by Dr. Nicholas Levy
Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects between 2 – 5 % of children to the extent that they have significant difficulty with educational activities and with social interactions. It can also interfere with other areas of a child’s life such as team sports and many of these children have below average hand-eye coordination which impacts athletic ability as well. The disorder is inheritable and is often present in one or other parent of a child who has been diagnosed with it.
Many things other than ADHD may lead to inattention in children. Problems in the home (such as an ill parent, parents who are not getting along or a cantankerous divorce situation), problems at school (such as bullying, learning disability and auditory processing) and a variety of other psychological conditions (such as bipolar disorder, anxiety disorder and depression) can appear as inattention and may also be associated with oppositional and defiant behavior. Sometimes children are referred to their physician by a teacher who recommends that they be given medications for ADHD. It is prudent at this time to do an evaluation that looks at all of these other areas so that children are not started on medications without a good reason. While there is no one specific test for ADHD, it is wise to be as sure about the diagnosis as possible before considering the use of medications.
On the other hand, it is also important to understand that, while the goal is to avoid medication where possible, the response to medication in true ADHD is remarkable and extremely beneficial. There is essentially a normalization of neurological pathways and for these patients a sense of clarity and the ability to direct and maintain focus. Children who suffer from ADHD have trouble suppressing impulses, thoughts, feelings and ideas and tend to act on them even when they intellectually know that they shouldn’t. While some may have physical activity associated with this lack of suppression (i.e. hyperactivity), others will tend to follow a train of thought unrelated to the academic or social situation in the moment and so “day dream”. These patients (who used to be labeled ADD and are now called ADHD inattentive-subtype) are often missed in their younger years as they are not disruptive in the classroom. If they are also of high intelligence, they may manage to get through their schoolwork and even achieve adequate grades early on. By the time they reach Middle School, however, the academic demands generally prove too great and they begin to fail or not do nearly as well as expected. These are children who should be straight A students and have trouble maintaining B’s.
Another area of concern for children with ADHD is organizational skills. There is poor intrinsic organization and since they are inattentive to instructions regarding this, they sometimes do not learn how to keep themselves organized. Those children who are diagnosed with ADHD and who have a positive response to medications will learn organizational skills readily and be able to use these.
There are often concerns from parents that, since the medications used to treat ADHD are almost all stimulants (amphetamine and methylphenidate), children will become addicted to them or be more likely to use recreational drugs as teenagers. There is substantial research on this and it has been found that ADHD patients who are treated with stimulant medications have a significantly lower risk of drug abuse than their untreated ADHD peers. It has also been found that management of ADHD leads to a lower incidence of truancy, teen pregnancy and petty theft and a higher degree of academic achievement and adult professional success.
Please read about El Camino Pediatrics evaluation program for ADHD and also look at our Bookstore for recommended books on the topic.