Paying Attention to Attention Deficit/Hyperactivity Disorder
November 2002 — Attention-deficit/hyperactivity disorder (ADHD) affects 4 percent to 12 percent of American children. Yet for years, because of the absence of a diagnostic test and the reliance on subjective criteria to identify the disorder, many questioned whether ADHD was real.
That has changed recently in dramatic fashion, as current research and increased knowledge have led to changes resulting in improved diagnostic accuracy and appropriate treatment of ADHD, says Alberto Kriger, MD, a developmental-behavioral pediatrician on the medical staff at Joe DiMaggio Children's Hospital and Memorial Hospital West.
"The reluctance to accept it was based in part on the stigma associated with labeling a condition that, in young children, is manifested mainly through behavior, as a medical situation and treating it with medication," says Dr. Kriger, who specializes in ADHD. "There is always a group that feels that, with adequate parenting, better schools or a better environment, we would not need to diagnose children with ADHD."
Types of ADHD
There are three types of ADHD: hyperactive/impulsive, inattentive and a combination of the two. Many young ADHD children, who predominantly display hyperactivity, are often not diagnosed due to a belief that "boys will be boys." (ADHD of the hyperactive type is thought to be much more common in males than females.)
The ADHD/Hyperactive Child
- Has difficulty waiting his or her turn
- Is always on the go
- Has difficulty playing quietly
- Fails to complete school work or chores
- Often leaves his or her seat at inappropriate times
- Talks excessively
- Interrupts or intrudes on games and conversations
The ADHD/Inattentive Child
- Doesn't pay attention to details
- Can't sustain attention
- Doesn't listen, even when spoken to
- Runs or climbs at inappropriate times
- Avoids tasks requiring sustained mental effort
- Is easily distracted
- Squirms and fidgets
Children with inattentive ADHD are often called daydreamers. Generally sweet-tempered, they have trouble focusing. These children (especially girls) are also often diagnosed late because they do not display behavioral problems.
Treating ADHD
Until recently, standards for addressing ADHD have been ill defined and inconsistent. However since the American Academy of Pediatrics adopted new guidelines in 2001, the evaluation and treatment of ADHD have slowly become more uniform. Medication is still considered the most effective treatment for the core symptoms: hyperactivity, inattention and impulsivity. However, psychological, behavioral and educational interventions are also often crucial to diagnose and treat associated conditions, such as learning disabilities, depression and anxiety disorders — present in up to 40 percent of ADHD children.
As with almost any medical condition, environmental factors also play a major role.
"If you put a child with ADHD in a schoolroom with 32 other kids, five or six of whom also have ADHD, he might require medication," Dr. Kriger says. "But if that child is in a highly structured classroom with just 10 other children and a teacher who knows how to handle the disorder, he might not need medicine."
ADHD treatment options also depend on the condition's severity and whether other complications are present.
"There are many capable pediatricians or family practitioners who can treat some children with relatively uncomplicated ADHD," Dr. Kriger says. "But for those children who are having less-than-optimal success, or who show other symptoms that may or may not be related to ADHD, such as depression, failure at school or anxiety — for those kids, parents should look for a specialist."
If you think you or a member of your family might have ADHD, contact your physician. For a referral to a physician, call Memorial Physician Referral Service toll-free at (800) 944-DOCS. We’re available 24 hours a day, 7 days a week.