Bertroche & Associates
ADHD

Topic Overview

 

What is attention deficit hyperactivity disorder (ADHD)?

 

Attention deficit hyperactivity disorder (ADHD) is a behavioral condition in which children have difficulties paying attention and focusing on tasks.  This common disorder begins in early childhood and can continue into adulthood.  If not recognized and treated, it can cause problems at home, school, and work and with relationships.

 

What are the symptoms of ADHD?

 

The three types of ADHD symptoms are:

 

  • Inattention.  This is the most common symptom.  In addition to having difficulty paying attention, people with this symptom often are unable to consistently focus, remember, and organize.  They may be careless and have a hard time starting and completing tasks that are boring, repetitive, or challenging.
  • Impulsivity.  People who frequently act before thinking may not make sound judgments or solve problems well.  They may also have trouble developing and maintaining personal relationships.  An adult may not keep the same job for long or spend money wisely.
  • Hyperactivity.  A hyperactive child may squirm, fidget, and climb or run when it is not appropriate.  These children often have difficulty playing with others.  They may talk a great deal and not be able to sit still for even a short time.  Teenagers and adults who are hyperactive don’t usually have the more obvious physical behaviors seen in children.  Rather, they often feel restless and fidgety and are not able to enjoy reading or other quiet activities.

 

Many children with ADHD have signs of both hyperactivity and attention problems.  This is called combined type ADHD.  When children have significant problems with hyperactivity and impulsivity and fewer problems with attention, it is called predominantly hyperactive-impulsive type ADHD.  Some children mainly have problems with inattention and fewer problems with hyperactivity and impulsivity.  This is called predominantly inattentive type ADHD.

 

Symptoms of all types of ADHD can range from mild to severe.

 

Other conditions, such as learning disabilities, depression, anxiety disorder, and oppositional defiant disorder, are sometimes mistaken for ADHD.  They may also occur along with ADHD, which can make diagnosis of the primary problem difficult.

 

What causes ADHD?

 

While the exact cause is not clear, researchers have found that ADHD tends to run in families, so a genetic factor in likely.  Ongoing research is focused on identifying genes that cause a person to be susceptible to ADHD.

 

Studies have also shown a possible link between alcohol and tobacco use during pregnancy and ADHD.

 

How is ADHD diagnosed?

 

ADHD is often diagnosed when a child is 6 to 12 years of age.  Children in this age group are most easily diagnosed because symptoms become more noticeable in school.  It is more difficult to diagnose ADHD in a child younger than age 6 because the symptoms can also occur periodically during normal development.

 

ADHD is diagnosed by first having a thorough medical examination to rule out other conditions.  An evaluation by a pediatrician, family doctor, psychologist, or child and adolescent psychiatrist uses specific criteria established by the American Psychiatric Association (APA).  Observations of a child’s behavior documented by parents, classroom teachers, and others who have regular contact with the child are evaluated.

 

How is it treated?

 

Although there is no cure for ADHD, treatment can help control symptoms.  Stimulant medications, such as amphetamine (examples include Dexedrine or Adderall) and methylphenidate (examples include Ritalin, Concerta, or Metadate CD), are effective in controlling symptoms in children.  A new medication for ADHD, atomoxetine (Strattera), has recently been approved.  This no stimulant medication may provide an alternative when stimulant medications are not effective or not well tolerated.

 

Studies show that some children who receive behavioral therapy along with medication improve more than those who receive medication alone.  Often, extra support at home and at school and counseling help children find success at school and feel better about themselves.

 

Doctors recommend that children be closely followed after they begin to take medications for ADHD.  Side effects—including loss of appetite, headaches, or stomachaches, tics or twitches, and problems sleeping—usually decrease after a few weeks on the medication, or the dosage can be lowered to offset them.

 

How does ADHD affect adults?

 

Many adults do not realize that they have ADHD until their children are diagnosed and they begin to recognize their own symptoms.  Adults with ADHD may find it hard to focus, organize, and finish tasks.  They are often forgetful and absent-minded.  Some adults with ADHD learn to manage their lives and find careers in which they can use their strengths—intellectual curiosity and creativity—to their advantage.

 

However, many adults have difficulties at home and work.  As a group, adults with ADHD have higher divorce rates, are more likely to smoke, and have more substance abuse problems than adults without the disorder.  Also compared with their peers, fewer enter college and fewer graduate.  Treatment with medication, counseling, and behavioral therapies can provide significant benefit.

 

Cause

 

The exact cause of attention deficit hyperactivity disorder (ADHD) is not known.  However, inherited genetic factors are likely responsible.  Ongoing research is focused on identifying genes that cause a person to be susceptible to ADHD.

 

Using various imaging tests, researchers have been able to observe the brain at work.  They have found a possible link between ADHD and:

 

  • Brain structure
  • The functions of chemicals in the brain that help regulate attention and activity (dopamine and norepinephrine).
  • Differences in function of some of the areas of the brain that affect attention and impulse control.

