Attention-Deficit Hyperactivity Disorder

Attention-Deficit Hyperactivity Disorder (ADHD or ADD)

ADD/ADHD is a fairly complicated condition that is often under diagnosed but often over treated with medication.  It can be isolated, but often will be accompanied by other conditions such as anxiety, depression, oppositional defiant disorder etc.  Whether we diagnose it here in the office, or the diagnosis comes from a psychiatrist/psychologist, we are happy to help you manage the treatment of this condition.

Disorders of attention, usually combined under the term Attention-Deficit Disorder (ADD), make up a pattern causing the most common biobehavioral disorder in children. It affects one school-age child in 20… about two million children at any given time. If you include adolescents and adults who have outgrown childhood but not necessarily outgrown ADD, there are 15 million Americans with the disorder. Incidence is about six times higher in boys than in girls. Heredity plays a major role, and 25-50 percent of first degree relatives (mother, father, sister, brother) will also have ADD.

A bare-bones definition of the disorder would include symptoms of:

1. Inattention and distractibility
2. Hyperactivity and impulsivity
3. Problems with:
4. Organization
5. Social skills

Everyone at some time has some symptoms of ADD.  However, to be of concern, problems in any or all of these three categories must be great enough to cause significant impairment at school, at home, with self-esteem, socially, or at the workplace.

There is no question about the validity or existence of the problem. All 126 medical schools in the United States have clinics for treating ADD, and all use stimulant medication of some form. The main public and professional criticism, often justified, is that ADD is often incorrectly diagnosed, hurriedly evaluated, or given slipshod follow-up.

Finally, after two years’ study, a large group of prestigious experts presented the “gold-standard” recommendations for the diagnosis and treatment for ADD. The first part, guidelines for diagnosis and evaluation, came out in the May 2000 issue of the Journal of Pediatrics. We have used almost identical recommendations in our office for years. This may bring an end to some of the critical publicity in the media – much of which was written by the uninformed as scare-tactics to gain circulation. The children who have the classic syndrome of ADD and are treated are immensely improved. If ADD is even suspected it should be investigated. It may be one of the most important changes for the better in the child’s life.

The first consideration in treatment of any disorder is making a correct diagnosis.

Some important things to remember:

• The primary objective in treating ADD is not merely to improve grades. We want the child to be able to think of him or herself as a competent person who likes school, is liked by others, and can learn just about anything with hard work. We want the children to learn to work smarter, not harder.
• The main issue to address is to identify problems, not just make a diagnosis.
• ADD never exists in isolation: Learning disorders, anxiety, dysfunctional family situations, immaturity, faulty discipline, depression, or low self-image may make it much more difficult to weigh the interplay of each problem on the other.
• It takes about three visits to evaluate the child who is suspected of having ADD. If the results of the work-up point to ADD and the child is started on a treatment program, we see the children at least twice a year and have frequent telephone progress reports. The child may ask “Why do I have to do all this stuff? Is something wrong with me?” We explain to the child that everyone has a special way of learning and that we are going to find out what his or her special way is, and to make school easier and more fun. A critical point to remember is that one has to learn how to learn. Learning how to learn is an art, just like learning to play the piano or play basketball. In fact, most of our strategy now is to teach the children how to pay attention, focus (and maintain focus), listen, remember, and recall. The basic principles of learning apply to everyone, whether ADD is involved or not.
• The child will be given an initial physical examination, including baseline height, weight, and blood pressure.
• It is crucial to realize that a combination of psychoeducational intervention and medication is needed. Neither alone will work.
• Stimulant medications to treat ADD have been the most intensely studied of all medications used in pediatrics. They have been labeled as “safe and effective.”
• A book, The ABCs of ADD: The basics of Attention-Deficit Disorder by Dr. Stoutt, is given to the parent(s) on the initial visit. This book of only 88 pages gives most of the essential information about the disorder. It is easy to read. The book outlines the entire process of evaluation and treatment. Defining and demystification of a complicated disorder such as ADD are of utmost importance.
• Because the diagnosis of ADD is made entirely by history, two sets of questionnaires are given to the parents and teacher to complete and return to us. Part of the questionnaires include the American Psychiatric Association’s criteria as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).
• Most problems that can be defined can be solved. Also, all behavior has meaning. Any child having difficulties in the classroom should be evaluated. What are the problems? What is causing them? Do they fit into a pattern? Learning disorders may be present. Children with learning disorders are often unable to learn; children with ADD are unavailable to learn because of lack of focus, distractions, inattention, hyperactivity, impulsively and so on – all symptoms of ADD.
• This brief outline is offered as an introduction to ADD and a description of some of the ways it is diagnosed in our office. The impressions given by the teacher are probably the best indication of whether the child needs help in attaining his or her potential.