Forms and Instructions
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Attention Deficit/Hyperactivity Disorder (ADHD) is a common problem that is thought to occur in 3-9% of school age children. The symptoms of poor attention span, high activity level and impulsiveness can cause behavior and school problems and may lead parents, doctors, or teachers to suspect this problem. It is important to remember that many children with ADHD are happy, intelligent and well adjusted. Also, some children with ADHD are not hyperactive. Boys are diagnosed more frequently than girls, but this may be because girls have fewer hyperactive symptoms, making the diagnosis less obvious. There seems to be an inherited component and some families have several members with this problem.
The exact cause of ADHD is unknown. Most researchers in the area agree it is biochemical, and for that for some reason the areas of the brain controlling attention span, focusing ability, and self control do not function as efficiently in patients who have ADHD compared to those who don't. EEG's that measure brain electrical activity, CT and MRI scans that show pictures of the brain itself, and PET scans that show brain function have all been performed on patients with ADHD. There are no consistent findings that are always found in association with ADHD and none of these tests are currently used to make a diagnosis of ADHD.
Doctors and mental health professionals generally agree that a complete patient history and physical exam, family and behavioral assessments, and evaluations for school performance and learning disabilities are necessary to make a correct diagnosis of ADHD. There are many conditions that can mimic the symptoms of ADHD, such as depression, bipolar disorder, learning disabilities, visual or auditory processing disorders, seizures, anxiety disorders, and severe family stress.
The presence of the following behaviors to an extent which interfere with normal school and home activities are important in making a diagnosis of ADHD: careless mistakes, difficulty sustaining attention, seeming not to listen, failing to finish tasks, difficulty organizing, avoiding tasks that require sustained attention, losing things, distractibility, and forgetfulness. Some children also are hyperactive with symptoms such as fidgeting, inability to stay seated in class, difficulty playing quietly, and moving around excessively, or are impulsive with symptoms such as blurting out an answer before a question is completed, difficulty awaiting a turn, and interrupting or intruding on others. These symptoms need to have been: present before age 7, observed for six months or more, present in two or more settings (home, school, day care, etc.), and inappropriate for the age of the child.
Treatment of ADHD can be very successful. Generally a combination of medication, behavior modification, and psychological counseling is most effective. Enlisting the support of teachers and school staff is extremely important. There has been much discussion and research about the effect of food dyes, additives, preservatives, and sugars on behavior, but there is no convincing scientific evidence that they cause or contribute to ADHD. Herbs such as St. Johns Wort, also have not been proven to have any effect on ADHD. Therefore, any dietary or herbal adjustment in the diets of children should be done under a doctor's supervision to decrease the risk of side effects and minimize any potential nutritional deficits.
Much has been written about the dangers and over prescribing of medication to treat ADHD in the press. However, with appropriate medical supervision, treatment is safe, effective, and well tolerated. Methylphenidate (Ritalin), Dextroamphetamine (Dexedrine), or Pemoline (Cylert) are most commonly used. Antidepressants and even blood pressure medications are sometimes prescribed. The most common side effects are headache, abdominal pain, decreased appetite, or moodiness. Children may respond well to one medication and poorly to others. Unfortunately, there are no tests which can be done to determine which medication will work best in a particular child. If you have questions or concerns regarding your child's behavior or school performance, a visit to your child's doctor for a complete evaluation would be advisable.
Dr. Robin L. Schaten is board certified in pediatrics. She joined Longmont Clinic in July 1986.
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