More about ADHD in Children and Adolescents

ADHD, or Attention Deficit Hyperactivity Disorder, is estimated to be present in 3 to 5% of school-age children.  It is often first diagnosed after a child enters school.  This is typically when educational and social behavior are affected and observed by professionals in comparison to their peers.  It is more common in children and adolescents with parents or siblings with this disorder.  Research also suggests it is more common with a parent with a Major Depression.  Studies also suggest that it is more common when primary family members have an Anxiety Disorder, a Learning Disability, Substance-Related Disorder, and Antisocial Personality Disorder.

Care must be taken to distinguish an Attention Deficit Hyperactivity Disorder from other disorders.  Inattention in school can also occur when bright children are placed in academically understimulating environments.  It should be distinguished from goal directed behavior in children from inadequate, disorganized, or chaotic homes or neighborhoods.  The disorder is not the same as an Oppositional Defiant Disorder, characterized by unwillingness to conform to authority or others' demands.  It can occur at the same time as a Mood Disorder (some type of depression). or an Anxiety Disorder (called co-morbid).

Recent research has demonstrated that ADHD may be a neurological disorder, related to underactivity of electrical activity in the pre-frontal region of the brain.  This underactivity can actually be measured and observed by a sophistocated research test called Positron Emission Tomography Scan (a PET scan).  With the use of a special dye, brain activity can be observed during thinking (cognitive) tasks.  Individuals with ADHD exhibit this underactivity, illustrated by cooler colors of blue and green, as opposed to hotter colors of red and orange normally seen when this area of the brain is utilized.  Activities of this area of the brain include managing impulses, sustaining attention and effort, starting tasks, organizing, anticipating consequences, and modulating emotions.  It is an area typically involved with executive functioning.  This finding is consistent with the considerable evidence that this condition is inherited (or runs in families).  It is also consistent with the increaseing realization that this disorder generally continues into adulthood, although the individual learns to cope and manages to decrease interference from their symptoms.  This finding is also consistent with the most common medication utilized for Attention Deficit Disorders, which is some form of a stimulant.

Proper identification of this disorder is vital to determining a treatment plan which can be successful.  It is important for the child or adolescent with ADHD to understand their disorder, as much as it is important for parents, siblings and teachers to understand.  There are a wide array of effective interventions for ADHD, from behavior therapy, to behavior management techniques, to individual and family therapy.  Therapy and interventions should be consistent across situations, and reinforcement and rewards contribute greatly to success.  Support from teachers in regular classrooms is necessary.  (It is fortunate that this help also benefits all the other students in the classroom.)

In many cases, medication contributes significantly to an effective treatment plan.  In some cases medication does not help at all.  Stimulant medication is the most often prescribed medical intervention for ADHD.  The advantage to stimulant medications is that their effectiveness can be observed almost immediately.  The disadvantages are also present, including that benefits are generally limited to 4 to 8 hours, appetite can be suppressed, and sleep may be affected.  Appropriate use can be quite beneficial and does not predict addiction or future substance abuse.  Quite the opposite.  When untreated, this disorder is often associated with alcoholism or substance abuse as the individual self-medicates inappropriately.  Of specific note, adolescents and college age students in general are prone to abusing prescription stimulant medications.  The method of abuse is to grind up the pills to snort or inhale, to smoke, or to inject intravenously.  Many children and adolescents dislike taking the medication, either because of complaints about eating or due to being identified as different as nurses at school have to administer doses during the school day.

Obtaining professional therapy treatment for your child or adolescent with ADHD can be very helpful.  This can be on an individual basis or family treatment.  Parent support groups are excellent sources of information and ideas that are effective.  Some children with this disorder will require special education intervention, such as resource room help, homework modifications, or special testing conditions.  Parents should talk with their child's school regarding special education evaluation and planning.

If you think that your child or adolescent might have an Attention Deficit Hyperactivity Disorder (ADHD) or any other mental health issue, you should talk to a professional about what to do and how to get help.  Talking to your child's pediatrician is often a good way to get a referral to a competent psychologist, social worker or child psychiatrist.  Another great source for referrals is your health insurance company.  Many have on-line lists of professionals in their network of providers, or have a phone number on your insurance card to consult for referral sources.  If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions and to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family.  See the Cranberry Counseling page of this web site for more information, or use the Contact Us form.  Psychotherapy can help to reduce problems related to ADHD.

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