Understanding ADHD

ADHD is often misunderstood.

From diagnosis and testing to ADHD treatments, many parents get confused by all of the information, and much of the misinformation, available about ADHD.

If you take a step back and look at ADHD like any other chronic childhood condition, like asthma, diabetes, or epilepsy, you will have a much easier time parenting your child with ADHD and getting help.

ADHD Symptoms

The symptoms of ADHD are usually grouped into three major categories, including:

• having trouble paying attention (inattention) and getting easily distracted
• being hyperactive or "on the go" (hyperactivity)
• being impulsive or doing things without really thinking about them (impulsivity)

Keep in mind that many children can occasionally get distracted or be a little hyperactive. To be considered a true symptom of ADHD, these symptoms should also be causing some kind of impairment, for example, leading to behavior problems, school performance problems, difficultly making and keeping friends, etc.

Types of ADHD

Children can have ADHD even if they don't have all of the symptoms of ADHD. That is because there are several types of ADHD, including:

• ADHD, Inattentive Type - which includes those children who mostly have symptoms of inattention, such as not being able to pay attention to details, getting easily distracted, being forgetful, etc.
• ADHD, Hyperactive - Impulsive Type - which includes those children who mostly have symptoms of hyperactivity and/or impulsivity, such as fidgeting a lot, having trouble staying in his seat, talking excessively, being on the go, interrupting others, having trouble waiting for his turn, etc.
• ADHD, Combined Type - if the child has all of the major symptoms of ADHD

A lot of people talk about ADD and ADHD as if they were two different things, reserving ADHD or attention deficit hyperactivity disorder for those kids who are hyperactive and ADD for those aren't. Keep in mind that both ADD and ADHD are simply generic terms for Attention Deficit Hyperactivity Disorder though and don't really describe the type of ADHD a person has.

Getting Tested for ADHD

Parents looking for a quick test for ADHD are going to be disappointed. Unfortunately, there is no blood test, x-ray, or other ADHD test. Instead, your child's pediatrician will test your child for ADHD by:

• asking the child's parents open-ended questions and focused questions in an interview
• providing questionnaires and ADHD symptom checklists or ADHD rating scales for the parents and teachers
• evaluating the child for other coexisting conditions, such as conduct disorder, oppositional defiant disorder, depression, anxiety, and learning disabilities

Other ADHD tests are available, however, the American Academy of Pediatrics states that "other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD." These would include regular screening for high lead levels, routine thyroid function testing, brain imaging studies (MRI, CT, SPECT, PET Scans, etc.), electroencephalography (EEG), or continuous performance tests (CPTs).

Your pediatrician is a good place to start when you are concerned that your child has ADHD, but other health professionals that do ADHD testing include child psychologists and child psychiatrists.

ADHD Treatments

Although there seem to be many ADHD treatments that you could use to treat your child with ADHD, only two types are recommended by the American Academy of Pediatrics. These recommended ADHD treatments are ADHD medications, including stimulants and non-stimulants, and behavior therapy.

The AAP states that behavior therapy can include "parent training in behavior therapy and classroom behavior interventions," and focus either on the "child's behavior problems and difficulties in family relationships" or on his behavior in the classroom.

ADHD Medications

Much of the stigma surrounding ADHD medications, besides the fact that they are stimulants, revolves around the side effects they cause. Originally, there were only two medications, Ritalin and Adderall, and they came in just a few dosages. That often meant that a child had to tolerate any side effects he had, such as weight loss, insomnia, or even changes in personality, if he wanted to continue taking the medication.

Fortunately, there is now a much greater choice in ADHD medications and each is available in a wide range of dosages. This makes it much easier to fine tune a child's dosage to maximize the medication's benefits and minimize, or eliminate, any possible side effects.

Commonly used ADHD medications include:

• Methylphenidate- (or Ritalin)-based
  • Concerta
  • Daytrana (patch)
  • Focalin and Focalin XR
  • Metadate CD
  • Metadate ER
  • Methylin Chewable Tablets
  • Methylin Oral Solution
  • Ritalin
  • Ritalin LA
• Amphetamine-based
  • Adderall and Adderall XR
  • Dexedrine
  • Vyvanse
• Non-stimulants
  • Strattera (non-stimulant)

These medications differ in how long they last (short-acting vs. long-acting), their side effects (which can differ from one child to another), and in what form they are available (capsules, patch, pills, etc.). If one doesn't work, your pediatrician will likely adjust the dose or switch to another until you find the right medicine for your child.

Extra Help for Kids with ADHD

If your child's ADHD medication is not working well, you may need extra help, which can include:

• further testing to confirm that the child truly has ADHD
• modifications at school under Section 504 of the Rehabilitation Act or the Individuals with Disabilities Education Act (IDEA)
• behavioral therapy
• an evaluation by a child psychologist and/or a child psychiatrist
• getting a good night's sleep

_Sources:

AAP. Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder. Pediatrics 2000 105: 1158-1170

AAP. Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder. Pediatrics 2001 108: 1033-1044.

American Academy of Child and Adolescent Psychiatry. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J. AM. ACAD. CHILDADOLESC. PSYCHIATRY, 46:7, JULY 2007