 

Also, research shows that a mother’s use of cigarettes, alcohol, or other drugs during pregnancy may increase the risk for ADHD.  Some studies suggest that exposure to lead may cause symptoms associated with ADHD.

 

Although many parents believe that foods with sugar and food additives make their children more hyperactive, these foods have not been shown to cause ADHD.  In a comprehensive review of research, the National Institutes of Health (NIH) found that restricted diets seemed to help only about 5% of children with ADHD, mostly either young children or children with food allergies.  Other research has shown that sugar is not related to ADHD.

 

Some people have misconceptions about ADHD, such as children with ADHD are lazy or dumb.  Discuss any questions or concerns you have about these issues with a health professional.

 

Symptoms

 

The symptoms of attention deficit hyperactivity disorder (ADHD) include:

 

  • Inattention, which is having a short attention span and being easily distracted.
  • Impulsivity, which can cause a person to do dangerous or unwise things without thinking about the consequences.
  • Hyperactivity, which is inappropriate or excessive activity.

 

These symptoms affect people in all age groups who have ADHD.  However, typical behavior varies by age.

 

  • In preschool-aged children, symptoms may be hard to identify.  Normal behavior in young children periodically includes all of the major symptoms.  ADHD is distinguished from normal behavior by the severity and consistency of symptoms.
  • Children between the ages of 6 and 12 usually show more obvious signs of ADHD than other age groups.  School expectations can make symptoms more noticeable.  For some children, school is the first setting where academic performance and socialization abilities are assessed.  However, it often is more difficult to detect ADHD when inattention is the primary symptom and the child is otherwise well-behaved.  The presence of ADHD may be indicated by:
    • Low grades or test scores, including achievement tests.
    • Poor organization and study skills.
    • Socialization problems and feeling rejected by peers.
    • Problems with self-esteem.
  • Teens between the ages of 13 and 18 may be in better control of disruptive behavior related to hyperactivity.  Other problems that began in earlier years may continue or become worse when ADHD is not treated.  Teens with inattention problems who previously managed to cope may start to fall behind in schoolwork.  This is especially true when major changes occur, such as starting at a new school or going to college.
  • Symptoms of ADHD in adults may not be as noticeable.  Many adults with ADHD have not been diagnosed and treated.  These people can develop problems such as depression and difficulty maintaining a job.

 

There are several other conditions with symptoms similar to ADHD.  For example, sometimes bipolar disorder and ADHD can be confused.  It can be difficult to determine whether symptoms are caused by ADHD, another condition, or both.

 

What Happens

 

Preschool age

 

Normally, children 3 to 4 years of age are often inattentive, hyperactive, and impulsive—all the symptoms of attention deficit hyperactivity disorder (ADHD).  Differentiating between what is normal for the age and what may be cause by ADHD can be difficult in children this young.

 

School-age and teen years

 

ADHD is most often diagnosed in children between ages 6 and 12.  After a child starts school, the symptoms of ADHD become more noticeable.  During the period, ADHD can disrupt many aspects of a child’s life.  Learning and academic performance, adjusting to change, sleeping, and getting along with others are all potential problem areas.

 

Symptoms of ADHD usually remain the same through early adolescence.  Approximately 75% of children with ADHD continue to have symptoms into the teen years.  Children with ADHD are often described as less mature than their peers and may lag behind in reaching milestones typical for their age group.

 

However, some symptoms typically improve or become less obvious.  For example, someone who had very disruptive hyperactive behavior during elementary school may only fidget or feel restless in high school.

 

Adults

 

Symptoms of ADHD can last into adulthood and include difficulty focusing, organizing, and finishing tasks.  However, adults often are able to adjust in the workplace better than they did in the classroom as children.

 

Many adults do not realize that they have ADHD until their children are diagnosed and they begin to recognize their own symptoms.  Some adults with ADHD learn to manage their lives and find careers in which they can use their strengths—intellectual curiosity and creativity—to their advantage.  However, many adults have difficulties and home and work.  As a group, adults with ADHD have higher divorce rates, are more likely to smoke, and have more substance abuse problems than adults without the disorder.  Also compared with their peers, fewer enter college and fewer graduate.  Treatment with medication, counseling, and behavioral therapies can provide significant benefit.

 

Effects on the family

 

Raising a child who has ADHD can be a challenge.  Parents must consistently monitor their child and respond to problem behavior appropriately.  If other issues are causing stress within a family (such as divorce, violence, or drug or alcohol abuse), it may be even more difficult to deal with a child who has ADHD.

 

Conditions the often accompany ADHD

 

There is mounting evidence that people with ADHD commonly have one or more other disorders such as dyslexia, oppositional defiant disorder, conduct disorder, anxiety, and depression.

 

Treatment for ADHD can help control symptoms, allowing a child to grow and develop normally.  Treatment also can decrease the frustration, discouragement, and failure that many people with ADHD experience throughout their lives.

What Increases Your Risk

 

So far, it appears that the greatest risk factor for developing attention deficit hyperactivity disorder (ADHD) is having an inherited tendency for the condition.

