkite’s library of free books for families affected by cancer.

If you or other adults involved in the children’s lives are concerned about how they are coping, speak to your GP or treating specialist about options for psychological support.

Cassy Dittman, Senior Lecturer/Head of Course (Undergraduate Psychology), Research Fellow, Manna Institute, CQUniversity Australia; Govind Krishnamoorthy, Senior Lecturer, School of Psychology and Wellbeing, Post Doctoral Fellow, Manna Institute, University of Southern Queensland, and Marg Rogers, Senior Lecturer, Early Childhood Education; Post Doctoral Fellow, Manna Institute, University of New England

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Attention deficit hyperactivity disorder (ADHD) is a condition that can affect all stages of life. Medication is not the only treatment, but it is often the treatment that can make the most obvious difference to a person who has difficulties focusing attention, sitting still or not acting on impulse.

But what happens once you’ve found the medication that works for you or your child? Do you just keep taking it forever? Here’s what to consider.

What are ADHD medications?

The mainstay of medication for ADHD is stimulants. These include methylphenidate (with brand names Ritalin, Concerta) and dexamfetamine. There is also lisdexamfetamine (branded Vyvanse), a “prodrug” of dexamfetamine (it has a protein molecule attached, which is removed in the body to release dexamfetamine).

There are also non-stimulants, in particular atomoxetine and guanfacine, which are used less often but can also be highly effective. Non-stimulants can be prescribed by GPs but this may not always be covered by the Pharmaceutical Benefits Scheme and could cost more.

How stimulants work

Some stimulants prescribed for ADHD are “short acting”. This means the effect comes on after around 20 minutes and lasts around four hours.

Longer-acting stimulants give a longer-lasting effect, usually by releasing medication more slowly. The choice between the two will be guided by whether the person wants to take medication once a day or prefers to target the medication effect to specific times or tasks.

For the stimulants (with the possible exception of lisdexamfetamine) there is very little carry-over effect to the next day. This means the symptoms of ADHD may be very obvious until the first dose of the morning takes effect.

One of the main aims of treatment is the person with ADHD should live their best life and achieve their goals. In young children it is the parents who have to consider the risks and benefits on behalf of the child. As children mature, their role in decision making increases.

What about side effects?

The most consistent side effects of the stimulants are they suppress appetite, resulting in weight loss. In children this is associated with temporary slowing of the growth rate and perhaps a slight delay in pubertal development. They can also increase the heart rate and may cause a rise in blood pressure. Stimulants often cause insomnia.

These changes are largely reversible on stopping medication. However, there is concern the small rises in blood pressure could accelerate the rate of heart disease, so people who take medication over a number of years might have heart attacks or strokes slightly sooner than would have happened otherwise.

This does not mean older adults should not have their ADHD treated. Rather, they should be aware of the potential risks so they can make an informed decision. They should also make sure high blood pressure and attacks of chest pain are taken seriously.

Stimulants can be associated with stomach ache or headache. These effects may lessen over time or with a reduction in dose. While there have been reports about stimulants being misused by students, research on the risks of long-term prescription stimulant dependence is lacking.

Will medication be needed long term?

Although ADHD can affect a person’s functioning at all stages of their life, most people stop medication within the first two years.

People may stop taking it because they don’t like the way it makes them feel, or don’t like taking medication at all. Their short period on medication may have helped them develop a better understanding of themselves and how best to manage their ADHD.

In teenagers the medication may lose its effectiveness as they outgrow their dose and so they stop taking it. But this should be differentiated from tolerance, when the dose becomes less effective and there are only temporary improvements with dose increases.

Tolerance may be managed by taking short breaks from medication, switching from one stimulant to another or using a non-stimulant.

Too many prescriptions?

ADHD is becoming increasingly recognised, with more people – 2–5% of adults and 5–10% of children – being diagnosed. In Australia stimulants are highly regulated and mainly prescribed by specialists (paediatricians or psychiatrists), though this differs from state to state. As case loads grow for this lifelong diagnosis, there just aren’t enough specialists to fit everyone in.

In November, a Senate inquiry report into ADHD assessment and support services highlighted the desperation experienced by people seeking treatment.

There have already been changes to the legislation in New South Wales that may lead to more GPs being able to treat ADHD. Further training could help GPs feel more confident to manage ADHD. This could be in a shared-care arrangement or independent management of ADHD by GPs like a model being piloted at Nepean Blue Mountains Local Health District, with GPs training within an ADHD clinic (where I am a specialist clinician).

Not every person with ADHD will need or want to take medication. However, it should be more easily available for those who could find it helpful.

Alison Poulton, Senior Lecturer, Brain Mind Centre Nepean, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.