http://www.pedseast.com/childillness/adhd en-us Thu, 20 Jun 2013 03:10:33 -0500 http://www.pedseast.com/childillness/adhd/adhdintroduction Attention-deficit/hyperactivity disorder (ADHD) is a common neurobiologic disorder characterized by developmentally inappropriate levels of (1) inattention, (2) hyperactivity, and (3) impulsivity. Some children may not have the hyperactivity or impulsivity and may primarily exhibit inattention. ADHD is a behavioral disorder, making it difficult to quantify, but it is one of the most prevalent chronic health conditions affecting school-age children. The diagnosis is reported 2.5 times more frequently in boys than girls, with 9.2% of males and 2.9% of females found to have behaviors that are consistent with ADHD. According to a 2003 national survey of children’s health, 56% of children with ADHD were treated with medication and problems in school were the primary difficulty.

ADHD is defined as a mental health disorder in the Diagnostic and Statistical Manual 4th Edition (DSM IV) (Table 1). The diagnosis requires a comprehensive clinical evaluation based on identifying children who have the core symptoms of inattention, hyperactivity, and impulsivity. No single test is available to establish the diagnosis, but rather a physical examination and battery of standardized psychological tests are preformed to rule out other causes, either physical or psychological, for the child’s difficulties. Studies show that as many as 67% of children who have ADHD may have a coexisting condition such as a psychiatric problem, learning disorder, or social immaturity. The most common comorbid psychiatric conditions that have been described include oppositional defiant disorder (35%), conduct disorder (30%), anxiety disorder (25%), and mood disorder (18%). It is important that any coexisting conditions be identified and treated.

Table 1 Diagnostic Criteria for Attention-Deficit/Hyperactivity Disorder

1. Either 1 or 2
1. Six or more of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
   
   Inattention
1. Often fails to give close attention to details or makes careless mistakes in schoolwork, or other activities
2. Often has difficulty sustaining attention in tasks or play activities
3. Often does not seem to listen when spoken to directly
4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
5. Often has difficulty organizing tasks and activities
6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. Often loses things necessary for tasks or activities (toys, school assignments, pencils, books, tools)
8. Often is easily distracted by extraneous stimuli
9. Often is forgetful in daily activities


2. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
   
   Hyperactivity
1. Often fidgets with hands or feet or squirms in seat
2. Often leaves seat in classroom or in other situations in which remaining seated is expected
3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. Often has difficulty quietly playing or engaging in leisure activities quietly
5. Often is "on the go" or acts as if "driven by a motor"
6. Often talks excessively
   
Impulsivity
1. Often blurts out answers before questions have been completed
2. Often has difficulty awaiting turn
3. Often interrupts or intrudes on others (eg, butts into conversations or games)
   
   
2. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before 7 years of age.
3. Some impairment from the symptoms is present in 2 or more settings (at school or at home)
4. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
5. The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder and are not better accounted for by another mental disorder (mood disorder, anxiety disorder, dissociative disorder, or personality disorder).

This page was authored by Dr. Edward C. Davis.

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Children who have a diagnosis of ADHD require long term follow up because evidence is increasing that ADHD does not resolve as a child gets older. With aging, their hyperactive and impulsive symptoms improve. However, most children continue to meet criteria for ADHD as adolescents and adults. Children whose ADHD is untreated are at increased risk for developing substance abuse problems, high risk behaviors, poor self esteem, and school/work failure. As a parent, if you feel that your child is having difficulties with any of the three core areas of ADHD, inattention, hyperactivity, and impulsivity, and it is adversely affecting their life in several areas such as school, home, social activities, you should discuss this with your pediatrician and make plans for a comprehensive physical exam with their doctor and psychological evaluation by a qualified psychologist or social worker experienced with ADHD. As pediatricians, we have seen the success stories of properly diagnosed and treated ADHD and will help you work out a plan that is best for your child.


This page was authored by Dr. Edward C. Davis
]]> Fri, 03 Sep 2010 00:00:00 -0500 http://www.pedseast.com/childillness/adhd/treatment http://www.pedseast.com/childillness/adhd/add inability to stay on task or focused on many areas including school work, tasks at home, and even conversations with parents and friends. 

In essence, people with ADD have the ability to perform, but their lack of attention results in variable performance - sometimes excellent (if the subject is interesting) or sometimes poor (if the subject is less interesting).  This leads to an eventual rising level of frustration with school, home, and sometimes sports.  Please note that the lack of focus has little to do with effort - you can push them to perform as much as you want to, but if their neurotransmitters aren't working, they just can't pay attention all of the time.

Proper diagnosis and treatment gives them much more ability to succeed at the task at hand, and leads to a much more satisfying and happy life, similar to how glasses helps the performance of someone who is nearsighted and can't see the board at school.  Diagnosis is accomplished with sophisticated testing, usually done by an experienced pediatric psychologist  and helps eliminate the risk of "putting all these kids on medicine that don’t need it."  Effective treatment requires a combination of understanding the disease itself, cooperation from the teachers and parents, and correcting the biochemical deficit with appropriate medications.

Parents tend to worry about potential side effects which include appetite suppression, weight loss, sleep problems, and changes in mood or personality.  These are all possibilities, but can be managed effectively through proper medical treatment and follow-up. 

Please see some of the attached links, documents and videos for more information and consult with your pediatrician with questions.

This page was authored by Lelon O. Edwards, M.D.

National Resource Center on ADHD
Children and Adults With ADD
Attention Deficit Disorder Association
ADD symptom quiz
ADD Resources


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