 

Environmental factors, such as certain parenting techniques, may influence, how symptoms of ADHD are expressed but do not cause ADHD.

 

A stressful family situation may contribute to a child’s symptoms.  A child may feel guilty because of his or her symptoms and the problems they cause, which can increase the risk of developing another condition, such as anxiety, along with ADHD.

 

When to call a doctor

 

Call a health professional if:

 

  • You notice that you or your child has symptoms of attention deficit hyperactivity disorder (ADHD) that began before age 7.
  • Your child is showing signs of ADHD, such as inattention, impulsivity, and/or hyperactivity that are causing problems at home or school.  Parents and teachers often notice this behavior during the child’s first few years in school.
  • Your child shows signs of other mental health disorders, such as depression or anxiety that last more than a few weeks or seem to be getting worse.
  • Your child is having academic or behavioral problems at school.

 

Watchful Waiting

 

Preschool Children

 

For young children who show signs of attention deficit hyperactivity disorder, watching waiting is appropriate.  It is difficult to diagnose ADHD in children younger than age 5.  Young children generally have short attention spans, and their normal range of behavior includes periods of high activity and impulsivity.  If you notice and ADHD symptoms in your preschooler that do not seem age-appropriate, work with your child to improve behavior.  Keep a record of your child’s behavior for 6 months to see if it improves.  If it continues or has consequences, such as being expelled from day care or preschool, talk with your health professional about having your child evaluated.

 

School-age and teen years

 

Watchful waiting is not appropriate for school-age children and teens with ADHD symptoms.  Children who have behavior problems that occur in more than one setting, such as poor relationships with parents and poor academic performance, need attention from a health professional.

Problems caused by inattention may not become significant until the teen years, when greater self-reliance is expected.  A change in school (such as advancing to junior high or high school) or a new environment (such as moving to another city) can trigger problems with inattention.  If you suspect your child may have an inattention problem, see a health professional to determine whether ADHD is the cause.

 

Adults

 

Watchful waiting may not be appropriate if you are an adult and suspect that you may have ADHD.  Consider how long you have experienced symptoms , and think about any major changes or difficult situations that are affecting your life.  Your symptoms may improve once you have addressed and worked on those issues.  However, talk to a health professional if your symptoms concern you.  If you have other symptoms, such as depression or anxiety, a health professional can help diagnose and treat your problems.

 

Who to see

 

Health professionals who can diagnose and treat attention deficit hyperactivity disorder (ADHD) with medication includes:

 

  • Family practice doctors.
  • Pediatricians (may specialize is developmental problems).
  • Psychiatrists (may specialize in adults or children and adolescents).
  • Neurologists (may specialize in child or adult nervous systems).
  • Nurse practitioners who specialize in psychiatry.

 

Health professionals who do not prescribe medications but can provide behavioral therapy or family counseling include:

 

  • Psychologists.  Psychologists also frequently diagnose ADHD.
  • Behavioral specialists.
  • Social workers.
  • Psychiatric nurse specialists.
  • Licensed professional counselors.
  • Family therapists.

 

Ask your health professional about his or her training and experience related to ADHD.  Diagnosing and treating ADHD requires an ability to identify and distinguish behaviors that can be subtle and complicated.  In addition, make sure your health professional has enough time to evaluate you or your child.  Accurate diagnosis and successful treatment of ADHD takes repeated office visits and observations.  It is also necessary that he or she be able to coordinate between other health professionals, family members, teachers, and caretakers.

 

Exams and Tests

The American Psychiatric Association (APA) has established criteria for diagnosing attention deficit hyperactivity disorder (ADHD).  These criteria divide the condition into three basic types based upon major symptoms:

 

  • ADHD, combined type
  • ADHD, predominantly inattentive type
  • ADHD, predominantly hyperactive-impulsive type

 

In addition, some people are diagnosed with “ADHD, not otherwise specified” when symptoms of inattention, hyperactivity, and/or impulsivity are present but do not fit into one of the three types.

 

A health professional will use criteria for diagnosing attention deficit hyperactivity disorders to determine whether a child has ADHD.  Information used to diagnose the condition includes:

 

  • An interview with the child.
  • Medical history, to include asking a parent about the social, emotional, educational, and behavioral history of the child.
  • Physical examination
  • Behavior rating scales or checklists for ADHD given to parents and teachers to evaluate the child’s symptoms.

 

It can be difficult to determine whether a child’s behavior problems are cause by ADHD, other conditions with similar symptoms, or a combination of ADHD and another condition.  Several verbal and written test for associated disorders are used to help with this determination.

 

In addition, children with ADHD may have difficulty learning to read, write, or do math problems.  Testing for learning disabilities will help teachers develop the best educational plan for a child with these difficulties.

