ADHD (Attention Deficit Hyperactivity Disorder)

Joan Lisanne Lange, M.D.  

We all know children who have trouble sitting still, don’t seem to listen or can’t wait their turn. Though almost all children will demonstrate these behaviors from time to time, children with ADHD will typically do so daily. This becomes a problem when these behaviors interfere with a child’s ability to function at home, in school, and in their relationships with others. ADHD is a very common disorder affecting 4-8% of school-aged children. As the name suggests, these children may struggle with inattention and/or hyperactivity as well as impulsivity. Symptoms need to be present in multiple settings (e.g. both home and school) and must be noted for at least 6 months to confirm the diagnosis. In many cases, difficulties may persist into adolescence and adulthood affecting job performance, social relationships and sometimes leading to anxiety and depression.

Patients will generally fall into one of 3 subsets of ADHD:

• Predominantly inattentive type:

  • -Difficulty sustaining attention
  • -Organizational difficulties
  • -Easily distracted
  • -Forgetful
  • -Losing books/assignments
  • -Making careless mistakes
  • -Daydreaming

• Predominantly hyperactive type:

  • -Fidgety
  • -Difficulty remaining seated
  • -Talking excessively
  • -Trouble waiting turn
  • -Interrupts others

• Combined type:

  • -Meets criteria for both

The diagnosis of ADHD is generally made after a patient’s history is thoroughly reviewed and consultations with parents and teachers. Clinicians will often use checklists or surveys to rate the severity and frequency of symptoms. A medical evaluation and physical examination is important to rule out any medical reason for the symptoms. Various professionals diagnose and treat ADHD. These can include general pediatricians, behavioral specialists, internal medicine physicians, psychologists, psychiatrists, and neurologists.

The most effective treatment for ADHD is one that involves varying interventions such as parent training, behavioral modification, school involvement and, sometimes, medication. For school-aged children, communication between the teacher and parent is essential to keep track of progress or worsening symptoms. Parents should be aware of daily assignments and upcoming tests. As organizational skills are often a problem in these children, a daily planner may help to organize their work. Some children are provided with preferential seating in the classroom or additional time for testing as well as separate testing environments to minimize distraction. This should be the case for homework as well: a quiet, distraction free area with occasional breaks to move around and release extra energy.

Of course, one cannot overlook the effect of lifestyle on ADHD. Attention to diet, sleep habits and exercise are crucial. People who are tired or hungry are not going to be able to focus well and exercise can help patients increase their concentration by boosting neurotransmitter levels.

Many patients who have been diagnosed with ADHD are also treated with medication. These help increase concentration and focus while decreasing hyperactivity and impulsive behavior. The most commonly used medications are stimulants, which come in short-acting and long-acting formulations.

The long-acting dosing allows someone to only take one dose in the morning and have the drug last 8-12 hours (through homework). Others prefer the short-acting forms, which wear off after only a few hours. Other non- stimulant drugs are also available. The choice of treatment and medications is best made after careful discussion with a physician and should be tailored to the needs of the individual patient and family, so talk to your doctor today!