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The Basics of Attention Deficit/ Hyperactivity Disorder

By Mark C. Edwards, PhD & Eldon G. Schulz, MD
Department of Pediatrics
University of Arkansas for Medical Sciences, Arkansas Children's Hospital

Attention Deficit/Hyperactivity Disorder, or ADHD, is a common problem. It has been around long enough that lots of opinion and debates exist about it. However, we know more about ADHD than many other mental health conditions. We also know what treatments help. In this article, we explain for parents from professional experience what ADHD is, how it can be evaluated, and what can be done about it.

What is ADHD?

The primary features of ADHD represent the high end of a range of traits all of us possess. We all have a certain ability to pay attention, a specific activity level and an individual range of impulse control. At certain times and in specific situations, we all might have problems paying attention or become overactive, restless and impulsive. However, ADHD is different from normal behavior in a number of important ways.

First, individuals with ADHD show many hyperactive-impulsive and/or inattentive behaviors. The current symptoms of ADHD include nine hyperactive-impulsive behaviors and nine inattentive behaviors (see below). Children must have at least six of the nine symptoms from either or both lists in order to qualify for ADHD. New standards for physicians and psychologists to diagnose ADHD will be released this summer. Those may require that patients meet only four symptoms from each list if they are 17 or older. A person can receive the label of ADHD by having enough symptoms in the hyperactive-impulsive area, the inattentive area or both.

Current ADHD Symptoms

Hyperactive-Impulsive

  • Often fidgets with hands or feet or squirms in seat;
  • Often leaves seat in classroom or in other situations;
  • Often runs about or climbs excessively;
  • Often has difficulty playing or engaging in play activities quietly;
  • Is often "on the go" or often acts as if "driven by a motor";
  • Often talks a lot;
  • Often blurts out answers;
  • Often has a hard time waiting turns; and
  • Often interrupts or interferes with others.

Inattentive

  • Often does not pay close attention or makes careless mistakes;
  • Often has a hard time keeping attention;
  • Often does not seem to listen;
  • Often does not follow through on directions and fails to finish things;
  • Often has a hard time staying organized;
  • Often does not want to do tasks that call for continued mental effort, such as schoolwork or homework;
  • Often loses things;
  • Often easily distracted; and
  • Often forgetful.

Second, the level of ADHD behaviors needs to be much higher than is typical for the person's age and gender. Third, the symptoms must be present across settings, such as home, school or work. Fourth, the symptoms tend to show up early in development. The current standards require the symptoms to be present before the age of 7. The new diagnostic standards coming out this summer may change this to before the age of 12. Fifth, the ADHD symptoms need to be present for at least a six-month period. Sixth, the symptoms need to be interfering with the person's life in a meaningful way. Last, no other conditions should be present that might explain the symptoms better.

Several studies have followed children with ADHD into adulthood. These studies have found that ADHD persists into adulthood for about a third of kids with ADHD. In addition, children with ADHD are at higher risk for developing other psychiatric problems in adulthood than children without ADHD. Findings like these highlight the importance of providing treatment early and having them available over time.

How is ADHD Evaluated?

There is no single test for ADHD. Professionals will use many methods to evaluate a child for ADHD symptoms. They will also look for other problems that may be causing or occurring with the symptoms. The evaluator will obtain reports and ratings from people who know the individual best. For children, this is usually the parent and teacher. An evaluation usually includes a careful interview with the parent and information from the school. Behavior rating scales completed by the parent and teacher are often helpful. The evaluator will also consider other methods, such as a physical exam or formal testing of mental ability, learning or speech-language skills.

A professional trained to work with children and ADHD can provide a good evaluation. This can be a psychologist, counselor or physician. Your primary care physician is a good place to start in seeking an evaluation. Your primary care physician can either perform or refer you to someone for the evaluation.

How is ADHD Treated?

There is no cure for ADHD. Instead, treatments are used to manage the ADHD symptoms and other problems linked to ADHD. Clinical guidelines focus on treatments that have the best research and expert support. Research has shown that medications are the most effective treatment for helping with ADHD symptoms. Behavioral treatments also have been found to be helpful with improving behavior and schoolwork.

Medication Treatment

Medication is the most common treatment for ADHD. The stimulants are most commonly used for children 5 years of age and older. Although some side effects are associated with stimulant use, most experience minimal side effects. For children younger than 5 years of age and people who do not respond well to the stimulants, other non-stimulant medications may be helpful.

Different generic and name-brand stimulants

  • Methylphenidate Dextroamphetamine
  • Ritalin Dextrostat
  • Methylin Dexedrine
  • Concerta Adderall
  • Metadate Vyvanse
  • Focalin
  • Daytrana

Behavioral Treatments

Behavioral treatments carried out at school and home can be helpful. Parents can request classroom help for children with ADHD by talking with the teacher. Parents can also ask for a Section 504 Conference from the school principal. Section 504 is a law that can require schools to provide classroom help for students with ADHD who qualify.

Teachers can do several things in the classroom to help children with ADHD, including the following:

  • Seating them close to the teaching area;
  • Employing shorter length of tasks;
  • Providing more teacher prompts and feedback; and
  • Using home – or classroom-based positive reinforcement programs.

Parent education classes or mental health therapy focused on helping parents to use effective behavior management methods in the home can be helpful.

Other Treatments

Although many other treatments for ADHD have been promoted, they generally are not recommended. Some treatments are not recommended because solid research showing their effectiveness is lacking. Cognitive or social skills training, dietary modifications or EEG biofeedback are examples of treatments that currently are not recommended for ADHD.

Some people with ADHD also have other problems in addition to ADHD. Specific treatments may be recommended to address those other problems.

Sherwood Boy Making Strides with Treatment

Taylor Kent's journey with Arkansas Children's Hospital (ACH) began well before his diagnosis with ADHD. He made an early debut in 2007, when his mother was just 26 weeks pregnant. At 1 pound, 8 ounces, Taylor was so tiny that his father, Mike, was able to slip his own wedding band over the newborn's foot and arm. After his birth and stay at another hospital, he was transferred to the Neonatal Intensive Care Unit at ACH.

Today Taylor is a happy, inquisitive 6-year-old who turns on the charm easily around adults. But Laura Kent, Taylor's mother, had noticed that her son had trouble interacting with other children. He would become shy and nervous, rarely engaging with his peers.

"He would constantly have to assess the situation before he would get involved and start playing," she said.

Taylor also had trouble focusing and answering questions since he had learned to talk.

"It could take him about 10 seconds before he'd answer any question you asked," Laura said.

The Kents had been bringing Taylor to ACH for some developmental delays and other medical issues related to his premature birth. In December, Dr. Eldon Schulz in the Dennis Developmental Center on the ACH campus diagnosed Taylor with ADHD, specifically with inattentive symptoms. Taylor does not have the hyperactive traits that are common in many ADHD cases.

Dr. Schulz recommended that Taylor start taking a stimulant that improves attention. Combined with the physical, occupational and speech therapies that he already takes, the medication is helping Taylor tremendously, Laura said.

"We are so blessed with the progress he's made," she added. "Since starting this treatment, he doesn't hesitate to jump in on the playground and make friends with kids around him. His teachers say that he completes tasks in a timely manner now."

Parent involvement and early treatment for disorders like ADHD can make a big difference in a child's long-term success.

Laura said she and her husband always felt it was essential to develop skills at home, but balanced the interventions with "knowing when to back off and be just Mom and Dad, too."

"I would tell other families that you really have to be your child's advocate," Laura said. "That is what keeps us going every day."

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