 

Additional tests may be done to identify other medical problems that might explain the child’s symptoms, such as:

 

  • Hearing or vision impairment.  This type of disability often interferes with school achievement.
  • Lead exposure.  Children who have even small amounts of lead in their bodies can have symptoms similar to ADHD.
  • Low red blood cell counts (anemia).  This condition can cause low energy and poor concentration.  It can be diagnosed with results from a complete blood count (CBC)
  • Thyroid disease.  Blood tests can help determine whether a person has too much or too little thyroid hormone, which also can affect energy and attention.  This is more common in adults than children.
  • Seizures.  Seizures can affect brain function and result in unusual behavior.  Rarely, a person with ADHD symptoms has an electroencephalogram (EEG) to determine whether seizures are occurring.

 

Parents often questions whether ADHD is over diagnosed.  Many health professionals and researchers believe that the increase in ADHD diagnoses results from improved detection techniques, especially the standardization of assessment criteria.  Current and future research should help in answering this question.

 

Many adults with ADHD have never been diagnosed or treated.  ADHD is a lifelong condition that, left untreated, can lead to low self-esteem, frustration, educational or job failure, drug abuse, and depression.  To diagnose ADHD in an adult, a health professional hay use the Wender Utah Rating Scale (WURS), a written test that consists of 25 questions about childhood difficulties that are often seen with the condition.  The scale evaluates the presence and severity of ADHD symptoms during childhood. 

 

Adults with untreated ADHD are at an increased risk of abusing drugs or alcohol.  If an adult is suspected of having or is diagnosed with ADHD, he or she may also be screened for alcohol and drug abuse.

 

Early Detection

 

General screening of all children for attention deficit hyperactivity disorder (ADHD) is not recommended.  However, if you are concerned about how your child’s temperament, learning skills, or behavior is developing, talk with your health professional during your next visit.

 

Before meeting with your health professional, think about at what age your child’s symptoms began.  In addition, you and other caregivers should record when the behavior occurs and how long it lasts.  An important component of evaluation  for ADHD is considering the kinds of problems that result from the behaviors and to what extent they affect academic performance and social behavior.

 

Some adults do not recognize their own symptoms of ADHD until their child is diagnosed with the condition.  If your child is diagnosed with ADHD and you think you have symptoms, talk with your health professional about being screened for ADHD.

 

Treatment Overview

 

Initial Treatment

 

Successful treatment of attention deficit hyperactivity disorder (ADHD) begins with an accurate diagnosis and understanding of a child’s weaknesses and strengths.  Learning about ADHD will help you and your child’s siblings better understand how to help your child.

 

The American Academy of Pediatrics (AAP) guidelines recommend medication and/or behavior therapy to treat children with ADHD.  This recommendation is based on numerous studies, including the landmark Multimodal Treatment Study of Children with ADHD.  In this large study, researchers found that school-aged children with ADHD who received medication had a significant decrease in core ADHD symptoms (inattention, impulsivity, and hyperactivity).

 

Your child’s health professional may recommend that your child take a stimulant medication, such as amphetamine (examples include Dexedrine or Adderall) or methylphenidate (examples include Ritalin, Concerta, or Metadate CD).  These medications improve symptoms in about 70% of children who have the condition.

 

While it may seem contradictory, stimulants usually decrease hyperactivity and impulsivity and improve focus.  Some parents worry about their children becoming addicted to stimulants.  Research has shown that these medications, when taken correctly, do not cause dependence.  However, parents should closely supervise the use to ADHD medications, because abuse by siblings, classmates, and adults has been reported.

 

Parents are also often concerned about medication side effects, including loss of appetites, nervousness, tics or twitches, and problems sleeping.  Children should be closely monitored after they start medications to assess whether they are receiving the correct dose.  These side effects usually decrease after a few weeks on the medication, or the dosage can be lowered to offset them.

 

Should my child take medications for ADHD?

 

A new medication called atomoxetine (Strattera) has recently been approved for ADHD.  This nonstimulant medication may be prescribed in stimulant medications are not effective or have bothersome side effects.  Strattera is not a controlled drug, allowing refills on prescriptions and telephone prescriptions.

 

The AAP guidelines also encourage behavior therapy.  Through behavior therapy, parents learn strategies, such as positive reinforcement to improve a child’s behaviors.  Children learn to develop problem solving, communication, and self-advocacy skills.

 

Counseling may help children and adults with ADHD recognize problem solving behaviors and learn ways to deal with them.  For both parents and children, counseling can serve to air frustrations and deal with stress.

 

Some children with ADHD also have other conditions, such as anxiety or oppositional defiant disorder.  Behavioral therapy can help treat some of these conditions.

 

Often, elementary school teachers are the first to recognize ADHD symptoms because in the classroom more demands are placed on children to sit still, pay attention, listen, and follow class rules.  Many times, teachers recommend to parents that a child be tested or see a health professional.

 

Most children with ADHD qualify for educational services within the public schools.  If your child qualifies, you will meet with school personnel to identify goals and establish an individualized education program (IEP).  IEPs are based upon the evaluation of a child’s disability and his or her specific needs.  This usually means your school will try to accommodate your child’s extra needs, which may be as minor as placing him or her at the front of the class or as involved as providing classroom staff to assist your child.

 

Your health professional will talk with you about setting realistic and measurable goals for your child’s behavior at school and at home.  Each child must be considered individually, taking into account his or her specific problems and needs.

