Attention Deficit Hyperactivity Disorder
(ADHD)

Is your child inattentive? Impulsive? Hyperactive?

Most children display these characteristics from time to time. But some children are unable to concentrate or pay attention most of the time. These children may have a problem called attention deficit hyperactivity disorder (ADHD). If untreated, a child with ADHD is likely to cause disruptions and frustrations both at home and in school. He or she runs a high risk of having poor learning skills, low self-esteem and social problems that continue into adulthood. Less than 5 percent of children have ADHD.

Causes
Although the exact cause of ADHD is not known, it is believed to be a neurobiological disorder. People with ADHD have been shown to have an abnormal brain metabolism: They use less glucose in the part of the brain that regulates attention, planning and motor controls. Glucose is the brain’s main energy source.

The developing evidence suggests that ADHD is not a problem of low blood sugar levels but rather that key areas of the brain are working less actively. Children with ADHD also display somewhat poorer fine motor skills than their peers (e.g., handwriting).

Treatments
A diagnosis of ADHD often leads to therapy with psychostimulant medications. This seems like a paradox: Why give stimulants to hyperactive children? Although these children externally may appear very hyperaroused, they are underaroused. And therefore, the use of psychostimulants in the central nervous system actually results in an increased arousal and increased ability to focus and persist.

Stimulants commonly used to treat ADHD include methylphenidate (Ritalin), dextroamphetamine (Dexedrine), pemoline (Cylert) and a combination of dextroamphetamine and amphetamine (Adderall). These drugs improve symptoms in about 75 percent to 80 percent of children with true ADHD. Many doctors agree that the effectiveness of psychostimulants adds to evidence that ADHD is a neurological disorder, not a problem caused by poor schooling or parenting. Antidepressants, prescribed less often, are typically used for ADHD children who do not respond to stimulants or have adverse reactions to them. Ritalin has generated a great deal of media attention as sales have more than doubled since 1990. Critics say it is prescribed too casually.

Ways you can help ensure that your child’s diagnosis and treatment are appropriate:
Look for thoroughness, not speed, in the diagnostic process. A second opinion may be helpful if you are in doubt. Take your child to the treating physician at least every three months in the first year of psychostimulant treatment. There is no single dosage that works for all children, so adjustments in the dosage sometimes must be made. The doctor should check for changes in blood pressure, height, weight and potential side effects.

Report changes in your child’s behavior as accurately as possible. The treating physician also should collect follow-up information from teachers or other adults who have regular contact with your child.

Stay in close contact with your child’s teachers. Medication is only a part of the treatment.

Some children with ADHD need extra training for social and organizational skills. It helps to keep children with ADHD on a consistent schedule for daily activities.

Avoid paying attention to your child only when he or she does something wrong.

Remember positive enforcement to build your child’s self-esteem.

Appetite loss and sleep difficulty are the most common side effects of psychostimulant medications when used for ADHD. Medications such as methylphenidate (Ritalin) reduce ADHD symptoms for only a few hours at a time. Some children experience irritability or increases in activity as the effect of the medication tapers off. Adjustments in doses often can offset these side effects.

Psychostimulants like Ritalin may be associated with a slightly reduced growth rate in children. This possibly results from a combination of reduced appetite and a change in the release of growth hormones in children taking psychostimulants. However, growing evidence indicates that although there is a slower velocity of growth in these children, their ultimate height is not severely affected.

Psychostimulants sometimes cause people to experience tics – involuntary motor movements such as eye blinking or shrugging. The tics usually go away when the medication is stopped. "Tics are very common in boys between the ages of 7 and 11, including boys not on stimulants who don’t have ADHD, "We think that tics have something to do with either a hypersensitivity to the neurotransmitter dopamine or an excess of dopamine. So it’s plausible that psychostimulant drugs like Ritalin, Dexedrine and Cylert, which increase the release of dopamine, can exacerbate tics already there."

There is no proof that psychostimulant drugs cause Tourette’s syndrome, a neurological disorder characterized by involuntary muscular or vocal tics, sometimes including the unintended blurting out of obscenities. Many children with Tourette’s also have ADHD. Tourette’s symptoms typically appear later than ADHD symptoms, which has led some people to speculate that psychostimulants prescribed for ADHD cause Tourette’s syndrome.
It’s easy to find Web sites that criticize the use of Ritalin. Beware of Web sites that offer such criticism while selling products with claims of "natural" cures. Unlike the psychostimulants mentioned in this article, alternative products such as Pycnogenol have not been scrutinized in adequate clinical trials to measure their safety and effectiveness

Some Coping Strategies for Teens and Adults with ADHD

When necessary, ask the teacher or boss to repeat instructions rather than guess. Break large assignments or job tasks into small, simple tasks. Set a deadline for each task and reward yourself as you complete each one. Each day, make a list of what you need to do. Plan the best order for doing each task, then make a schedule for doing them. Use a calendar or daily planner to keep yourself on track. Work in a quiet area. Do one thing at a time. Give yourself short breaks. Write things you need to remember in a notebook with dividers. Write different kinds of information like assignments, appointments, and phone numbers in different sections. Keep the book with you all of the time. Post notes to yourself to help remind yourself of things you need to do. Tape notes on the bathroom mirror, on the refrigerator, in your school locker, or dashboard of your car-- wherever you're likely to need the remainder. Store similar things together. For example, keep all your Nintendo disks in one place, and tape cassettes in another. Keep canceled checks in one place, and bills in another. Create a routine. Get yourself ready for school or work at the same time, every day. Exercise, eat a balanced diet and get enough sleep.

Taking action to help children with ADHD
Children who have ADHD tend to suffer. They are aware that often times their behavior or performance is unacceptable. This leads to criticism, isolation and ultimately rejection by their peers, relatives and teachers. Low self esteem and a lack of confidence usually develops and what usually occurs is a more pronounced acting-out of unacceptable behavior as a cry for attention in the absence of other more productive realized choices.

Psychotherapy with the child and their family is a major focus. It is necessary for a proper perspective and implementation of same. It is also an area for appropriate ventilation of feelings towards oneself and in dealing with your
feelings about others.