[ back ]
Q&A: Attention-deficit/hyperactivity disorder
How common is ADHD?
ADHD is the most common behavioral disorder in childhood, affecting an estimated 3 to 5 percent of school-age children. The disorder is more common in boys and usually develops before age 7.What causes ADHD?
The symptoms of ADHD are thought to be caused by neurological differences within the brain. Research has suggested that children with ADHD have low levels of dopamine, a neurotransmitter. Studies have also suggested that metabolism in certain areas of the brain is lower than normal in children with ADHD, especially in the areas that control attention, social judgment and movement.In truth, the etiology of ADHD is still not well understood and remains under scientific study. There is clear evidence that ADHD has a genetic component.
How is ADHD diagnosed?
A pediatrician, developmental-behavioral pediatrician, child psychiatrist or qualified mental health professional usually identifies ADHD in children as part of an individual or multidisciplinary team evaluation.A detailed history of the child's behavior from parents and teachers, observations of the child's behavior and psychoeducational testing contribute to diagnosing ADHD. Because ADHD is a group of symptoms, diagnosis often depends on assessing results from several different types of evaluations, including physical, neurological and psychological. Certain tests may be used to rule out other causes of attention problems, and some may be used to test intelligence and certain skill sets.
What role do pediatricians play in ADHD care?
Pediatricians provide a major component of the care for children with ADHD. Early diagnosis and management can help improve the core symptoms, and help the child achieve normal peer and family relationships. Pediatricians need to be aware of the symptoms so children suspected of having ADHD can be evaluated in a timely fashion and started on an appropriate treatment plan.Once a child had been diagnosed and treatment has been started, pediatricians may also be involved in follow-up care. This should include a complete medical, family, social and educational evaluation.
Interviews and/or questionnaires completed by parents, teachers and counselors can provide valuable information on the child's behavior. Follow-up should also include a discussion of possible side effects from medication, along with data collection from home and school.
When should patients be referred to a specialist?
The American Academy of Pediatrics (AAP) guidelines for the diagnosis and treatment of ADHD offer great assistance to primary care clinicians in recognizing and treating this disorder. Treatment often requires a significant time investment, and long-term commitment by the pediatrician and the family. If the pediatrician is not comfortable fulfilling the AAP requirements or if the case is complex, referral to a specialist may be appropriate.What are the first-line medication therapies for ADHD?
The two classes of stimulants most commonly prescribed are methylphenidate and amphetamine. There are many companies that make variants of these that differ in chemical structure and by mode and timing of release. When effective, these medications decrease distractibility, impulsivity and hyperactivity, and improve attention. They have been used since 1933 and are considered very safe and effective when prescribed appropriately and used correctly.Non-stimulants are not first-line medications, but they can be used for children who don't respond to stimulants or who experience negative side effects from stimulants, such as anorexia, insomnia or dysphoria.
Is there a connection between stimulants and cardiovascular health?
To the best of my knowledge, there is no new data that stimulants are a heart risk. Stimulants have been used for a long time to treat ADHD and have been shown to be safe and effective.However, before starting a child on a stimulant, clinicians should always perform a thorough history, a family history and a physical examination, including pulse, blood pressure and heart exam. From current data, it does not appear that an EKG and further studies are appropriate unless there are abnormalities in the child's history, family history or physical exam.
A child with congenital or acquired heart disease should always consult with a cardiologist before beginning any medication.
What is the role of behavior therapy?
Research has suggested that medications are more effective when combined with behavior therapy. Evidence has also shown that ADHD is managed more effectively when parents participate in treatment. Examples of parental involvement include giving praise for efforts; ignoring outbursts that seem to beg for attention; listening and responding to the child's needs; rewarding positive changes in behavior even if behavior is not perfect; using appropriate discipline for inappropriate behavior; and using appropriate language when talking about behavior such as "appropriate" and "inappropriate" instead of "good" and "bad."What research is being done on ADHD?
Much of the current research focuses on the genetics of ADHD since there seems to be a genetic component. Other research is looking at the structural and functional differences between the brains of children and adults with ADHD compared to normal controls.Of course, we are always searching for new medications. Unfortunately, there are very few studies that compare one medicine to another. Pediatricians are often left to decide which medication is best based on anecdotal evidence rather than empirical data.
This article was adapted from content provided by Children's Hospital Boston to the Health and Parenting sections of Yahoo! For more pediatric health information from Children's, visit http://health.yahoo.com, and select "Parenting" under Healthy Living.
Copyright ©2005, Children's Hospital Boston. All rights reserved.
Children's Hospital Boston
300 Longwood Avenue | Boston, MA 02115 | 617-355-6000
www.childrenshospital.org