Controversial Topic: Kids & ADHD
Kids & ADHD: ADHD is one of the most controversial topics in kid’s health today.
There is disagreement on how the disorder’s definition is applied to individuals, and some people are concerned about the treatments prescribed for it.
Few topics to do with kid’s health arouse more controversy than Attention-Deficit/Hyperactivity Disorder – or ADHD (the condition used to be known as Attention Deficit Disorder, or ADD).
There is an on-going debate about the best diagnostic criteria for ADHD, especially now that it is recognized to be a lifelong condition in most cases. The current symptom checklists were written for primary school-aged children, but these are being revised to include different age groups, such as adolescents and adults.
Another aspect of the controversy is that ADHD is usually treated with a class of drugs called psychostimulants. These are considered addictive and dangerous in adults.
But many people who have lived with ADHD, or have kids with it, say that since they were diagnosed and treated, their lives have been transformed. Where once they were not functioning well, they can now lead normal lives.
Children with ADHD are unusually inattentive, hyperactive, and show impulsive behavior at home, school, and in social settings. To the degree that is inappropriate for their age and development. They may:
fidget and squirm in their seats
have trouble concentrating on tasks or games
not listen when they’re spoken to
talk excessively, run about, and seem to be always on the go
to get easily distracted
not wait their turn and blurt out answers.
This behavior makes life difficult – often extremely difficult – for parents, siblings, and teachers, and often for the child as well.
ADHD is caused by an interaction between genetic risk and environmental factors – such as family interactions, stresses at school, etc. This results in a problem in those parts of the brain that generally inhibit impulsive behavior – the pre-frontal cortex and the limbic system. There is an imbalance in the brain’s message-transmitting chemicals (neurotransmitters) in these areas. ADHD often runs in families – studies with twins have shown that ADHD is inherited.
In some cases, children who have these symptoms haven’t bonded well with their parents. In the case of boys, the father may sometimes be absent or emotionally distant.
There are two types of ADHD. The most common is the ‘Combined’ type, where the child has poor attention, poor impulse control, and is hyperactive. Less common is the ‘Predominantly Inattentive’ type, where the child is inattentive but not impulsive or hyperactive.
ADHD is three times more common in boys than in girls. The symptoms usually start before the child starts school. Estimates are that between three and five percent of Australian primary school children have ADHD.
The diagnosis is usually made by a pediatrician or child psychiatrist, who will take a detailed developmental history from the parents. The pediatrician or child psychiatrist will also talk to the child, and usually check some developmental skills. Sometimes the child’s teacher will also be asked to fill in a questionnaire. For a positive diagnosis, the symptoms need to have lasted for at least six months, started before the child was seven, and be causing problems at home and school. If the child has enough symptoms of ADHD, and no alternative cause is identified, then the diagnosis of ADHD will be made.
Because all two- to three-year-olds (and many four- and five-year-olds) are impulsive and inattentive, the symptoms must be slowing the child’s ability to learn, socialize, or function before an ADHD diagnosis is given.
The problem is that deciding whether a child has those characteristics can be very subjective. There’s no sign of physical abnormality in these children, and there is no test or scan to prove that a child has the condition.
Pediatricians and child psychiatrists may differ in how often they will diagnose ADHD, and sometimes it will come down to which pediatrician or child psychiatrist the child sees as to whether the diagnosis of ADHD is made.
So doctors should take a careful history of the child’s family and social background to see whether things like upbringing and parental factors are the cause of the symptoms before a diagnosis of ADHD is made. It shouldn’t be made after a single session with the child.
Parents also need to be well informed about the condition, through reading about and researching ADHD, before accepting the diagnosis.
Children diagnosed with ADHD are given a management plan to reduce the effects of ADHD on the child’s social, emotional, and academic functioning.
The most common treatment for ADHD is psychostimulant medication, such as dexamphetamine or methylphenidate (Ritalin). These are thought to act by normalizing the imbalance in the brain’s neurotransmitter chemicals. In general, only psychiatrists and pediatricians are allowed to prescribe them. They are given daily (in two to three doses) in tablet form and may need to be continued for months or years.
There are now two long-acting forms of methylphenidate available. Ritalin LA (long-acting capsules) lasts six to eight hours, and Concerta lasts 10-12 hours. They are a significant advantage as they only need to be taken once a day.
In many cases (about three-quarters of cases where the child has been correctly diagnosed), these medications work wonders – the child becomes much calmer and more controlled. Teachers especially notice the difference as the child is much more focused and able to complete their work (although there’s no evidence yet that school performance is improved).
Like all medications, stimulants can have side effects. The most common include loss of appetite and difficulty falling asleep. Some children initially become irritable, teary, and withdrawn – this usually settles. In general, side effects are less familiar with methylphenidate (Ritalin) than with dexamphetamine. Children taking stimulant medication should be monitored.
In the long term, the stimulants may have a small effect on growth in some children. The long-term impact on the development of the child’s brain isn’t known. And this is cause for concern amongst some people, who worry that too many children are being treated with stimulants. Australia has about 50,000 children taking stimulants for ADHD, which makes it (per capita) the third highest consumer in the world after the United States and Canada. To put it another way, between 1 and 2 percent of children in Australia take stimulant medications.
Some people believe this is too high and that there should be more effort made to look at other possible social causes of the child’s symptoms. If there are problems in the family or at school, then these need to be addressed, rather than having the child put on stimulants.
There is now a non-stimulant medication – atomoxetine (Strattera) – available to treat ADHD. This medication may help reduce anxiety, which can be quite severe in some kids with ADHD.
Some people turn to alternative therapies, and a diverse range of complementary and alternative therapies are used. Few of these have been subjected to scientific research trials. Some of these therapies can be expensive, and some practitioners offer parents unrealistic hopes of a cure.
To Medicate or Not?
Not all children with ADHD require medication, and those that do shouldn’t be treated with medication alone. Parents may need support and advice to help them manage their child’s behaviors.
Some suggestions for parents of a child diagnosed with ADHD include:
- Try to stay calm when you can.
- Give praise and rewards for good behavior.
- Set non-negotiable rules for behavior and clearly state the consequences of not following the rules. If the rule is broken, give a warning, then act calmly and without argument.
- Be tolerant; ignore all but the critical misbehaviors.
- Find creative ways to have fun with your children.