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The number of children in the United States diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) is astounding. The Centers for Disease Control and Prevention (CDC) estimate that number to be 6.1 million as of 2016. It is one of the most commonly diagnosed conditions in children.
The National Institute of Mental Health defines ADHD as “a disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.” For boys, hyperactivity and impulsivity are more common, while girls tend to be more inattentive.
ADHD is a clinical diagnosis. No special testing is required. Pediatricians can make a diagnosis using established criteria and clinical measures that are available. That should be combined with a child’s medical history and a report from school, which can provide clear evidence of issues at home and school. Symptoms must be present in two settings, most often school and home, to meet the criteria for an ADHD diagnosis.
Many children with ADHD are diagnosed and treated by pediatricians, and no specialists are needed. However, if a child’s case is less straightforward or there may be other conditions of concern such as cognitive disorders, pediatric providers can refer children for further neuropsychological testing or to a psychiatrist who specializes in behavioral health. Otherwise, patient history and clinical measures may often be adequate for an ADHD diagnosis.
When explaining ADHD to families, I like to use the analogy of the game Simon Says. Most parents and kids know the rules of the game – you move when “Simon says” to, and you stop when “Simon says stop.” For children with ADHD, they never hear that “Simon says” at all. They are just reacting immediately. This is the way their brain is wired.
As they get older and grow up, their brains will be better at controlling their impulse to move. Kids with ADHD aren’t broken – they just need more time to adapt. These kids’ brains frequently need more stimulation in order to focus. As long as the brain is stimulated, it can stay focused. Unfortunately, we cannot always provide them with the one-on-one attention and stimulation they need in schools, but medications called stimulants can help. This helps parents understand how kids may be able to focus on highly stimulating video games for hours but may only be able to focus on a book or classroom lesson for a few minutes. Stimulant medications function in part to help provide stimulation to the brain to bridge the gap between kids with ADHD and those without.
Although behavioral interventions may be helpful, medication treatments have been repeatedly demonstrated as more effective than non-medication interventions. However, some kids may also need other support as well, especially if they are experiencing other issues at the same time, such as anxiety. For these children, cognitive behavioral therapy may also be helpful. Almost all children may benefit from assistance in developing organization and planning skills.
There are several types of medications available that have been shown to be very effective in helping children better manage their ADHD. When treating children with these medications, we focus on three areas:
Our goal is to provide children with the right amount of medication to help keep them focused during those hours when they are in school or interacting with family and friends. Sometimes we need to alter the dose and make it longer lasting, or if they’re having side effects like not sleeping or losing their appetite, we can alter the time of day they take their medication.
It’s natural for parents to have concerns. Many worry that stimulants may make ADHD worse, or lead to increased anxiety or moodiness. It makes sense to think that a stimulant will cause them to be more hyperactive. The reality is that they don’t in most cases. These medications may in fact reduce irritability and anxiety. Not to mention, that a more organized and focused brain will be better equipped to manage most challenges that our children struggle with on a daily basis.