Switch stuck in the “on” position?
Do you have a child that is always on the go, talks too much, won't sit still, can't seem to follow directions or complete tasks, doesn't pay attention, can't keep track of his or her things, cannot play quietly, or is forgetful? Sure, many of these qualities are just kids just being kids, especially if they are younger in age. However, if these symptoms don't improve over time and are beginning to affect your child's school, family and social life, they could be due to something called Attention deficit/Hyperactivity Disorder (ADHD).
ADHD stands for AttentionDeficit/Hyperactivity Disorder and it is a common behavioral disorder that affects approximately 10% of U.S. children ages four to seventeen. Symptoms usually arise in early childhood, and can continue throughout teenage years into adulthood. Despite numerous studies, researchers have yet to pinpoint an exact cause of ADHD. Nonetheless, these studies have suggested there is a strong genetic link because ADHD can run in families. There also is evidence to suggest that exposure to pesticides or lead in early childhood, brain injury, and prematurity and/or low birthweight may increase likelihood of having ADHD.
ADHD is characterized by developmentally inappropriate levels of inattention, impulsivity and hyperactivity. It is classified into three subtypes, “primarily inattentive”, “primarily hyperactive” and “combined type” which would be inattentive and hyperactive. There is a common misconception that ADHD only applies to the child who is hyperactive, impulsive and is always bouncing off the walls. This isn't true because the calm and quiet child could also have ADHD with predominantly inattentive symptoms. In addition to subtypes, ADHD can be classified as “mild”, “moderate” or “severe”. In the same way a child may have mild asthma with symptoms occasionally affecting activities of daily living, you can also have mild ADHD.
There is no single test to diagnose ADHD. It is a complex process that takes time and effort and involves collecting information from the child's parents, teachers, and health careprofessionals. The most recommended method by medical organizations is to complete an ADHD rating form by at least 2 adults from 2 different settings, usually home and school. ABC Pediatrics uses the Vanderbilt, (click here), but other institutions may use the Conners evaluation forms. In order for a diagnosis of ADHD to be made, children should have 6 or more symptoms of the disorder present for greater than 6 months and symptoms must have appeared before 12 years of age. In addition, the child's health care provider will do a thorough medical history and physical examination in order to screen for other conditions that could be affecting the child's behavior.
If a diagnosis of ADHD is made, the treatment varies depending on the child's age and severity. Treatment for ADHD is multimodal, usually consisting of behavioral, educational, medical, and psychological intervention. Many parents are hesitant to put their child on medication, but it seems to be an essential part of treatment for ADHD as medications have outperformed behavioral and nutritional therapy alone in clinical trials. The medications for ADHD fall into two categories: psychostimulants and nonstimulants. Stimulants are the first line therapy as they have been the most widely studied. The effectiveness of nonstimulant medication is based on limited clinical trials and, mostly, clinical experience. The child's provider will tailor medication to the special needs of the child and his or her family with the end goal being the best possible outcome with the least amount of side effects. Most side effects are mild and short-term and include appetite suppression, insomnia, anxiety, and agitation. In the same way some parents might be hesitant to put their child on medication, they also need to be aware that there is no magic pill to cure ADHD. Medications will not control the child's behavior, but they will decrease symptoms of ADHD so the child can function more effectively at school and at home.
Finally, parents need to be aware that after a diagnosis is made, it is just the beginning of a long journey ahead. The first step is to become better educated in all things ADHD. Read as much as you can and don't hesitate to contact your health care provider with any questions that may come up.
Parenting a child with ADHD can be difficult, confusing and stressful. Parents may have to change the way in which they rear their children in some instances. There are a wealth of resources available and I will often direct my patient's families to the Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) website (click here) and if you live in Utah, the Utah Academy of Child and Adolescent Psychiatry (UACAP) (click here) is great as well.
Last, but not least, the following informational brochure is loaded with tips for parenting a child with ADHD (click here) As always, please do not hesitate to contact us here at ABC Pediatrics with additional questions. We are here for you!
*Information provided adapted from the American Academy of Pediatrics “ADHD: Clinical Practice Guidelines for the Diagnosis, Evaluation, and Treatment of Attention Deficit/Hyperactivity Disorder in Children and Adolescents”, the Utah Academy of Child and Adolescent Psychiatry's website on ADHD, and from the Children and Adults with Attention Deficit/Hyperactivity Disorder's website.
Mary-Faith Fuller, CPNP
I am a Pediatric Nurse Practitioner who has worked at ABC Pediatrics since January 2014.