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Attention Deficit Hyperactivity Disorder (ADHD): Questions & Answers

Questions & Answers

Isn't a lot of activity and running around just part of being a boy? Wouldn't Huck Finn and Tom Sawyer be taking Ritalin today?

ADHD is real. There are essential symptoms or criteria that comprise the disorder. The most compelling evidence of how young people with ADHD differ from garden variety "boys will be boys" comes from outcome studies in which adolescent boys diagnosed earlier with ADHD still show higher rates of ADHD symptoms.

Should we tell the teacher our child has ADHD?

Parents often ask if they should tell the teacher that their child has ADHD, fearing that the teacher will then have negative behavioral expectations. While parents should be concerned about potential preconceptions and protecting their child's privacy, there are greater disadvantages of not informing the teacher of the diagnosis and treatment plan. While the child's untreated or under-treated difficult behaviors will bias the teacher and peers in negative ways, sharing the diagnosis and fine-tuning the treatment plan assures teachers that parents are on top of the situation and can be counted on to partner in the child's success throughout the year.

With so many different kinds of therapies, how do we know what works and what doesn't?

Parents today are bombarded with often exaggerated claims - both positive and negative - about a plethora of treatments for ADHD such as behavior therapy, psychostimulant medications, sand tray therapy, biofeedback, elimination diets, and social skills training. Parents must become well-informed consumers by looking to science to help differentiate treatments with sound research support from those treatments that simply sound good or logical on the surface, but lack enough evidence to support recommending them at present. Several national organizations (www.clinicalchildpsychology.org) provide online information about how treatments become validated and what to look out for in alternative treatments. They also list the treatments for ADHD that have proven benefits in controlled studies. National advocacy groups such as CHADD (www.chadd.org) also educate consumers and provide excellent annotated references (www.help4adhd.org) to all the major mainstream and alternative treatments for ADHD.

Does ADHD lead to drug abuse?

There is no evidence that this is the case. Untreated ADHD can lead to serious conflicts with authority and with age may turn into a pattern of behavior called Conduct Disorder. This adds significantly to the risk for drug abuse. However, it appears that if ADHD children do not develop a Conduct Disorder they are not more prone to drug abuse than their peers who never had ADHD.

My 6-year-old child just got diagnosed at the end of first grade. Will he ever outgrow it? Is there a cure?

ADHD is best understood as chronic and not as a short-term or temporary condition, even with effective treatment. Viewing it this way encourages the child and family, and later the independent adult, to always be re-evaluating how their care plan is working for them and fine-tuning it as needed. ADHD changes over time and manifests differently over the lifespan. For example, while children must have six out of the nine impairing hyperactive or impulsive symptoms to qualify for that part of the diagnosis, very few adults have this many symptoms, yet they still report interference from symptoms and are in need of interventions. Developmentally, we know that the hyperactive and impulsive characteristics actually start to lessen in the early teen years for the typical child with ADHD. Their inattentive and disorganized qualities, however, persist at fairly high rates and if untreated (or under-treated) continue to interfere with accomplishing what they otherwise might.

Why are so many more children being diagnosed with ADHD now compared to when I was a kid? Is it really more prevalent or are people just making excuses for bratty behavior in a society where parents no longer set limits?

Estimates of the prevalence of ADHD vastly differ depending on how the study collects the information. The best overall estimate is that between 3-5% of elementary school-aged children have the disorder - on average, about one child per class. Unfortunately, even though the number of children identified with ADHD has increased significantly, there are still so many more children who have the condition and are not being identified or getting appropriate help. The U.S. Surgeon General reports that only one out of five of the 10 million youth with a psychiatric illness is receiving proper diagnosis and treatment. Stigma and limited healthcare coverage still prevent vulnerable children from getting the help they need.

Do adults have ADHD?

Recent studies show that the children with ADHD continue to have symptoms through adolescence. It is not clear how many continue to have the disorder, but many improve during late adolescence. Adults with ADHD continue to have problems such as disorganization, impulsively saying or doing things that cause problems with others, being chronically late, not following through on assignments, a quick, explosive temper, recklessness, etc.

How does medication help ADHD?

Medication may affect the brain centers involved in attention. It decreases distractibility, focuses attention, and promotes self-control. Medication often leads to direct improvement in school functioning and to improved behavior and social relationships.

Why is behavior therapy important?

Behavior therapy involves developing a system of dealing with the child's behavior to curtail problem behaviors and increase self-control and compliance. Two broad sets of techniques are involved. One tries to increase positive behaviors by making the child aware of the circumstances that trigger the behavior, such as giving very clear directions, changing the class seating arrangement, modifying school demands, providing structure during peer interactions. The second set of techniques deals with the way adults react to the child's behavior so that positive consequences follow compliance and mild undesirable consequences following difficult behaviors. Consequences for positive behavior may include rewards; consequences for negative behavior may include loss of rewards and time-out. Collaboration between parents and school by means of a daily or weekly report card is helpful.