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Diagnosing Childhood ADHD

Posted Aug 24 2008 1:49pm
ANNOUNCER: It's estimated that three to eight percent of children are affected by attention deficit hyperactivity disorder, or ADHD.

JAMES McGOUGH, MD: Attention deficit hyperactivity disorder is a behavioral disorder generally first seen in childhood that is defined as developmentally inappropriate levels of difficulty with either inattention or hyperactive impulsive symptoms.

ANNOUNCER: ADHD can be present in toddlers, but symptoms generally become more apparent when children reach school age.

ANN ABRAMOWITZ, MD: ADHD, if it's present, is a disorder of the lifespan. So if ADHD is diagnosed in a youngster of age, maybe, six, which is a very common age for diagnosing it, because these are kids who are in school and are experiencing difficulty, then our understanding is: That child also had ADHD when younger, although it may not have interfered as much with his or her life.

ANNOUNCER: Common symptoms for ADHD include hyperactivity, inattention and impulsivity. But the symptoms must be present in more than one setting, such as home and school, for a diagnosis.

MELVIN OATIS, MD: It's not enough just to have the symptoms that are listed regarding hyperactivity, impulsivity and inattention, but you're looking for an impairment, or the persistence of these symptoms. And you're looking for these symptoms to occur in more than just one area. For instance, in two or more areas that can be demonstrated at home or it may be demonstrated at school or in their peer interactions on the playground or other after school activities in which you might see these symptoms impairing children.

ANNOUNCER: Diagnosing ADHD requires the focus of a qualified clinician.

JAMES McGOUGH, MD: ADHD is a clinical diagnosis. There isn't any neuroimaging test, any blood test, any psychological test that will give you a diagnosis. A good clinician will attempt to get information from a wide variety of sources, so information will be solicited from the teacher or the teachers, from the parents and time will be spent with the child themselves. This might sound somewhat subjective, but actually our success in diagnosing children in this way is just as reliable as many other disorders in medicine. And, if we use standard criteria, you can be very assured that, 95 percent or better, skilled clinicians will identify the same children as having ADHD.

ANNOUNCER: Once a child is diagnosed, educating the entire family about ADHD is a priority.

JAMES McGOUGH, MD: My starting point, once I complete an assessment and make a diagnosis of ADHD is really to begin a process of education, both with the parents and with the child. First of all, there are a lot of misconceptions about what ADHD is all about, and it's important for these families to understand that it really isn't simply a matter of bad parent training or something that was done to the particular child. This is essentially a genetically driven condition that can be influenced somewhat by the environment.

ANNOUNCER: The first line of treatment for ADHD is medication.

M. CHRISTOPHER GRIFFITH, MD: The standard treatment now for treating ADHD is to use the long-acting stimulants. These medications may last anywhere from 8 to 12 hours. Some of the common preparations include once-daily Adderall XR. We have several methylphenidate preparations; they include Concerta, and Focalin-XR. There's only one non-stimulant that's approved for the treatment of ADHD now, and that's called atomoxetine, or the name many people will know it as is something called Strattera.

ANNOUNCER: In addition to medications, clinicians will develop behavioral, psychological and educational interventions for children.

ANN ABRAMOWITZ, MD: Structure is really important to children with ADHD. No matter whether you're working with the classroom or with the parents, you always really want to introduce as much structure, both within the day and from day to day, as you can, starting with a schedule, a predictable schedule, when things should be done, and keep that, as much as possible, consistent from day to day. Also, rules are very helpful. Clearly-stated rules, and frequently-stated rules because kids with ADHD tend to forget rules and do benefit from reminders.

ANNOUNCER: Children may outgrow some symptoms, but in most cases ADHD will persist into adulthood.

MELVIN OATIS, MD: ADHD should be seen as a chronic disorder. It doesn't mean that the impairment that exists in front of you when you first make the diagnosis is going to be there forever. Establishing education and establishing goals is very important. And over time, you might find you've met a goal, and now it's time to set a new goal.

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