Attention Deficit Hyperactiviey Disorder


ADHD is the most frequently diagnosed psychiatric disorder in children. Symptoms include inattentiveness (distracted by minor noises, daydreaming, unable to finish school work, unable to stay organized); over-activity (constantly on the move, unable to stay in seat at school, climbing, fidgeting, excessive talking); impulsiveness (unable to take turns, blurting out or talking out of turn, rushing through school work, careless errors).

Unfortunately these same symptoms can also be present in children who don't have ADHD . For example children with depression, anxiety, bipolar disorder, learning disabilities, physical abuse, or family problems can look as though they have ADHD. To further complicate the picture at least half of children with ADHD have other treatable conditions such as learning disabilities, anxiety, depression and disruptive behaviors such as Oppositional Defiant Disorder (ODD).Untreated ADHD increases the chances of a child becoming demoralized or depressed. Research suggests that children with untreated ADHD are at higher risk to abuse drugs and alcohol.

What should a parent expect from a professional offering help for a child with possible ADHD?

First and foremost you should expect a careful and thoughtful evaluation. A thorough evaluation will include an interview with both parents to establish current concerns as well as a thorough review of the development of the problem and the child's development in general (social development, relationships with parents, siblings, peers, teachers etc). Information is also needed from the school including all report cards, current teacher observations, and any educational evaluations that have been completed. The child's pediatrician should also be contacted to be sure there are no pertinent medical problems that could be contributing to the difficulty. An interview with the child is also necessary. Needless to say this type of evaluation cannot be completed in a 15 minute visit to the pediatrician or any other professional. A solid evaluation will take at least 2 to 3 hours.

At the end of the evaluation you should expect a clear explanation of the examiners findings and recommendations for treatment. The doctor should explain the reason for the recommendations as well. You should have a clear understanding of the potential benefits and risks of the treatment as well as an understanding of what to expect if no treatment is provided.

There is no specific "Test" for ADHD. The diagnosis is based on the careful consideration of the information collected as described above. Improved attention when placed on stimulant medication does not establish a diagnosis either. Most people when placed on a stimulant medication (Ritalin / methylphenidate, Adderall,. Concerta) will pay better attention.

It is critical to have an accurate diagnosis and not falsely treat "ADHD". For example children with Learning Disabiliteswill not learn better unless their specific learning problems are understood and correctly addressed. This is also true for children with ADHD and Learning Disabilities. The same is true for children with depression and anxiety disorders and for children who are worried about or are experiencing family stress. Only interventions aimed at those specific difficulties will have a chance of improving the situation for the child and family.

What treatments are available for ADHD?

For mild ADHD medication may not be needed. Structured, dependable routines; frequent feedback and praise for staying on task, and assistance with organization skills may be sufficient. For more severe ADHD attention focusing medications such as Ritalin or Concerta (different brands of methylphenidate); Adderall; Strattera; Wellbutrin; or Tricyclic antidepressants may allow a child to focus enough to respond to what parents and teachers have to offer. For children who are overactive medication such as Tenex may be useful. Oppositional Defiant Disorder (ODD)is frequently present in children with ADHD and requires special family interventions as medication rarely resolves behaviors associated with ODD. The doctor or therapist should work closely with parents to set up structured routines at home and in cooperation with the school to assist their child with completing school work, home work and chores at home as well as fostering improved relationships with siblings and peers.

Warren J. Steinmuller, M.D. Child, Adolescent, and Adult Psychiatry and Psychotherapy. 225 E. Kingston Ave, Charlotte NC 28203. 704 376-7654

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