adhd part 2

Hyperactivity: what we need to know (part II of a II-part series)

by Barry Bittman, MD

The phone rings. It’s not unexpected. Yet there’s a pit in your stomach. You take a deep breath, and agree to meet your child’s teacher who is at her wits-end.

If this sounds familiar, read on. Your knowledge and approach are critical to the well-being of your child.

In order to work out a strategy with your child’s teacher, you are going to need a plan to move forward in a positive direction. In all likelihood, you may have anticipated the diagnosis or sought medical attention already. Perhaps you get a call like this every September. In any event, if you’re searching for answers, read on.

Children with correctly diagnosed ADHD, Attention Deficit Hyperactivity Disorder, often experience serious consequences when the condition is left untreated. Children with ADHD tend to be disruptive, distractible, and impulsive. Often shunned by other students, they typically feel alone and unwanted. Their behavior, if unchecked, can tear a household apart. In many cases, lack of social acceptability coupled with poor school performance and academic achievement leads to major problems as adults. They also tend to have higher accident rates, and in combination with conduct disorders are more likely to experience drug abuse and antisocial behavior.

Assuming the diagnosis of ADHD is in question, consider the following:

· ADHD is not typically situational. A child with this disorder does not manifest symptoms only in the classroom. A youngster that can sit through a family dinner or watch a television program without getting up several times is unlikely to have ADHD. Symptoms occur in multiple settings.

· ADHD does not occur in the presence of one teacher alone. A child who is well-controlled in one classroom, and unable to sit still in another does not have ADHD. Teachers are not the cause of ADHD.

· ADHD does not occur in the presence of one parent alone. A child who is well-behaved and focused with one parent, and who is quite the opposite when with the other, does not have ADHD.

· An accurate diagnosis of ADHD requires observation as well as information. While a clinician depends to a substantial degree on witnessing your child in action, your history and account of what is occurring is crucial. Issues that may impact your child’s behavior in your household must be openly discussed.

Assuming treatment is in question, consider the following:

· There’s no proven cure for ADHD. Ongoing treatment with frequent adjustments is often necessary. Discovering effective strategies is a longstanding process.

· Medication, alone, is not a rational solution.

· Short-term research trials of medications like Ritalin have demonstrated effectiveness for some symptoms. Medication approaches have never been shown to normalize the entire range of behavior problems.

· Side effects of medications can be carefully monitored. What works for one child may cause adverse effects for another. Be prepared to discuss any potential problems with your physician.

· At times, medications other than those typically used for ADHD, have demonstrated effectiveness. Certain antidepressant drugs have been shown to be associated with improvements of teacher-rated symptoms.

· Psychosocial treatments have been shown to be useful in many cases. Behavioral strategies at home and in the classroom can often be helpful. Parent training, behavior therapy and contingency training (rewards, timeouts, etc.) have been documented to produce beneficial effects.

· Biofeedback and other centering techniques have been shown to aid in improving mental focus and performance. Applying techniques learned in a clinical setting to real life experiences is essential.

· The jury is still out on the issue of diet and sugar for children with ADHD. Until further data is available, one should not veer from a well-balanced diet.

· It is not uncommon for children with ADHD to have sleep problems. While you may think this is associated with the use of stimulant medications, insomnia occurs in children with ADHD off medicines as well. Less sleep in a 24 hour period was has been associated with increased behavior problems. Practices designed to promote adequate sleep may be helpful.

In conclusion, an accurate diagnosis is essential prior to investing time, effort and expense in a treatment regimen. Always begin with your family physician or pediatrician and consider seeing a specialist when in doubt or if treatment is not preceding as expected. Consider your child’s teacher an important member of your child’s healthcare team, and share those insights with your physician. Realize that a combination of approaches is essential, and know that effective treatment strategies often lead to a light at the end of the tunnel¾ Mind Over Matter!