ADHD Diagnosis & Medical Treatment
Julianne Lovejoy-Downs, R.D. | March 2004

Attention Deficit Hyperactivity Disorder (ADHD), once called hyperkinesis or minimal brain dysfunction, is considered to be one of the most common mental disorders among children today. In the past, the term Attention Deficit Disorder was used or ADD for short. More common today is to combine these in a single category under ADHD with varying manifestations of the disorder. It is estimated that 5-10 percent of school age children have this behavioral disorder. Interestingly, ADHD can also affect teenagers and adults.

Signs and Symptoms of Attention Deficit Hyperactivity Disorder
Specific areas of behavior are assessed in determining whether or not a diagnosis of ADHD is in order: Inattention, Hyperactivity, and Impulsivity.

1. Inattention:
  • Becoming easily distracted by irrelevant sights and sounds
  • Failing to pay attention to details and making careless mistakes
  • Rarely following instructions carefully and completely
  • Losing or forgetting things like toys, pencils, books, and tools needed for completing a task
2. Hyperactivity
  • Feeling restless, often fidgeting with hands or feet, or squirming
  • Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
3. Impulsivity
  • Blurting out answers before hearing the entire question
  • Interrupting conversations, or interjecting inappropriate comments in conversations
  • Having difficulty or unable to wait in line or for waiting for their turn
It is important to note that everybody exhibits some of these behaviors from time to time. What makes it ADHD? The behaviors must appear early in life, before 7 years of age, and continue consistently for at least 6 months. In children, they must be significantly more frequent, ongoing, and more severe than in other children of the same age and developmental period. They must also create a real problem in at least two significant areas of the person's life: school, work, home, relationships, and/or social settings.

What causes ADHD?
No one is quite sure of the exact cause of this disease. Research is revealing more evidence that ADHD does not stem from the home environment but from biological causes. Whether the biological causes stem from a chemical imbalance, genetics, or a combination of the two is not clearly understood. Research has not found a clear relationship between home life and ADHD. Not all children from unstable or dysfunctional homes have ADHD and not all children with ADHD come from dysfunctional families. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child's behavior.

In recent years, scientists demonstrated a link between a person's ability to pay continued attention and the level of activity in the brain. The researchers measured levels of glucose--the brain's major source of energy-in parts of the brain that inhibit impulses and control attention. The investigators found important differences between people who have ADHD and those who don't. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention. The next step will be to research why there is less activity in these areas of the brain. Research continues in many areas to determine biochemical possibilities contributing to ADHD.

Are there other problems that look like ADD, but aren't?
Yes there are and that makes diagnosing ADHD a challenge. The National Institute of Mental Health (NIMH) describes it this way: "Anything from chronic fear to mild seizures can make a child seem overactive, quarrelsome, impulsive, or inattentive." For example, a formerly cooperative child who becomes overactive and easily distracted after a parent's death is dealing with an emotional problem, not ADHD. Chronic middle ear infection can also make a child seem distracted and uncooperative. So can living with family members who are physically abusive or addicted to drugs or alcohol. In other children, ADHD-like behaviors may be their response to a defeating classroom situation.

Between 30-40% of children with ADHD have learning disabilities, although it is important to note that the child is not mentally retarded and in many cases is quite bright. Poor nutrition can manifest itself in behaviors that look very similar to those which are seen in ADHD and it is extremely important that parents model good nutritional habits. Any of these things can present the same symptoms as ADHD, but cannot, in fact, be diagnosed as ADHD.

Who is qualified to properly diagnose ADHD?
It is typically some interaction between a teacher and a parent that begins the process of diagnosing ADHD. A referral should always be made to an appropriate professional who has been trained in this area and is aware of all possible treatments.

Specialty
Diagnose
Prescribe Medications
Counsel
Psychiatry
Yes
Yes
Yes
Psychologist
Yes
No
Yes
Social Worker
Yes (if trained)
No
Yes
Family Therapist
Yes
No
Yes
Pediatrician
Yes
Yes
No
Family Physician
Yes
Yes
No
Neurologist
Yes
Yes
No

Before any treatment, a physical examination should be done to rule out other causes for your child's behavior, such as chronic middle ear infection, sinusitis, visual or hearing problems, or other neurological problems.

Conventional Treatment with Medications
There are numerous medications physicians will use to treat this disorders. Here are a few of the more common medications.

Ritalin (methylphenidate) is the most commonly prescribed medication for ADHD. This is a stimulant that has the paradoxical effect of calming the nervous system and enhancing the ability of a hyperactive child to pay attention. Concerta, Metadate CD, and Ritalin LA are all longer lasting forms of Ritalin. Ritalin LA can be opened and sprinkled on food if the child cannot swallow pills. Potential side effects of Ritalin include insomnia, decreased appetite, weight loss, slowed growth, increased heart rate and blood pressure and an initial period of increased tearfulness and irritability.

Adderall and Adderall XR are central nervous system stimulants that have recently been added to arsenal of medications used to treat ADHD. It is a mixed amphetamine blend. Side effects are similar to other stimulants.

Cylert (Pemoline) is a central nervous system stimulant that is often prescribed. It enhances nerve impulse transmission in the brain. It can cause insomnia and is not recommended for children under the age of six.

Dexedrine(Dextroamphetamine) is also a stimulant have the same calming effect as Ritalin with similar side effects.

Strattera (atomoxetine) is a nonstimulant recently approved by the Food and Drug Administration for the treatment of ADHD. Strattera is a selective norepinephrine reuptake inhibitor. Side effects can include upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, mood swings, and weight loss.

The question that every parent asks is "Do I really have to give my child a powerful medication to help him or her with ADHD?" The answer is different for every family. ADHD can be very disruptive in the home, school, church, and other public places. If every other attempt to solve the disorder has been explored, it seems reasonable to at least try the medications-even if for a limited amount of time. The key is to work with the healthcare provider and the school to develop a strategy of treatment because in effect, it's everyone's problem.

Are there alternative treatments for children and adults with ADHD?
Alternative treatments may include dietary changes, nutritional supplements, herbal medicines and homeopathy, massage and acupressure.

What other therapies can be helpful in treating ADHD?
ADHD creates what is termed "system issues." Simply stated, this means that when a family member is suffering from the effects of the disorder, everyone else in the family is also affected in various ways. There is typically more marital stress, more sibling distress, more arguments, less leisure time, and more time devoted to conflict resolution. There are several kinds of therapies that can be helpful and these are briefly outlined below:
  1. General Psychotherapy works to help individuals with ADHD to like and accept themselves despite their disorder.
  2. Cognitive-Behavioral Therapy helps individuals work on immediate issues and change specific behaviors to compensate for the disorder.
  3. Social Skills Training can help children learn new behaviors by demonstrating and modeling appropriate behaviors.
  4. Support Groups can connect others who share the experiences of having or having to deal with ADHD.
  5. Parenting Skills Training offered by therapists or classes teach parents the tools for appropriately handling the disorder.
  6. A System of Rewards and Penalties help the child identify which behaviors will be consistently addressed, and how to stay in a "reward" format.
Remember, it is a combination of treatments, therapies, and medications that will be most effective in dealing with Attention Deficit Hyperactive Disorder. Utilize all resources and experts and work out the best program that works for you and your child.
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