Is it Attention Deficit Hyperactivity Disorder?
Author: Michael J Smith, MD, FAAP
There may be times when a parent or teacher has a concern about a behavior or performance. This often leads to the question of a possible diagnosis of attention deficit disorders. There may be many faces to attention deficit. A child with ADHD may have several different appearances including a child who is extremely easily distracted and thus may be forgetful or often lose things, make careless mistakes. They may have a hard time resisting temptations when presented, even if these are relatively minor. This child may have difficulty with school, and at other times have difficulty getting along with classmates or friends. While we do not know the exact percentage of children who have this condition, in Wisconsin by parent reporting, it is estimated at approximately 12.5%. Unfortunately there is no single test or blood work that can give us this diagnosis. This is often a diagnosis, therefore which is delayed.
While we do not know the causes of ADHD, several different factors may contribute in some children. This may include environmental exposure such as lead or prenatal alcohol or tobacco use, difficulty with delivery especially if premature or low birth weight. Studies have not shown an association with ADHD and excess amount of sugar intake or television viewing.
Once one is considering the diagnosis, evaluation should be undertaken by a physician who will perform a medical exam. With this they will rule out other causes that may be present similarly to ADHD. Additionally, the patient or family may be asked to complete a questionnaire regarding ADHD symptoms, and often this questionnaire is extended to others such as teachers or other caregivers. These questionnaires focus on the criteria for diagnosing ADHD, which includes questions regarding inattention, hyperactivity and impulsiveness. These symptoms must be present for at least six months. Often, however, these symptoms have been present for years prior to a diagnosis being established.
Once the physician has established that the child meets the criteria for ADHD and has no other condition that is contributing to or causing this, the treatment plan can be established. It is very important to know that treatments for ADHD are multifactorial and include behavioral interventions, parent and family education, adjustments in their environment including school and the development of a specialized learning plan, as well as medications. While ADHD is not a curable condition, it is a condition that can be managed successfully with an intervention program utilizing treatments in the above areas.
Although medication is utilized, it should not be the first step in the approach. However, once the decision has been made that a child would benefit from the assistance of medication in treating their condition, one should not delay proceeding to this step.
There are two main classes of medications utilized for ADHD. Stimulant medication is some of the earlier medication that was utilized and still the mainstay of treatment. Most children tolerate these medications well with minimal side effects. The second class of medication is the non-stimulant medications, which are also often tolerated well and can have a longer lasting effect. Whether a stimulant or non-stimulant medication is utilized, each child is different and their medication use will need to be tailored specifically to them and their response to the medication.
Social and parental support and education is also critically important. There are a variety of manners in which this can be achieved. This can occur through better understanding with reading on the subject through your library or internet. There are support groups in our environment that readily welcome new participants. The school systems and counseling systems also are well-versed in assisting in the improvement and treatment of ADHD.
While this can be a complex condition, it is often a condition that is very treatable. If your child displays these symptoms, one should be encouraged to discuss this with your physician or healthcare provider at the earliest opportunity.