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ADHD

ADHD. It’s everywhere these days. Every kid who jumps up and down in the store gets “the look”. Or someone says, “he should be on Ritalin”. Now you’ve gotten a note from school saying your child looks like he has ADHD and the school wants you to take him to your doctor. But does he really have ADHD?!? What is ADHD anyways?

ADHD is a brain disorder involving attention, impulsivity, and distractibility. The diagnosis is not simply based on hyperactivity or poor attention. There are many reasons that children can be overly active or inattentive, such as depression, anxiety, learning disabilities, or lead toxicity. So a thorough evaluation with information gathered from multiple sources is a requirement for the accurate diagnosis of the problem. A brief visit to a doctor’s office is probably not sufficient to accurately diagnose ADHD or distinguish it from other problems.

In the past five years, there have been position papers published by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry on the recommendations for the diagnosis and treatment of ADHD. This was done in response to concern expressed by the public on the epidemic proportions of children being diagnosed with ADHD. Now there are several epidemiological studies, which show that 8% of children have ADHD.

We now known that children with ADHD often have lots of attention, but they cannot focus it on anything for very long. They get distracted easily. Many children and adults with ADHD can become hyperfocused and so appear to be ignoring everything else. For example, a child who is hyperfocused on a video game may not hear his parents call, but at the same time he cannot focus on his homework for long. Children with ADHD often have difficulty with impulse control, so they can have problems with anger management, frustration control, social interactions, and making safe choices. Of course, children are active and sometimes can be silly and hyperactive, but this is only considered a symptom of ADHD when it is outside the standard range of activity for the child’s age and developmental level. Now there are some children with ADHD who aren’t hyperactive at all. Instead, they are quiet, daydreaming often and present little problem in class. But, they aren’t learning very well either, because they can’t pay attention. So, you can see that it is not always simple to diagnose ADHD. Indeed, symptoms must be present in multiple settings (e.g., home, school, extracurricular activities), must begin before age 7 years, and must cause problems for the child to be considered diagnostic for ADHD.

Unfortunately, there is no blood test that can diagnose ADHD. The diagnosis is best made by a combination of observation of the child, computerized tests for attention span and distractibility, reports on the child’s behavior in multiple settings, and a careful psychiatric evaluation to look for other possible causes of the child’s symptoms.

 

Read Dr. Henderson’s article on a potentially dangerous adverse reaction to an ADHD medication.

Aggression, mania, and hypomania induction associated with atomoxetine.