Tags: Special Needs
Again you remind your son to put on his shoes and get in the car. Your daughter takes twice as long as her friends to complete assignments. Is it ADHD?
Granted, the statistics are high. Nationally, the American Psychiatric Association notes that between three and seven percent of school-aged children have ADHD. In Indiana, a 2007 National Survey of Children's Health reveals parents report 13.2 percent of youth ages 4 to 17 have been diagnosed with it.
So, what exactly is ADHD? Attention-deficit / hyperactivity disorder or ADHD is a brain-based disorder that may be highly genetic in its etiology according to Dr. Ernie Smith, board-certified developmental-behavioral pediatrician at Peyton Manning Children's Hospital at St.Vincent. Some of the common symptoms are a high activity level, problems staying focused and concentrating, impulsivity, being easily distracted, not attending to details, and difficulty starting and finishing tasks and organizing and getting things done.
According to Dr. Leslie Hulvershorn, a child adolescent psychiatrist at Riley Hospital for Children at Indiana University Health, kids with ADHD can be predominantly inattentive, predominantly hyperactive and impulsive, or more commonly can exhibit a combination of inattention and hyperactivity-impulsivity symptoms.
"If a child has ADHD they have to have significant impairments in the home and school environments. Someone can have a little bit of inattention and hyperactivity, but it may not be clinically significant, so they should not be diagnosed or treated. If someone has the full-blown disorder they would need treatment and would have a difficult time functioning without it," Hulvershorn said.
Medicine plays a major role in ADHD treatment, but it's not the only treatment since the disorder occurs along a spectrum. Treatment depends on the severity of the child's symptoms and the context in which the child has difficulties, such as in the classroom.
Smith considers ADHD treatment to be threefold. First, families must have a general understanding of the condition. ADHD is not a learned behavior, which he said makes behavioral interventions less affective than with kids who are simply misbehaving. Secondly there must be a good support system at school and at home. Third is medication.
One area mom of three, each child with a diagnosis of ADHD, said, "I thought anyone who would give kids drugs is ridiculous." The mom, who asked to remain anonymous, tried everything from altering her oldest son's diet to serving coffee. Ultimately after a scare when he got lost at Disney World she tried medication. It worked, continues to work, and is taken by all three of her children.
Through her own research and working with a trusted physician, she made peace with her decision. "I was reading all about how kids make inappropriate decisions and if they go untreated, they end up in prison or self-medicating with alcohol or drugs. That made sense because my son is well behaved, but when he would do something dumb we were screaming 'Why are you doing this?' and he would cry like he was heart broken and would say 'I don't know. I don't know,'" she explained.
Still, some parents cringe at the thought of medication. There are side effects to consider such as decreased appetite or change in affect. There's also the black market for ADHD medications and kids who misuse their own prescription.
On the flip side, stimulants have been around for decades and are well studied. In fact, Smith said stimulants work in up to 80 percent of kids with ADHD. Non-stimulants are less effective, with about 50 percent of kids responding to them.
Generally ADHD medications change the neurochemistry of the brain. The theory is that the medication creates a more typical or natural neurochemistry. Kids with ADHD have a neurochemical makeup different than that of typical kids.
While medication plays a significant role in the treatment of ADHD, other interventions are being studied. For instance, Hulvershorn mentioned that a good deal of research is currently underway on computer-based treatments that allow kids to play computer games that zero in on ADHD deficits.
One area clinical psychologist, Dr. Charles Shinaver, says he has found success in the use of computer-generated activities in treating ADHD. "I have assessed and treated ADHD for 15 years and my oldest son has it. I've tried several approaches because I found the traditional approach unsatisfying," he said.
In 2009 Shinaver looked into Cogmed Working Memory Training and found it compelling. He is now one of a handful of experts offering Cogmed to patients in the state.
He describes Cogmed as a combination of software program and coaching. The program consists of 25 computerized training sessions that occur over the course of five weeks and can be done at home. There are also once-a-week sessions with the coach. Too good to be true? Maybe not. Peer-reviewed studies of the program are favorable.
Where to Start
If you are concerned your child may have ADHD, talk to your primary care provider, a child and adolescent psychiatrist, or a pediatric neurologist. Be prepared to provide the doctor with a history of your child's behavior from teachers who observe him or her in the classroom. Also, ADHD can coexist with other behavioral or emotional difficulties like anxiety or depression, so it's important to screen for those as well.