|
Attention deficit hyperactivity disorder is a neurochemical problem affecting about 4 to 6 percent of the population in the United States. It persists throughout a person's lifetime. Diagnosis and treatment of ADHD requires team effort and constant communication between patient, family and health professionals.
There are several hypotheses, but no known causes for ADHD. However, there does appear to be a genetic link.
"There may be other factors," said Dr. Thomas England, a licensed clinical psychologist in Grand Island, "but there does seem to be a percentage of kids with ADHD where one or both parents, or other close relatives, have had similar problems."
About one-third of people with attention deficits do not have the hyperactive behavior.
Others may have trouble concentrating, while others exhibit both types of behavior.
"ADHD is the one big label, which is divided into various subtitles," said Dr. Kavir Saxena, a psychiatrist with St. Francis Medical Center in Grand Island and Mary Lanning Memorial Hospital in Hastings. "ADD is a part of the ADHD. It's a variant, meaning their deficit is only in the area of focus and concentration. The more common kind in children would be the combined type."
So there are three types of ADHD: the inattentive type, the hyperactive type and the combined type. When attempting to diagnose a child, there are two or three core areas to be considered. One is whether the child has difficulty paying attention. Does he or she have problems with focusing or concentration. Is he or she easily distracted or is he or she often forgetful in daily activities?
When looking for hyperactivity, look to see if the child is not able to sit in a seat without fidgeting, if he or she is always needing to move or fiddling with their hands or has trouble playing quietly.
The third type, impulsivity, means the child has a hard time waiting for his or her turn, interrupts or raises his or her hand in class before questions are even complete.
Diagnosis of ADHD is done through observation, a detailed history and feedback of collateral information from schools or pretreatment programs.
"There isn't any one test," England explained. "It's a question of compiling information from different sources. (One is) behavioral rating scales that either the parent or teacher, or both, can fill out. There are some other forms of tests that we can use. There are tests called continuous performance tests.
"Of course, there's the direct interview with the child and observations on their behavior. Social history information, getting accounts of behavior at home observed by the parent, and looking at that over time, and any changes in that behavior over time. And then, compiling information from those different sources and seeing that all points of correction refer to a potential problem."
Symptoms must be out of the normal range for the child's age and development to be diagnosed as ADHD.
Treatment will vary from patient to patient depending on the extent of the symptoms. There are several questions that need to be addressed when deciding whether to proceed with treatment.
"What is it (ADHD) doing (for the child) academically?" Saxena said. "What is it doing socially? What is it doing in terms of relationships with your family members? If your grades are getting compromised, if you are behind as far as grade level performances, that's one reason that you might recommend getting treatment. If it's socially a problem, not getting along with kids, being bossy, not able to make friends or keep friends, then that objectively would be another area of impairment, similarly at home as well."
A combination of medication, therapy or counseling for coping skills and adaptive behaviors, and ADD coaching for adults has proven to be the most effective treatment for ADHD.
"I think there's a lot of concern about medicating kids," England said. " I think you'll find physicians, pharmacists, certainly most mental health professionals don't medicate, or don't recommend seeking medication, unless that seems to be a necessary part of treatment. Unfortunately with ADHD, it typically is.
"Medication will help those areas of the brain responsible for the activity (behave) correctly. Without that, it's a function of the person being able to exert enough self-control to focus on tandem things, which is often difficult for someone with ADHD. Essentially, it would be like taking someone with a seizure disorder and expecting them to not have a seizure. That doesn't work. For many people with ADHD, simply trying by sheer will to maintain focus doesn't work."
So many parents face the decision of whether to medicate their children. One such parent was Jane, whose 8-year-old son, Chad, was diagnosed with ADD last year.
"He has difficulty concentrating and difficulty staying on task," Jane said. "It's not that he doesn't want to stay on task. It's just that it's so difficult for him. It's just so easy for him to get distracted, and the medicine makes a difference. We tried a couple of different medications until we found the one that works for him. He's a much calmer child when he's on it (medication). She (the doctor) prescribes medication and then we see a counselor on the side, just for helping Chad deal with his issues. The teacher says she's noticed a big difference in his being able to stay on task. He's much better."
Medications help balance the biochemistry of the patient so he or she can gain better control, and the child is strictly monitored for side effects.
Stimulant medications, such as amphetamine (examples include Dexedrine or Adderall) and methylphenidate (Ritalin, Concerta, Metadate CD, Focalin, or Daytrana) can be effective in controlling symptoms in children, according to Healthwise.com.
A nonstimulant medication, atomoxetine (Straterra), has also become available. Dosages come in short, intermediate, and long-acting forms. The best treatment choices and schedules may change over time.
Most experts agree that treatment for ADHD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Treatment should include behavioral management, structured classroom management, parent education (to address discipline and limit-setting) and tutoring and/or behavioral therapy for the child. Psychosocial support is extremely important.
Healthy nutrition and regular exercise are important for those with ADHD just the same as for all youth.
ADHD affects an estimated 3 to 5 percent of school-age children. About half of the children with ADHD will continue to have symptoms as adults.
|
