Whether you call it ADD or ADHD does not matter; we are talking about pretty much the same thing. Some kids have hyperactivity along with difficulties in focusing; some do not. Try not to over think this disease or fine-tune it by getting hung up on terminology. Generally speaking, medication works better than counseling. Once I suspect that a child has ADHD, I give a “trial” of medication. This does not mean that I am experimenting on your child. I call it a trial because there is no blood or reliable brain-wave test for ADHD as of yet; the diagnosis of ADHD is aided by the giving of the medication.
There is a lot of information on ADHD on the internet. I will give you a lot of info at the office.
Here is pretty much what I will give you:
ADHD
How common is ADHD? ADHD affects about 5% of school-age children.
What is ADHD?
The hallmark symptoms of ADHD are:
- Hyperactivity
- Easy distractibility
- Impulsivity
You don’t need all three to have ADHD. Hyperactivity is seen more often in smaller children. For a diagnosis of ADHD, I like to see easy distractibility.
Hyperactivity – always moving about, restless, can’t sit still, always getting out of his seat at school or at the dinner table.
Easy distractibility – can’t focus, doesn’t listen to you or the teacher, forgets assignments and instructions, can’t organize tasks, loses things, absent minded.
Impulsivity – interrupts, acts before thinking, quick to act, difficulty waiting in line.
How do we diagnose ADHD? It’s done by history. The doctor asks you questions. There is no good objective test to detect ADHD. There are a few companies that make computer tests that can help, and I used such a test at one point in my office. I found that the computer tests were too clever by half meaning that they measured so many fancy parameters so as to give less meaningful results. There are no x-ray studies and labs that can give a diagnosis.
What causes ADHD? There are no good theories; but since it does run in families, it is probable that there is a genetic link. What this means is that there is most likely a pattern in the way that the neurons (brain cells) link up with each other that causes “brain overload” at the cellular level.
Definitely ADHD is not caused by diet or the food you are eating.
Will I grow out of it? I doubt it, but it may get better or worse as time goes by. For example, I feel my ADHD has gotten worse as I have gotten older.
At what age can ADHD be diagnosed? Pretty early. I can see which kids might have ADHD by age three. Usually I like to wait until they are a bit older before making a definitive diagnosis. Parents usually desire medication earlier than I want to give it. Insurance companies have been convinced by consultants to not approve medications for kids less than six years. This makes it tough to treat smaller kids less than six years of age. In the past I have treated many four year olds which I think is a reasonable age to begin stimulant medications.
What’s going on in the brain with ADHD? In my opinion, the brain cells are being bombarded with too many impulses at the same time. As a result, the brain cells go haywire, even more so when there are more distractions in the environment. What this means is that the person with ADHD will do better in an environment that is quieter with fewer distractions and people. As more people enter the room, the person with ADHD will perform worse.
Treating ADHD
Medications work best. In my experience the child will have ADHD throughout life. Medications are most important during the school years. If the child can not get an education, options are limited in life. Unless you can sing, dance or have some amazing talent, you will need an education to succeed in life. To get a good education medications can really help out.
Stimulants are the best medications. Even though they are called stimulants they calm the child down. The other medications that are prescribed in my opinion do not work nearly as well. I almost never start a child on any medication that is not a stimulant.
The best stimulants are taken orally. There are patches that I have used on kids that will not take oral medication. They are okay, but I prefer an oral medication.
The effects of the stimulate medications last about 4-5 hours. There are stimulant medications that are advertised as long lasting, but I have not found these claims to stand up. The long-lasting stimulant medications last about 4-5 hours also.
After The Diagnosis
Okay, let’s say that I have diagnosed your child. Now, you will want to know even more information. So here goes …
Your child has been diagnosed as having or potentially having ADHD.
Here are some important points:
1. The medicine that I am prescribing is safe. It does not cause addiction. In fact studies have shown that children who take stimulant medications for ADHD have a decreased chance of becoming addicted to recreational drugs.
2. The medication will cause a decrease of appetite. This is generally not a reason to stop the medication. Other side effects include headache and stomach ache and change of mood. Generally, I do not stop the medication because of these side-effects.
3. The long-acting stimulant medications usually take about an hour to start working and continue to work for about six to eight hours. These medications when taken properly do not build up in the body.
4. You will notice that your child will be much calmer on the medication. Many parents think incorrectly that their child has turned into a zombie whereas what has happened is that the parent is seeing for the first time how their child should behave normally.
5. Continue to give the medication on weekends.
6. Call me before you run out of the medication, not afterwards.
7. The stimulant medications can at times make your child seem more sentimental. Minor mood swings are sometimes seen. Please do not stop the medication without calling me first unless you feel there is a good reason for doing so.
8. There are many self-styled experts on ADHD. Before taking their advice, ask them how many patients with ADHD they have treated over the years.
9. You should notice an improvement in your childs performance right away provided the correct dose has been given. Sometimes I need to adjust the dose upwards before we see a good result. Please be patient.
10. Well over 50% of children have ADHD into adulthood. This is generally not a disease that goes away in a few years. Your child will most likely require the medication for a number of years.
11. I have confidence in the stimulant medication; and in my opinion the medication does not have any serious long-lasting effects that will effect intelligence or mental functioning.
12. The stimulant medication does not “fry” the brain.
13. Medication is only part of the solution, although it is a big part. For the best treatment of ADHD it is important that your child have an optimal home and school environment.
14. Your child, because he or she has ADHD, is eligible to receive special education mandated by Congress. Your school has forms that I can fill out that will enable a resource class for your child.
15. It is important that your child have a stable home environment. Psychological problems resulting from screaming, yelling and abuse only magnify the ADHD problems.
16. Children with ADHD do not disobey on purpose; the problem they have is that they are physically incapable of obeying. Their minds are going in one hundered directions at once; consequently, screaming and yelling are of little benefit.
17. Boot camps will do little to improve ADHD.
18. You have to stay in contact with your child’s teacher to see how he or she is doing so that you can make modifications if necessary.
Side Effects of ADHD Medication
1. Anorexia. Not wanting to eat.
2. Insomnia. Inability to sleep.
3. Abdominal pain.
4. Headaches.
5. Emotional lability.
Black Box Warning
The FDA has recommended a warning on stimulant medications stating that sudden death has ben reported in association with CNS stimulant treatment at usual doses in children and adolescents with structural cardiac abnormalities or other serious heart problems.