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Ask the Expert: Attention Deficit Hyperactivity Disorder

Dr. Lori Holtzman, a pediatrician with Baptist Medical Group-Wolf River Pediatrics, is this month’s Ask the Expert on Attention Deficit Hyperactivity Disorder. BMG-Wolf River Pediatrics is accepting new patients. For more information or to make an appointment, please call 901-227-9521.

1. What is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder, also known as ADHD, is a neurobehavioral disorder that usually appears in children before the age of 7 and may persist into adolescence and adulthood. Children with ADHD may have difficulty controlling their behavior in school and in social settings and as a result, they often fail to achieve their full academic potential.

Clinically, the child may present with varying symptoms of hyperactivity, impulsivity, and/or inattention. The child may be easily distracted, be unable to pay attention and follow directions, be overactive, and/or have poor self-control.

2. How common is this disorder?

ADHD is one of the most common chronic childhood disorders. It is a common neurodevelopment disorder that affects 4 to 12 percent of school-age children.

3. What is the difference between Attention Deficit Disorder and ADHD?

There are 3 subtypes of ADHD now: ADHD-Inattentive Only, ADHD-Hyperactive/Impulsive Form, and Combined Inattentive/Hyperactive/Impulsive ADHD.

The first type, ADHD-IA, is formally known as ADD and children with this form are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. This type is the most difficult form to diagnose.

Children with the next type, ADHD-H/I, show hyperactive and impulsive behavior but have less trouble with paying attention. These children need to be differentiated from a child who is simply more active than others.

The last type, Combined Inattentive/Hyperactive/Impulsive ADHD, includes children who exhibit all three symptoms. This is the most common form of ADHD.

4. What causes ADHD?

ADHD has a substantial genetic component. Several possible genes have been identified for ADHD, therefore it is thought that ADHD is a disorder involving multiple genes.

5. How can this disorder be prevented in children?

ADHD cannot be prevented because it is a genetic disorder.

6. What symptoms should parents look for if they suspect that their child has ADHD?

Inattention symptoms of ADHD include not paying attention to detail, making careless mistakes, failing to pay attention and keep on task, not listening, being unable to follow or understand instructions, avoiding tasks that involve effort, being distracted or forgetful, and losing things that are needed to complete tasks.

Hyperactivity/ Impulsivity symptoms of ADHD include fidgeting, squirming, getting up often when seated, running or climbing at inappropriate times, having trouble playing quietly, talking excessively or out of turn or interrupting.

7. How are children with ADHD diagnosed and evaluated?

An effective treatment for ADHD begins with an accurate and well-established diagnosis. The assessment of ADHD requires evidence directly obtained from parents/caregivers and teachers/school professionals. Parents need to provide information about core symptoms in various settings, the age of onset, duration of symptoms, and the degree of functional impairment.

In addition to providing information on the core symptoms of ADHD, teachers/school professionals can also discuss the duration of the symptoms, degree of functional impairment and coexisting conditions.

8. How can ADHD be treated?

The treatment of ADHD varies considerably. Families must become educated regarding the symptoms of ADHD and understand that it is a neurological disorder that at times is difficult for children to control.

These children need structure and consistency in daily routines. It is important to try to boost the child’s self-esteem because psychological complications are common in this disorder.

Many children with ADHD have significant social difficulties, so social training can be helpful. Individual counseling is beneficial in alleviating poor self-esteem, oppositional behavior and conduct problems. Family therapy is also helpful in assisting parents in dealing with the behavioral issues associated with ADHD.

The use of mediation can be helpful, but it should always be combined with other treatments both at home and in school settings.

Medications used for the treatment of ADHD are usually stimulants, however non-stimulant medications are also available. Different medications (or combinations of medications) work differently for each child with ADHD.

9. Is there a cure for ADHD or will children continue to have this disorder as they grow older?

There is no cure for ADHD. Although symptoms begin in early childhood, they can diminish between the ages of 10 and 25. The symptoms of hyperactivity decrease more quickly than the symptoms of impulsivity and inattentiveness, which may persist into adolescence and adulthood.

10. What are some common misconceptions about ADHD?

The most common misconception about ADHD is that children have control over their behaviors and that they are simply “being bad.” While children have choices about their behavior, they don’t have total control over all of their behaviors, especially those associated with impulsivity. At no time though should ADHD be used as an excuse for a child and bad behavior.

11. Anything else?

ADHD is often seen with other conditions, such as mood disorders, conduct disorders and oppositional defiant disorder. ADHD is also associated with a variety of genetic disorders related to developmental disorders, including Fragile X Syndrome, Williams Syndrome, Angelman Syndrome, Klinefelter Syndrome, and Turner Syndrome.

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