 

If your child is preschool age, your health professional may encourage behavioral therapy in an effort to curb symptoms and avoid using medication at an early age.  However, if behavioral therapy is not effective in controlling symptoms, some health professionals recommend medications.  Whether preschool-aged children should receive medication is somewhat controversial, because there are few studies in this age group.  However, the ongoing Preschool ADHD Treatment Study (PATS) is exploring whether the stimulant medication methylphenidate (such as Concerta) is safe for preschool-aged children.

 

Recent Research

 

  • Although short-term studies have shown stimulant medications are safe, long-term effects have not been studied.  In a recent 2-year study, children who took stimulant medication grew almost per year slower than children not on medication.  The study followed 540 youngsters with ADHD who were ages 7 to 9 at the outset of the study.  More studies are needed to determine whether growth is affected at other ages (younger than age 7, older than age 9) or whether children taking these medications might catch up over a period of time.  As with any medication, parents should balance the benefits their child might receive from taking these medications with any potential risks.
  • In another study, children who received medication ad behavior therapy did not have significantly greater improvement in core symptoms than those taking medication only.  However, these children saw some improvements in other areas, including a decrease in anxiety, better academic performance, and improved parent-child relations and social skills.

 

Ongoing treatment

 

Regular communication among parents, teachers, and health professionals benefits a child with attention deficit hyperactivity disorder (ADHD).

 

Teens will benefit from continuing to take a stimulant medication—such as amphetamine (for example, Dexedrine or Adderall) or methylphenidate (examples include Ritalin, Concerta, or Metadate CD)—or nonstimulant atomoxetine (Strattera) if either type of medication has been helpful in the past.

 

Parents can also be reassured that taking stimulant medication for ADHD does not increase the risk for substance abuse later.  In fact, a recent analysis that followed children and teens with ADHD for at least 4 years found less alcohol and drug abuse in those who had taken stimulant medications than in those who did not receive medication.  For more information, see:

 

Should my child take medications for ADHD?

 

Staying tuned into your teen and continuing behavior therapy takes a lot of hard work but may pay off in the long run.  The teen years present many challenges, including increased schoolwork and the need to be more attentive and organized.  Making good decisions becomes especially important during these years when peer pressure, emerging sexuality, and other issues surface.  Use consequences that are meaningful to your teenager, such as losing privileges or having increased chore assignments.  Parents and teens can work together to establish reasonable, obtainable goals and negotiate appropriate rewards when those goals are met.

 

ADHD in adulthood

 

Unfortunately, attention deficit hyperactivity disorder (ADHD) often goes undiagnosed in adults.  The right treatment can help those who have struggled with the condition for years.  Like ADHD in children, adults may benefit from medication combined with psychological support, including education about the disorder, support groups and/or counseling, and skills training.  Skills training can include time management, organizational techniques, and academic and vocational counseling.

 

Studies have found that about 58% of adults with ADHD report a better ability to focus and less hyperactivity and impulsivity when taking stimulant medications.  If stimulant medications have bothersome side effects or are not effective, your doctor might recommend atomoxetine (Strattera).  This nonstimulant medication has recently been approved for ADHD.  Strattera is not a controlled drug, allowing refills and telephone prescriptions. 

 

Certain antidepressants, such as bupropion (for instance, Wellbutrin), or tricyclics (such as imipramine, nortriptyline, and desipramine) are sometimes also recommended for adults with ADHD.

 

What to Think About

 

There are several myths that can interfere with a realistic perception of ADHD.  It is important to understand that ADHD is a medical condition that cannot be consistently controlled without treatment.  Help your child with ADHD to learn about the condition and the importance of following treatment plans.  Your child is more likely to successfully control symptoms when he or she actively participates in treatment, such as taking medications on time.

 

Some people use treatment methods that have not been proven helpful, such as diet restrictions.  Do not substitute these practices for conventional medical treatment.  Some treatments are potentially physically and emotionally harmful or unproven.  Using them not only can be dangerous but may also prevent you from using proven methods of treatment.  Talk with a health professional about any concerns or questions that you or your child has about ADHD or its treatment.

 

Prevention

 

There is no known way to prevent attention deficit hyperactivity disorder (ADHD).  Avoiding alcohol, drugs, and smoking during pregnancy may help prevent a child from developing behavior similar to ADHD as well as many other health problems.

 

Although you cannot prevent ADHD, you can help your child have fewer learning and attention problems by;

 

  • Having a good medical care and practicing healthy habits during pregnancy.
  • Learning and applying good parenting skills, including setting consistent behavior limits.
  • Maximizing preschool learning and attention skills by reading to your child and providing new learning experiences such as puzzles and board games.  The development of attention skills can be increased with these types of activities rather than watching television.

 

In addition, nurturing techniques that begin at birth and continue throughout childhood will help your child reach his or her potential regardless of whether ADHD is a concern.

 

Home Treatment

 

Many home treatment methods can help reduce your child’s symptoms of attention deficit hyperactivity disorder (ADHD).  The approached differ for children and adults, but treatment for all ages emphasizes understanding the condition, establishing daily structure, and using support systems.

