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Jason is an eight year old boy who is having school challenges. While a happy, inquisitive and intelligent boy, he has difficulties staying focused at school and during other activities. The teacher reports that he often interrupts the class with impulsive statements or questions, has difficulty staying on task and remaining focused. He is quite forgetful and has difficulty organizing himself. He is high energy – constantly on the go, fidgeting and squirming during class. During soccer, he is often at the opposite end of the field picking dandelions instead of chasing the ball. Homework is a struggle at home and he often gets distracted during bedtime and morning activities.
ADHD is an established neurobehavioral disorder (meaning the brain affects behaviour, emotion, social abilities and learning). It has been described in all cultures and in all parts of the world. It is common – as many as ten per cent of boys and four per cent of girls have ADHD. It has only recently been recognized as a distinct diagnosis. As with many other medical disorders, the cause is still unknown. Newer diagnostic techniques, such as PET scans, provide some insight as to the parts of the brain affected by ADHD. They also point to specific naturally occurring chemicals that may be affected. These chemicals, called neurotransmitters, assist in sending messages between nerve cells. We still have much to learn about the exact cause of ADHD. Parenting, disciplining and teaching children with ADHD can be very challenging. However, it is the disease that causes ADHD, not poor teachers, ineffective parents or loose discipline strategies.
There are three core features of ADHD – inappropriate lack of attention, impulsivity and hyperactivity. Children with ADHD are easily distracted or less able to concentrate – especially with boring or routine tasks. Schoolwork, waiting in line and household routines are common examples. Paradoxically, children with ADHD may focus too keenly on high-interest activities. It is not unusual for parents of children with ADHD to report that ‘a bomb could go off’ when they are playing video games and they wouldn’t notice. The impulsivity and hyperactivity that children with ADHD show is often demonstrated in blurting out answers in class, being constantly on the go, fidgeting or interrupting others. All children exhibit some or all of these behaviours at some time. The key to diagnosing ADHD involves spotting symptoms in two or more settings. For instance, your son or daughter might show symptoms both at school, where he has trouble keeping up with the work, and at home, where it is hard to keep him on schedule.
Although it seems inconsistent with the name of this disorder, not all children with ADHD are hyperactive. A subset, known as ADHD with primary inattention (sometimes called Attention Deficit Disorder or ADD), includes all of the other features except for behavioural hyperactivity. These children are often distracted by their own thoughts. Teachers report that they daydream or don’t pay attention in class. They are not necessarily disruptive – they are just ‘tuned out!’
As many as 87 per cent of children with ADHD will be diagnosed with another condition. Learning disorders, mood and behavioural disorders are commonly found at the same time. Once ADHD is suspected, doctors will rule out any other problems. In many cases, treating ADHD will also improve the other condition.
Hundreds of clinical studies and millions of ‘patient years’ of use have confirmed the safety and effectiveness of medication used to treat ADHD. New medications have been developed and older versions reformulated to allow simplified dosing and better effects.
Children do best with longer-acting medications combined with behavioural and school interventions.
A landmark government-funded study compared four treatment methods for children with ADHD. The different methods tried included:
Children fared best when treated with both school and home interventions plus intensive medication therapy. However, the medication supplied most of the treatment’s effect. Based on this study, specialists writing Canadian guidelines on how to treat children with ADHD are strongly recommending regular use of long-acting medications.
Long-acting ‘stimulants’ are still important first options for medical treatment. However, another class of medications (neurotransmitter NE reuptake inhibitors) have recently been approved for treating children, adolescents and adults with ADHD. Some anti-depressant medications have also been used. Which medication is best? No trials have compared all available treatment options. Parents and doctors should decide together on what medication is best. Often, more than one medication will be tried before the right one is found.
Eighty percent of children diagnosed with ADHD symptoms still show them in adolescence, while sixty percent of adults will remain symptomatic.
Children treated with stimulant medication have a lower incidence of substance abuse in adolescence.
Critics of medical therapy claimed that children would be turned into drug addicts by taking stimulant medication. The opposite is true. Several studies have demonstrated that children with ADHD who are treated medically are less likely to develop substance abuse problems as teenagers as compared with children with ADHD who were not treated medically. Likewise, teens taking medication for ADHD have a lower incidence of motor vehicle accidents and traffic violations compared with teenagers with ADHD who do not take stimulant medication. It is the motor vehicle safety finding that supports the use of longer-acting medications in teenagers – since most driving is done outside of school hours.
Of ‘mental disorders’ in children, ADHD is the most likely to be inherited. If a child is diagnosed with ADHD, there is a good chance that a first-degree relative also has ADHD. Doctors will often ask about siblings or parents, inquiring about symptoms or a formal diagnosis.
Research and study of ADHD continues. Effective treatments allow children, teens and adults to be at their best and while reducing the risks of this disorder. While school and home intervention, programs and structure are an important part of therapy – medication remains the mainstay of treatment for patients suffering from ADHD.
If you suspect that your son or daughter suffers from ADHD, talk to the school and see your family doctor. Educational assessments may be done through schools or private educational psychologists. Learning centers may also provide assessment and direction. Many of these resources work with or could recommend a physician if you do not have one. Some pediatricians and family physicians have interest in ADHD and will assess and treat ADHD. Other times, referral to a developmental pediatrician or child psychiatrist will be made. Some communities are fortunate to have multi disciplinary clinics that specialize in treating children with ADHD. Finally, CHADD is a support group for families who live with ADHD.
Log on to www.caddra.ca for more information produced by Canadian ADHD experts.
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