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Attention-Deficit Hyperactivity Disorder (ADHD) is a greatly misunderstood health concern for school-aged children. Many critics claim that children with ADHD simply, "aren't trying hard enough," and, "with a little extra effort," they can, "get over it." Unfortunately, it isn't this simple. Think of a child with asthma or diabetes. Those medical issues are not solved by will-power alone, and neither is ADHD.
It is not uncommon for a child with ADHD to struggle academically. These children struggle at school without ever doing well, ultimately becoming so discouraged that they give up. Bad experiences at the elementary-school level snowball into a lifelong aversion toward school and learning. In addition, a large body of current research concludes that children with untreated ADHD are at risk for developing other problems, including conduct disorder, oppositional defiant disorder, substance abuse, depression and anxiety.
What is ADHD?
The human brain is constantly being bombarded with input. All at once, information that we see, hear, feel, experience and remember, is going through our minds. One of the brain's functions is to filter this input, decide what is important and disregard the rest. This "filtering" step is where people with ADHD have a problem. A child with ADHD receives input and, because they cannot filter, they attempt to act on everything all at once.
Children with ADHD can display a variety of different behaviors. Some children are very active, impulsive, unable to sit still, constantly interrupting, always in motion and frequently getting into trouble. These kids would be described as having ADHD with predominantly hyperactive/impulsive subtype. Other kids will seem to "space out" frequently, very forgetful, unable to complete anything, and needing constant reminders to stay on task. These children demonstrate ADHD with predominantly inattentive subtype. And of course, many kids will show a combination of these symptoms, known as the combined type ADHD.
Every child is inattentive or hyperactive at times, but not every hyperactive child has ADHD. Only 4-12 percent of all school age children have ADHD and it is very difficult to properly diagnosis. There is no simple blood test or x-ray to make the diagnosis. A panel of medical, psychological and developmental experts has developed very specific criteria that define the condition and published them in the DSM-IV (Diagnostic and Statistical Manual of mental disorders, 4th edition). These guidelines define specific behaviors that children between the ages of 6 and 12 must display. The behaviors have to be outside of what is normal for children of the same age, they have to present in more than one location and they must cause functional impairment for the child. Parents must work closely with their child's pediatrician, teachers, daycare providers and other adults who interact with the child to establish the diagnosis, and to separate ADHD type behaviors from age appropriate behavior or other medical or psychological problems.
Who should be evaluated for ADHD?
In some cases it is obvious: A child who can never sit still at school or at home, is always fidgeting and never follows instructions is a strong candidate. So many children, however, only demonstrate more subtle signs of the disorder. Children experiencing school difficulties including struggling in class or who appear to be underachievers who just, "don't care" about their academic performance should be evaluated. Children with ADHD may also have low self-esteem because they believe they are "stupid" or "slow." In addition, some children with ADHD have a lot of trouble socializing with family members and peers. Any child with these problems should be evaluated for ADHD as well as other medical and psychological issues.
How is ADHD treated?
As with other chronic conditions, families must manage the treatment of ADHD on an ongoing basis. Treatment for ADHD must be guided by a long-term management plan that defines target outcomes, outlines specific treatments and allows for monitoring of the child's progress. Behavioral therapy that helps a child to improve behavior is crucial to the success of treatment. Success also depends on teamwork between the child, doctors, parents, teachers, caregivers and other health care professionals to insure that everyone is helping the child reach his goals. Finally medications, most commonly stimulant medications that are proven to be safe and effective, are often needed as well.
It may take some time to tailor a child's treatment plan to meet her needs. Although treatment may not fully eliminate the ADHD-type behavior, by implementing a complete plan the treatment can enable the child to succeed in school. Most school-aged children with ADHD respond well when their treatment plan includes participation of parents and teachers as well as both behavioral therapy and stimulant medications.
If you have concerns that your child may have ADHD you should make an appointment with your pediatrician to discuss it further. More information can be found at the American Academy of Pediatrics at http://www.aap.org/healthtopics/adhd.cfm.
Dr. McAllister is the medical director of Performance Pediatrics in Plymouth.http://www.PerformancePediatrics.com.
© 2006 Enterprise NewsMedia, divison of GateHouse Media All rights reserved.