 

When your child has ADHD, working together can improve behavior and functioning at home and school.  In addition, it is important for you to recognize that helping yourself will also help your child.

 

Tips for self-care

 

  • Take care of yourself.  It is often challenging to raise a child with ADHD.  Caring for your own physical and mental health is an important part of helping your child and will help provide the needed energy.
  • Educate yourself about ADHD.  Learn as much as you can about the condition and your child’s specific symptoms.  You will be better able to help your child if you understand the condition.
  • Learn behavior management skills.  Children usually need help learning how to interact appropriately with other people.  You can help your child by learning behavior management skills.  An important component of behavior management is establishing natural and logical consequences for misbehavior.

 

Tips for your child

 

Help your child develop healthy self-esteem.  Behaviors caused by ADHD can affect a child’s feelings about himself or herself.  You can help your child develop healthy self-esteem by encouraging a sense of belonging, confidence in learning, and an awareness of his or her contributions.

 

Help your child be successful in school.  The symptoms of ADHD can interfere with a child’s ability to succeed in school.  Promoting school success will help your child academically, socially, and developmentally.

 

Help your child accomplish tasks at home.  Children with ADHD have more difficulty than other children paying attention to instructions, and they frequently get distracted before they can complete a task.  Your patience, persistence, and creative thinking can help your child learn skills and accomplish tasks at home and school.

 

Medications

 

Medications are used to help control the symptoms of attention deficit hyperactivity disorder (ADHD): hyperactivity, impulsivity, and inattention.

 

Most often, stimulant medications are used to treat ADHD.  These medications are effective for people of all ages, although more research is needed on how adults respond.  In general, stimulant medications improve symptoms in about 70% of people who have ADHD.  There are often quick and dramatic improvements in behavior.

 

Other types of medications may be used to treat ADHD.

 

  • Atomoxetine (Strattera) is a nonstimulant medication for ADHD.
  • Antihypertensives, designed to treat high blood pressure, can also help control aggressive and impulsive behaviors in some people.
  • Antidepressants may be needed if psycho stimulants do not improve symptoms.

 

Medications may be needed to treat other mental health conditions, such as anxiety disorders, that often occur along with ADHD.

 

If you are giving your child medication for ADHD, it is important to make sure it is taken consistently.  In addition, you will need to regularly monitor the effects of the medication and communicate closely with your child’s health professional.

 

Medication Choices

 

The following medications are used to treat attention deficit hyperactivity disorder (ADHD):

 

  • Stimulants, such as Ritalin, Concerta, Metadate CD, Dexedrine, and Adderall
  • Atomoxetine (Strattera), a recently approved nonstimulant medication for children, teens, and adults with ADHD.

 

The following medications are sometimes tried if symptoms persist after initial treatment with one of the above medications.  These medications are usually not used in younger children.

 

  • Antihypertensives, such as Catapres and Tenex, which may be used to treat aggression and impulsivity not controlled by ADHD medications.
  • Antidepressants, such as bupropin (for example, Wellbutrin)

 

FDA Advisory.  The U.S. Food and Drug Administration (FDA) has issued an advisory to patients, families, and health care providers to closely monitor adults and children taking antidepressants for signs of suicide.  This is especially important at the beginning of treatment or when doses are changed.

 

The FDA also advises that patients be observed for increases in anxiety, panic attacks, agitation, irritability, insomnia, impulsivity, hostility, and mania.  It is most important to watch for these behaviors in children who may be less able to control their impulsivity as much as adults and therefore may be at greater risk for suicidal impulses.  The FDA has not recommended that people stop using antidepressants, but simply to monitor those taking the medications and, if concerns arise, to contact a health professional.

 

What to Think About

 

All of a child’s behavior problems may not be controlled by medication for ADHD.  The child may still have a higher level of some behavior problems than other children the same age.  In addition, it has not been established that medication improves the long-term educational, occupational, and social functioning of a person who has ADHD.

 

New longer-acting medications allow many people to take one pill a day for their ADHD symptoms, avoiding the multiple dosages that were once standard.

 

Although short-term studies have shown stimulant medications are safe, long-term effects have not been studied.  In a recent 2-year study, children who took stimulant medication grew almost per year slower than children not on medication.  The study followed 540 youngsters with ADHD who were ages 7 to 9 at the outset of the study.  More studies are needed to determine whether growth is affected at other ages (younger than age 7, older than age 9) or whether children taking these medications might catch up over a period of time.  As with any medication, parents should balance the benefits their child might receive from taking these medications with any potential risks.

 

Most medications to treat ADHD are approved by the U.S. Food and Drug Administration (FDA) for children age 3 and older.  However, there are a few studies on the use of ADHD medication for children age 5 and younger.  Most health professionals do not prescribe medications for a child with ADHD symptoms until he or she starts school.  Younger children are more likely to have side effects from medications.  However, they may be prescribed for younger children when symptoms severely affect a child’s behavior and quality of life.

