Is ADHD Affecting Your Child?
If you suspect ADHD, you need to know the basics:

1. What is ADHD?
2. How ADHD is diagnosed?
3. What treatment is available for ADHD?

Does your daughter quietly sit in the classroom and “space out”? Or, is your boisterous son throwing pencils, blurting out answers, and running around like the Energizer Bunny?

Although the behaviors of these two children sound different, both exhibit symptoms of Attention Deficit Hyperactivity Disorder, or ADHD. ADHD is a common childhood disorder that affects 5 to 10 percent of all children. Boys are three times more likely than girls to suffer from ADHD.

SYMPTOMS
ADHD is characterized by the following behaviors that have persisted for an extended period of time:

• Inattention
  
• Hyperactivity
  
• Impulsivity

TYPES OF ADHD
There are three types of ADHD: Inattentive, Hyperactive, and Combined Type.

1. Inattentive Type ADHD (formerly known as Attention Deficit Disorder, or ADD)
   Symptoms include:
   • Making careless mistakes
     
   • Failing to follow through with tasks
     
   • Difficulty with organization, and tasks that require sustained term effort
     
   • Being readily distracted and forgetful
     
     
2. Hyperactive and Impulsive Type ADHD
   Symptoms include:
   • Fidgeting, squirming
     
   • Running around, climbing on things
     
   • Talking too much, interrupting
     
   • Moving quickly from one activity to another
     
     
3. Combined Type of ADHD
   The combined type of ADHD includes both inattentive and hyperactive symptoms.

DIAGNOSING ADHD
There is no specific blood test or brain scan that is used to diagnose ADHD. ADHD is a clinical diagnosis based on careful evaluation by a primary care or mental health provider. Symptoms must be present in more than one setting (e.g., both at home and at school) -so it is important that the evaluation involve gathering information from parents or guardians and from other adults involved in the child’s life, like teachers or coaches.

Many disorders can look a lot like ADHD-including depression, anxiety, visual or hearing difficulties, learning disorders and even sleep apnea (a condition that involves disordered breathing). These other disorders sometimes exist along with ADHD and also need to be treated.

CAUSES
ADHD is considered a neurological disorder of the brain. Children with ADHD have a hard time focusing or controlling their behavior because they lack the right balance of neurotransmitters, or chemicals, in their brains that help them focus and inhibit impulses.

Findings show that ADHD often runs in families which may point to a genetic link.

BEHAVIOR & SOCIALIZATION
Because kids with ADHD are often unaware of their behavior They may not be aware of how their behavior harms others nor how their behavior has a relationship to how they are treated by their peers. , They may become agitated, defiant and may even lie and claim, “I didn’t do it!” A symptom of ADHD is having difficulty paying attention and children with ADHD may miss important information that is happening around them. Children and teenagers with ADHD can have difficulty figuring out acceptable social behaviors on their own may need to be shown how to have successful social interactions.

TREATMENT
A diagnosis of ADHD indicates a psychiatric disorder and does not mean that the child is “crazy"; but it does require adequate treatment, much like asthma, diabetes or other medical illnesses.

Treatment usually involves education with a mental health provider about the disorder, as well as therapy to help parents and children learn how to cope with the symptoms and problem-solve regarding school, sports, and family functioning. School systems should accommodate symptoms according to the child’s needs. Parents may ask for a 504 or Individualized Educational Plan (IEP) evaluation from the principal after a diagnosis of ADHD is made if the child’s symptoms are severe enough to interfere with adequate school functioning.

Medication is often very helpful in reducing the symptoms and helping the child learn and succeed academically to their full potential. The most commonly used and most effective medications are stimulants, but there are non-stimulant options as well. Common concerns about medication are “I don’t want my kid to turn into a zombie” and “I don’t want my child to become addicted to a drug.” In reality, a “zombie” effect only occurs if the dose is too high. Kids with ADHD who are treated do not become addicted to the medication and are actually at less risk of using other illegal drugs in adolescence, presumably because they do better in school and generally feel better about themselves.

When left untreated, a child with ADHD often feels that he or she doesn’t do as well as they could in school and may develop poor self-esteem because they are “in trouble all the time.” They may even appear depressed. Other kids may perceive them as the class clown, or they may not want to play with a playmate who is constantly jumping from one activity to another. As people with untreated ADHD get older, they are at greater risk for driving accidents, unwanted pregnancy and substance use, as well as higher rates of divorce and job change. Recent studies have shown that certain parts of the brains of kids with ADHD that are treated develop at the same rate as the brains of kids without ADHD, while untreated kids’ brains mature more slowly.

OUTCOMES
Up to a third or more of people with ADHD outgrow the symptoms- particularly the hyperactive and impulsive symptoms-but sometimes the disorder persists into adulthood and may require indefinite treatment. Although both children and adults suffer from the disorder, ADHD at age 5 can look very different from ADHD at age 15 or 45.

ADHD is a common disorder that many children live and thrive with, but it is important as a parent to remain supportive: Remember that children with ADHD aren’t “trying to be bad”; they just really have a hard time controlling their behavior.

SCREENING YOUR CHILD FOR ADHD AT CHILDREN'S HOSPITAL
Children’s Psychiatry department’s preferred screening tool is the Vanderbilt Assessment Scale for ADHD. This initial assessment tool, for use with children ages 6 to 12, contains rating systems for symptoms and for impairment in academic and behavioral performance. Although this tool is not intended for diagnosis, it is widely used to provide information about symptom presence and severity, along with performance in classroom, home, and social settings. The Vanderbilt Scale takes 10 minutes to complete and both parents and teachers give their assessments

ADHD SYMPTOMS
Source: American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV®)

Criteria Before Age 7:
Six or more of the following symptoms have been present for at least 6 months, to a point that is disruptive and inappropriate for developmental level, both at home and at school.

INATTENTION

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
   
2. Often has trouble keeping attention on tasks or play activities.
   
3. Often does not seem to listen when spoken to directly.
   
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in school (not due to oppositional behavior or failure to understand instructions).
   
5. Often has trouble organizing activities.
   
6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
   
7. Often loses things needed for tasks and activities (e.g., toys, school assignments, pencils, books, or tools.)
   
8. Often easily distracted.
   
9. Often forgetful in daily activities.

HYPERACTIVITY/IMPULSIVITY
Hyperactivity:

1. Often fidgets with hands or feet or squirms in seat.
   
2. Often gets up from seat when remaining in seat is expected.
   
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless.)
   
4. Often has trouble playing or enjoying leisure activities quietly.
   
5. Often “on the go” or often acts as if “driven by a motor.”
   
6. Often talks excessively.

Impulsivity:

1. Often blurts out answers before questions have been finished.
   
2. Often has trouble waiting one’s turn.
   
3. Often interrupts or intrudes on others (e.g., butts into conversations or games.)

RESOURCES

• Petra Steinbuchel, MD
  Children’s Hospital Child and Adolescent Physchiatry
  510-428-3570
  
  
• Centers for Disease Control and Prevention: www.cdc.gov/ncbddd/adhd/
  
  
• National Institute of Mental Health: www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml

Information based on an original story, writtenby Petra Steinbuchel, MD, Child and Adolescent Psychiatrist at Children's Hospital & Research Center Oakland. It was published in the winter 2011 issue of Children’s Hospital’s Handprints magazine.