ADHD in Children
Attention Deficit Hyperacitivity Disorder
By Nathan Rendler, MD
What is ADHD?
Since I started practice, I have shared a special interest in helping patients with attention deficit and learning problems. It is one of the most common concerns that I evaluate and treat daily, and it is especially gratifying for me to treat these patients and watch them grow and succeed in the long term, from the early school age years and all the way through the college years. The parent usually brings in the child with a history of worsening attention problems, hyperactive and impulsive behavior, and poor social interactions with his/her peers and other family members. While most kids present in early school age, I also see teens come in with similar concerns that have not been addressed previously.
Oftentimes, the child is easily distracted, has problems focusing and paying attention, is forgetful, and has trouble listening and following directions both at home and at school. Along with the attention problems, parents are concerned about hyperactivity, where the child has trouble sitting through a class and has poor self-control. Impulsivity is also very common and is marked by trouble waiting or taking turns, frequently interrupting others and getting into trouble at school. The combination of these behaviors significantly affect academic performance and the way teachers, parents and peers view and interact with the child, and may lead to school failure and poor performance in day to day life activities. It may also lead to feelings of poor self-esteem that makes the problems even worse for the patient and family.
How Common is ADHD
Conservative estimates suggest that at least 3-7% of school-aged kids have ADHD. Studies now show that up to 80% of kids with ADHD will still have symptoms as teens and well into adulthood. Fortunately, we can help them adjust and succeed for the long term.
Is there a known cause?
While no specific cause has been identified, research suggests that an imbalance in the neurotransmitters (chemical messengers) in the brain, specifically dopamine and norepinephrine, contribute to the symptoms of ADHD. Please see the ADHD Helpful Diagram that is included. One of the challenges we face is that no single blood test or imaging study, such as an MRI or CT scan of the brain, is diagnostic.
We do know that ADHD runs in families, and immediate family members like parents and siblings may have up to a 3 time greater risk of having it than other non-related strangers. Therefore, while helping the child, we may also have an opportunity to help another affected family member undergo evaluation and treatment.
Researchers have also learned that many factors have not been proven to cause ADHD. These include poor parenting, bad teachers, poor schooling, family problems, food allergies, too much sugar, and even too much television. Nevertheless, it’s always important to address parental concerns about these factors and take the time to address these particular concerns.
How do we diagnose ADHD
A combination of helpful information leads to the diagnosis of ADHD. First, a thorough medical history and physical exam is important to rule out any organic causes, including hearing problems and metabolic disorders. Our practice combines the history and physical with an easy to use ADHD checklist, based on well-established criteria from the most current edition of the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association, as well as observation rating scales from parents, teachers and other objective observers. These helpful handouts are included for your review. As needed, we also have an experienced psychologist, Dr. Jeff Daly, who can perform psycho-educational testing to rule out any associated learning problems, since up to 20-30% of kids with ADHD have associated learning disorders. We also assess for any associated mood disorders, including anxiety, depression, oppositional defiant disorder and conduct disorders. While we perform the evaluation, we provide the parents and caregivers with useful educational resources that make them more comfortable with understanding the disorder and options for treatment. These resources are also included for your review.
Developing an individualized ADHD treatment plan
After careful assessment and diagnosis, I meet with the parents and patient and design a personalized and total treatment plan. Such a plan includes behavior management, counseling and support, and medical treatment. Careful and consistent follow-up with outcome progress reports are especially important for assessing the success of treatment, and making any needed adjustments. I’ve also included this outcome progress report for your review.
The American Academy of Pediatrics has a very useful Tips Sheet for Parents of Children with ADHD which I have also included. It can be used to encourage improvement in behavior through positive reinforcement and addresses solutions to the common everyday problems that parents face, from getting ready for school, to dealing with homework challenges, as well as helping deal with potential medication side effects. Dr. Erikah Holtermann, our behavioral psychologist, is always willing to meet with parents and patients and help teach parenting and social skills that help the patient learn to control anger and impulsivity, improve communication skills and learn problem solving skills. As needed, we also work closely with the schools to encourage additional help through specialized programs, like a 504 plan, special education classes, AVID or an individualized educational plan (IEP).
Over the years , we’ve enjoyed helping many of our patients succeed in school and in their personal lives, protecting their self-esteem and watching them thrive as they learn to successfully deal with their attention problems and learning challenges.
We’ll be happy to share contact information for families of patients who have benefited from our treatment plan, and look forward to helping you with any specific concerns. Working together, we look forward to helping your child succeed and thrive, socially and academically.