 

Some medications used to treat ADHD (such as stimulants) can be abused.   Make sure your child knows not to sell or give medication to other people.  An adult should supervise the medication.

 

Surgery

 

There is no surgical treatment for attention deficit hyperactivity disorder (ADHD).

 

Other Treatment

 

Methods of treatment that may be used for attention deficit hyperactivity disorder include behavior management, social skills, and counseling.

 

Treatment for ADHD is based on your or your child’s symptoms and problem behaviors.  Medication is the most effective treatment for the major ADHD symptoms of inattention, impulsivity, and hyperactivity.  Other treatment is sometimes recommended if:

 

  • Symptoms are mild.
  • Symptoms do not respond to medication.
  • Medications cause significant side effects.
  • Another condition, such as anxiety, occurs along with ADHD.  Medication combined with other treatment often is used.

 

Other Treatment Choices

 

Behavioral interventions

Behavioral interventions help train parents, teachers, and other adults responsible for a child with ADHD.  Programs emphasize the need to establish routines and rules for behavior and to closely monitor how a child responds.  The adult consistently delivers rewards or consequences depending upon how the child complies with the rules.  This type of treatment has been shown to be more effective than cognitive behavioral therapy techniques.  Cognitive-based therapies depend more upon then child to self-direct behavioral changes.  A child with ADHD is not likely to have the skills to change his or her behavior without help and guidance from adults. 

 

Behavioral interventions most often used to help treat ADHD in a child include:

 

  • Behavior management.  Time-out and reward systems can help a child with ADHD learn appropriate behaviors for the classroom and home.  Parent training in behavior management skills is conducted during a series of 6 to 12 couseling sessions of 1 to 2 hours per week.
  • Social skills training.  These techniques help the child learn to be less aggressive and impulsive, manage anger, and behave in a more socially acceptable way.
  • Counseling, including family therapy.  All household members can benefit from learning methods to deal effectively with ADHD behavior.

 

Behavioral intervention for adults focuses upon assistance with organizational skills and healthy relationships.

 

Complementary and alternative medicine

 

Complementary and alternative medicine (CAM) is used by some therapists or others who do not operate within mainstream medical practice.  However, none of these complementary therapies have been shown through clinical research to be effective in treating ADHD and should not replace proven conventional methods.  More research is needed before any can be recommended as primary treatment for ADHD.  However, a person with ADHD may benefit from safe, nontraditional therapies used in addition to conventional medical treatment.  For example, acupuncture or biofeedback may help relieve stress and muscle tension and improve a person’s overall well being and quality of life.

 

If you are considering using complementary and alternative medicine to help treat ADHD, be open with your health professional about the subject.  He or she can help direct you to treatments that are safe to use in combination with proven techniques.  Only those treatments that best help control ADHD symptoms without causing physical or emotional harm should be used.

 

What to Think About

 

Overall, medications are the most effective treatment for ADHD, although individuals vary in their response to medication.  Behavioral training, training and education for parents, and counseling are sometimes used as the primary treatment for mild symptoms.  Usually, these methods are used in addition to medication for people with moderate to severe symptoms.

 

Parents may understandably be reluctant to give their child medication indefinitely.  However, studies show that these medications are safe and that they can positively affect behavior and improve the quality of life for people with ADHD and their families.  It is important to talk openly about any concerns with your health professional in order to best understand and treat ADHD.

 

Other Places to Get Help

 

Books

 

ADHD: A Complete and Authoritative Guide

Author/Editor:                          Michael I. Reiff, MD, Editor in Chief, with Sherill Tippins

Publisher:                                 American Academy of Pediatrics

141 Northwest Point Boulevard

Elk Grove Village, IL  60007-1098

Publication Date:                      October 2003

 

This child care guide is based on evidence-based clinical practice guidelines for ADHD.  It offers parents information to help them understand and manage this challenging and often misunderstood condition.  This resource provides up-to-date information on evaluation and diagnosis, coexisting conditions, behavior therapy, ADHD and academics, and the role of medications.  Can be ordered from AAP online bookstore at http://www.aap.org/bookstorepubs.html

 

 

Helping Parents, Youth, and Teachers Understand Medications for Behavioral and Emotional Problems, 2nd ed.

Author/Editor:                            Dulcan MK, Lizarralde C.

Publisher:                                   American Psychiatric Publishing, Inc.

Washington D.C.

Publication Date:                        2002

 

This book provides a wide variety of resources related to the treatment of attention-deficit/hyperactivity disorder (ADHD).  There are also recommendations on where to find specific additional information, such as newsletters, books, and Web sites.

 

 

Organizations

 

Learning Disabilities Association of America (LDA)

4156 Library Road

Pittsburg, PA  15234-1349

Phone:                                      (412) 341-1515

Fax:                                          (412) 344-0224 (FAX)

E-Mail:                                     info@ldaamerica.org

Web Address:                           http://www.ldanatl.org

 

This organization works to advance the educational and general welfare of people with normal or potentially normal intelligence who have perceptual, conceptual, or coordinative disabilities.  Specifically, LDA:

 

  • Promotes research, education, and training on learning disabilities.
  • Educates people with learning disabilities and their families about the nature of the disability and informs them of their rights.
  • Promotes public awareness and acceptance of learning disabilities.
  • Develops and promotes legislative assistance to improve regular and special education.
  • Provides and distributes information on learning disabilities.
  • Promotes career opportunities for learning-disabled people.

