A generation ago, children who didn't perform well in school were often labeled as "unmotivated" or "daydreamers." Others who couldn't sit still or misbehaved in class were sometimes seen as fidgety, lazy or the products of bad parenting. Today, health care professionals recognize that those behaviors can be symptoms of Attention-Deficit/Hyperactivity Disorder, or ADHD, a condition that affects 9 percent of children ages 6 to 12.
The good news is, there are now reliable screening tools and questionnaires that parents, teachers and other caregivers can use, in conjunction with health care providers, to determine whether a child has ADHD. Dr. Lewis First, chief of pediatrics at the University of Vermont Children's Hospital, discusses when and how to treat the condition based on newly released guidelines from the American Academy of Pediatrics.
KIDS VT: What is ADHD?
LEWIS FIRST: ADHD is a chronic neurological condition in which the brain makes it difficult for children and adults to control their attentiveness, hyperactivity and/or impulsivity. You don't need to have all three symptoms to have ADHD, which is why it's sometimes called attention deficit disorder, or ADD. If a child demonstrates problems with attention, hyperactivity or impulsivity for more than six months in at least two different settings, such as at home, in school and during team practices, then it's worth bringing to the attention of a health care professional.
KVT: What causes it?
LF: ADHD can have a genetic component and run in families. Environmental factors may also play a role, including prenatal exposure to alcohol and nicotine, exposure to lead as a child, and head injuries. We may not know exactly what causes a child to have ADHD, but we do know it is not caused by vaccines, food additives, allergies, video games or eating too much sugar.
KVT: How early can ADHD be diagnosed?
LF: Between ages 4 and 12 is the prime time to identify it, particularly if children are struggling in school. It is possible, though rare, to diagnose it by age 4. Before that age, the vast majority of kids are going to be hyperactive in association with their growing brains, and many of these childen will not end up having ADHD. But if a child 4 to 6 years old is demonstrating six or more symptoms of ADHD for over 6 months in more than one setting — and a health care professional can provide parents and teachers with that checklist — then it is possible for them to be diagnosed early.
KVT: How is ADHD treated?
LF: The best success occurs when a coordinated plan is put in place that includes medication and behavioral modifications that involve teachers, counselors, coaches and other adults in that child's life, all working in coordination with a health care provider and the child's family.
KVT: What do you mean by "behavioral modifications"?
LF: Behavioral counselors can give parents tools for reinforcing positive behaviors and dissuading negative ones. This may involve using time-outs and withdrawing privileges to stop unwanted behaviors, and offering privileges and rewards for positive behaviors. Other behavioral modifications include keeping the child on a regular daily schedule, cutting down on distractions, setting easy goals, limiting choices and helping the child stay on task.
KVT: Can ADHD be treated without medication?
LF: The evidence is very clear that it cannot be done effectively after age 6 without medication. Behavioral modification alone may result in some improvements. However, when it comes to kids focusing on school and getting things done, the research is clear: Beginning at age 6, medication is recommended in addition to behavioral management.
KVT: Why are some parents wary of ADHD meds?
LF: Many of these meds are in the amphetamine family, which means side effects such as decreased appetite, weight loss, trouble sleeping, social withdrawal and, occasionally, blood pressure problems can occur if the dosage is not right. But these side effects are easily reversible by changing the medication or dosage. There is now a variety of ADHD medications available — from short-acting to long-acting, some that are stimulants, others that are not. They will not make kids addicted but will help them focus. All should be started at a low dose to ensure the benefits of using a medication outweigh any side effects, should they start to occur.
KVT: At what age do you recommend medicating children?
LF: The new AAP guidelines say that before age 6 children should not be medicated. Before then, children will benefit from behavioral modifications alone. And, it's worth noting that only 10 percent of children identified by teachers in preschool as potentially having ADHD eventually turn out to have it.
KVT: Can ADHD be mistaken for or mask other conditions?
LF: Yes. Health care professionals are being advised to look for other chronic conditions with similar symptoms, such as anxiety, depression, sleep disorders or learning disabilities. ADHD is not itself a learning disability, but it does make it more difficult for a child to learn. In teenagers, it's worth looking to see if there's substance abuse as well. Also, if a child is not diagnosed with ADHD but is still having difficulty in school, there may be another explanation, such as needing glasses, having trouble hearing, being dyslexic or having other learning challenges.
KVT: Are there common myths about ADHD?
LF: Yes. Kids will not outgrow ADHD, and it is not something that will go away once they have it under control. It is not a function of poor parenting. Also, medications don't "cure" kids of ADHD. As they get older, children may become less hyperactive but still have issues with attention. So, there are adults who benefit from staying on medication their whole lives. Finally, there's a myth that only boys get ADHD. While boys outnumber girls by two or three to one (depending on the study), girls get ADHD, too.