06 February 2016
It is believed that anywhere from 3-10% of children in the United States have ADHD or attention deficit hyperactivity disorder. Most often, this condition is recognized when the child starts attending school and he or she requires a more structured environment. But quite often, the signs and symptoms are apparent at a younger age.
Here in our practice, we have several children with ADHD and it’s something we get a lot of questions about from our parents. I wrote this blog to share some information about this condition and to help families who have a child with ADHD.
How can you tell if your child has ADHD?
ADHD often runs in families, with a father, mother or sibling having similar symptoms. Some children might have a minor case, while others will have inattention or hyperactivity to a much greater degree. Many children will outgrow this condition, but some will not and may need treatment into their adolescence and even adulthood.
ADHD encompasses many symptoms that include:
- inattention and distractibility
- not staying focused
- not listening or paying close attention
- not organized
It may also include, especially in younger children:
- being hyper or always on the go
- being fidgety
- talking excessively
An ADHD child may:
- be impulsive
- not be able to wait their turn
- blurt out answers
- interrupt others often
- have a problem with inhibition
Not unusually, a child with ADHD can have unbelievable attention and concentration when playing a captivating video game, but will have trouble focusing when something is less enticing (such as school and math) while simultaneously trying to filter out birds, cars or kids playing outside the window. He or she might have real difficulty putting the brakes on distractions (causing inattention), controlling their inside thoughts (causing impulsivity) and staying quiet (causing hyperactivity).
Before a diagnosis of ADHD is made
Parents, teachers, and doctors must be sure there is not a LEARNING DISORDER masquerading as ADHD. A child who has learning issues in math, reading, etc. will act very similar to a child with ADHD. If a child can’t read or do math, they will quite often give up and tune the teacher out, and become fidgety and distracted.
Some children will have minor ADHD symptoms and some major
For those in the latter group, caregivers and doctors may suspect the child has ADHD, usually after the age of 5. The symptoms must be present in two or more environments, for example: at home, at school, at an afternoon program. Younger children will have more of the impulsive and hyperactive symptoms, while inattention is present in younger and older patients. And, boys outnumber girls with this condition.
Children with ADHD will do better in small group activities or one on one. There is also a maturation factor, especially for minor cases, which often causes the symptoms to be outgrown in later years.
Two defining situations when ADHD becomes apparent:
- when a child begins a school program and rules and regulations start to be enforced.
- when a child who is very bright has to become more organized and there is less oversight. Typically this occurs in middle or high school when there are a multitude of different classes, teachers and homework assignments.
Two treatments for children with ADHD
Here at Westchester Health Pediatrics, if we think your child may have ADHD and a learning issue has been ruled out, the next step is to speak to your child’s teacher. There are various tests that will be given to the parent and teacher(s) in assessing a child’s behavior. Sometimes behavior exhibited in the home environment suggests that a child has ADHD, but then this same behavior may not be duplicatedin the school environment. BOTH AREAS MUST INDICATE THAT A CHILD HAVING SYMPTOMS OF ADHD—SCHOOL AND HOME.
If we feel that indeed, your child has ADHD, we will suggest two proven, effective treatments. Each treatment may work fine alone but applied together, both work better.
The first is called behavior modification. This involves making the child’s home more regimented and directed. A schedule put in the child’s room, bathroom, kitchen and other areas with various times and check-off boxes for him/her to see and successfully complete can be very effective. The morning time period should include time for dressing, brushing teeth, eating breakfast and getting ready for school, in 15 minute intervals.
Afternoon and evening time slots should include a play period, homework time, reading and TV time (less than 1 hour per day), bedtime preparation and getting the backpack ready for school. Setting out the clothes for the next day can be done the night before. With each successful task completed, a check mark or star can be given. After a certain predetermined amount of positive experiences, a small reward can be given.
It is most important that parents are consistent and immediately give rewards for good behavior and discipline for poor behavior. Poor behavior can lead to removal of privileges and “good” points, a time-out period, or loss of fun privileges (i.e. TV time, computer games, etc). For younger children, teachers should provide feedback regarding individual target behaviors. A daily report card with smiling or frowning faces should be checked off and sent home daily for the parents to review.
Along with behavioral therapy, psychological and pharmacological therapy can be used. A therapist can help to navigate social and academic situations, as well as help parents manage the child’s behavior and routines.
It is imperative that a child does not have another issue such as depression, anxiety, OCD or other issues that is being overlooked. Four out of ten children may have two issues occurring at the same time.
Many children with ADHD will also need medication. The most common are psychostimulants which help control attention, impulsive and self-regulation of behavior, with a success rate of 80%. Your pediatrician will go over the different types of medication and any side effects. A child has to be monitored while on these medicines, and they will be adjusted as the child grows and gains weight. There are other classes of medicines which are not stimulants that can be tried alone or combined with others in certain situations. Usually the first line of treatment entails psychostimulants.
Some patients may be able to wean off their medicine after a few years, while others will need to continue them through adolescence and adulthood. Teenagers who have ADHD and drive a car should make sure to take their medicine, even on non-school days, since it has been shown to decrease the likelihood of a motor vehicle accident.
The good news
The vast majority of children who have the diagnosis of ADHD are successfully treated and do very well in social and academic situations. Your pediatrician will be able to help you navigate through each step.
Come see us; we’re here to help
If you think your child might have ADHD, please make an appointment with Westchester Health Pediatrics. One of our pediatricians will meet with you, diagnose whether or not your child does indeed have ADHD, and together, you can move forward with a plan.