 

 

National Attention Deficit Disorder Association (ADDA)

P.O. Box 543

Pottstown, PA  19464

Phone:                                     (484) 945-2101

Fax:                                         (610) 970-7520

E-mail:                                    mail@add.org

Web Address:                         http://www.add.org

 

The ADDA provides a wide variety of information about attention deficit hyperactivity disorder (ADHD).  Basic facts, special links for children and teens, family issues, books, and other resources are examples of the many issues addressed on the Web site.  In addition, there are links and suggestions for finding local support organizations.

 

 

Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD)

8181 Professional Place

Suite 201

Landover, MD  20785

Phone:                                     1-800-233-4050

Fax:                                         (301) 306-7070

E-mail:                                    national@chadd.org

Web Address:                         http://www.chadd.org

 

This organization works to improve the lives of people affected by ADHD by providing education, advocacy and support.  This group provides general information and support group leads on their Web site, as well as publishes scientific, evidence-based materials on research advances, medications, and treatments affecting individuals with ADHD.

 

References

 

Citations

 

  1. National Institute of Mental Health (2003).  Attention Deficit Disorder.  NIH Publication No. 03-3572.  Available online: http://www.nimh.gov/publicat/adhd.cfm
  2. American Psychiatric Association (2000).  Attention-deficit and disruptive behavior disorders.  In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 85-103.  Washington, DC: American Psychiatric Association.
  3. MTA Cooperative Group (1999).  A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder.  Archives of General Psychiatry, 56: 1073-1086.
  4. MTA Cooperative Group (1999).  Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder.  Archives of General Psychiatry, 56: 1088-1096
  5. Lamberg L (2003).  ADHD often undiagnosed in adults:  Appropriate treatment may benefit work, family, social life.  JAMA, 290(12): 1565=1567.
  6. Woldrach ML, et al. (1995).  The effect of sugar on behavior or cognition in children.  A meta-analysis.  JAMA, 274: 1617-1621
  7. Diagnosis of Attention-Deficit/Hyperactivity Disorder (August 1999).  Summary, Technical Review Number 3 (AHCPR Publication No. 99-0049).  Rockville, MD: Agency for Health Care Policy and Research.  Also available: http://www.ahcpr.gov/clinic/adhdsutr.htm (accessed: August 26, 2000)
  8. Robin AL (1999).  Attention-deficit/hyperactivity disorder in adolescents: Common pediatric concerns.  Pediatric Clinics of North America, 46(5): 1027-1038
  9. Schweitzer JB, et al. (2001).  Attention-deficit/hyperactivity disorder.  Medical Clinics of North America, 85(3): 757-777
  10. Brown University Psychopharmacology Update (2002).  How Safe Is Methylphenidate in Preschoolers? 13(9): 2-3
  11. MTA Cooperative Group (2004).  National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up:  Changes in effectiveness and growth after the end of treatment.  Pediatrics, 113(4): 762-769
  12. Wilens TE, et al. (2003).  Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse:  A meta-analytic review of the literature.  Pediatrics, 111(1): 179-185.
  13. Weiss M, Murray C (2003).  Assessment and management of attention-deficit/hyperactivity disorder in adults.  CMAJ, 168(6): 715-722
  14. Brue AW, Oakland TD (2002).  Alternative treatments for attention-deficit/hyperactivity disorder:  Does evidence support their use?  Alternative Therapies, 8(1): 68-74

Other Works Consulted

 

  • Consensus Development Panel (2002).  National Institutes of Health Concensus Development Conference statement: Diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD).  Journal of the American Academy of Child and Adolescent Psychiatry, 39(2): 182-193.
  • Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD).  NIH Consensus Statement, vol. 16, no. 2 (1998 November 16-18).
  • Dulcan MK, Martini DR (2003).  Attention deficit/hyperactivity disorder section of Axis 1 disorders usually first diagnosed in infancy, childhood, or adolescence:  Attention-deficit and disruptive behavior disorders.  Concise Guide to Child and Adolescent Psychiatry, 3rd ed., pp. 24-41.  Washington, DC: American Psychiatric Press.
  • Greenhill LL, et al. (1999).  Stimulant medications.  Journal of the American Academy of Child and Adolescent Psychiatry, 38(5): 503-512.
  • Zametkin AJ, Ernst M (1999).  Problems in the management of attention-deficit hyperactivity disorder.  New England Journal of Medicine, 340(1): 40-46.

 

 

 

 

                         Author: Nancy Reid

          Medical Review: Michael J. Sexton, MD – Pediatrics

                                      Mina Dulcan, MD – Child and Adolescent Psychiatry

                                  
Web Hosting Companies