Does Your Child Have ADHD?
by Amy E. Brown
The Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM) is the official guidebook for U.S. mental health professionals. Here is a summary of how it defines ADHD:
• Developmentally inappropriate levels of inattention, impulsivity and/or hyperactivity
• Symptoms, which begin before age seven, cause problems in at least two settings (such as social, home or school), and persist for at least six months
Signs of inattention include:
• Often easily distracted by irrelevant stimuli
• Rarely follows instructions carefully; frequently makes careless mistakes
• Often loses or forgets things such as toys, books, or clothing
• Frequently moves from one uncompleted activity to another
Signs of hyperactivity/impulsivity include:
• Appears physically restless or fidgety
• Often seems unable to sit still
• Blurts out answers before hearing the whole question
• Has difficulty taking turns or waiting in line
Seven-year-old Joey daydreams throughout spelling drills; 9-year-old Anna fidgets and chatters during her piano lesson; 10-year-old Michael chases butterflies rather than fly balls during his Little League game.
Despite their apparent differences, all of these children have some symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Children with ADHD have difficulty paying attention or controlling their behavior.
Most children have trouble with attention and behavior at times. However, these problems are more pronounced and problematic for children with ADHD. According to the National Institute of Mental Health, when “hyperactivity, distractibility, poor concentration, or impulsivity begins to affect performance in school, social relationships with other children or behavior at home, ADHD may be suspected.”
NIMH reports that ADHD, the most commonly diagnosed behavioral disorder in children, affects 3 to 5 percent of school-age kids and is approximately three times more common in boys than girls. ADHD is a neurological problem in brain areas responsible for problem-solving, planning, and impulse control.
The principal characteristics of ADHD are inattention, hyperactivity, and impulsivity. There are three types of ADHD: combined (inattentive and hyperactive/impulsive);
primarily inattentive, and primarily hyperactive/impulsive.
Thomas Power, PhD, director of The Center for Management of ADHD at the Children’s Hospital of Philadelphia, says that approxi-mately 60 percent of children diagnosed with ADHD have the
combined type, 30 percent have the primarily inattentive type, and
10 percent have primarily hyperactive/impulsive symptoms.
Recognizing ADHD
Teachers are often the first to notice that a child has trouble controlling behavior or paying attention.
However, Dr. Power notes that children who are primarily inattentive but don’t have hyperactivity are less often identified “because they generally do not disturb others or dis-rupt class” although they are easily distracted and have difficulty sustaining effort on demanding activities.
Children with ADHD often have social difficulties. “Children with ADHD have trouble adhering to rules and cooperating with others. Therefore, they often have difficulty taking turns, joining groups, and maintaining friendships,” Dr. Power says. Additionally, their impulsive behavior can lead them to interrupt, grab toys and annoy their peers.
Children with ADHD also experience problems at home because they have difficulty controlling their behavior and emotions. These children may have trouble remaining seated at the dinner table, over-react to minor frustrations or need frequent reminders to complete tasks.
Homework is often especially troublesome for these children. Because children with ADHD often have great difficulty with projects that require sustained attention, Dr. Power says that they may forget the assignment, work inefficiently, or completely avoid homework because they are unable to focus long enough to complete the work.
What to Do
If you think your child may have ADHD, the first thing to do, according to Rhonda S. Walter, MD, Chief of the Division of Developmental Medicine at A.I. duPont Hospital for Children in Wilmington, DE, is contact your pediatrician.
“If parents think that their child is easily distractible, or has a short attention span (even for preferred activities), they should consult with their doctor,” she says. Pediatricians can provide information about “age-specific expectations of attention, focus, activity level and distractibility,” says Dr. Walter.
It is important that the child receive a thorough examination and diagnosis by a well-qualified physician. Other disorders, such as anxiety, learning or mood problems, can cause symptoms similar to ADHD.
Says Amy MacIntyre, MD, a child and adolescent psychiatrist in private practice in Bala Cynwyd, PA, “I generally look at overall patterns of behaviors and any possible precursors or stressors.” Dr. MacIntyre notes that it is important to look for possible learning differences as approximately 20 to 30 percent of children with ADHD also have a specific learning disability.
Parents should get screened for ADHD as well. According to Dr. Power, approximately 30 percent of children with ADHD have at least one parent with ADHD. Parents with untreated ADHD generally have greater difficulty responding appropriately to their child. Children and their parents benefit when parents get treatment.
The National Institute of Mental Health reports that behavioral therapies (such as those that aim to increase positive and diminish negative behavior) and medications are the most researched treatments for ADHD. Other approaches and newer medications are being studied but are still considered to be unproven and experimental.
Rhonda S. Walter, MD, chief of developmental medicine at A.I. duPont Hospital for Children, cautions against using unproven treatments. “There is little controlled study data regarding herbal or supplement approaches to ADHD, although this is a huge part of what is advertised as parents surf the internet for alternative approaches.”
Most children with ADHD benefit from a combination of medication and behavioral treatments. However, Thomas Power, PhD, director of The Center for Management of ADHD at the Children’s Hospital of Phila-delphia, says that approximately 25 percent of children with ADHD respond sufficiently to behavioral interventions without medication, especially if their parents and teachers are well-versed in behavior management techniques.
According to Dr. Power, stimulants are the most common type of medication for ADHD. He says research suggests that up to 70 percent of children with ADHD respond stimulant medications such as Ritalin or Adderall. Daytrana (methylphenidate) is a newly introduced skin patch that can be worn on the hip and lasts for about nine hours.
Strattera is a non-stimulant drug that can be prescribed when children either don’t respond well to stimulants or cannot tolerate them. Other non-stimulant medications used to treat ADHD include Wellbutrin, Tenex and Catapres.
Dr. Power notes that just within the last eight years there has been great progress in acceptance of the disorder and treatment options.
“We’ve become more aware and accepting of ADHD as a society, and have better developed and refined family and school-based interventions,” he says. “We now have longer-acting stimulants that can eliminate frequent dosing or the need to take medication at school.”
Costly if Untreated
Children with untreated ADHD are at risk for social, emotional and substance abuse problems later in life. According to Dr. Power, approximately 40 percent of children with ADHD do not receive treatment; children of lower socioeconomic status are particularly under-diagnosed.
Liz Kuh, MD, child and adolescent psychiatrist in private practice in Bala Cynwyd and Media, PA, reports that the cumulative effects of untreated ADHD are far-reaching: “Children with untreated ADHD are often stigmatized and penalized for negative behaviors not entirely within their control. They often experience conflict at home, with peers and with teachers. Too often, these children gradually experience an erosion of self-esteem. They are then vulnerable to anxiety, depression, and substance abuse”.
Says Sion Segal, PhD, a clinical psychologist in private practice in Bryn Mawr, PA, “Children learn the rules of social interaction informally, by paying attention to the behavior of others. Children who have difficulty focusing in groups tend to miss social cues and incorrectly interpret the behavior of others. This can have a strong impact upon peer interactions, friendships, confidence, and self-esteem.”
“Schools can help by implementing accommodations that address problems with attention, impulsivity and organization. Therapists and physicians can collaborate to help the family work more effectively with their child. These combined efforts can increase social and academic success, decrease family discord, and enhance the child’s self-esteem.”
Parents of children with ADHD need to learn about the conditon and obtain appropriate services to help them and their children. “When parents effectively collaborate with professionals, they maximize the
likelihood that their children will realize their full potential,” says Dr. Segal.
Amy E. Brown is a local freelance writer and a therapist in private practice specializing in adolescents and their families.