The Best Approach to AD/HD: Careful Diagnosis and Comprehensive Treatment
AD/HD 101
Signs of inattention:
- Becoming easily distracted by irrelevant sights and sounds
- Failing to pay attention to details and making careless mistakes
- Rarely following instructions carefully and completely losing or forgetting things like toys, pencils, books or tools needed for a task
- Frequently skipping from one uncompleted activity to another
Signs of hyperactivity-impulsivity:
- Feeling restless, often fidgeting with hands or feet, or squirming while seated
- Running, climbing or leaving a seat in situations where sitting or quiet behavior is expected
- Blurting out answers before hearing the whole question
- Having difficulty waiting in line or taking turns
Commonly used rating scales for AD/HD:
- Conners' Parent Rating Scales, which evaluate the child's symptoms
- Child Behavior Checklist, which evaluates the child's overactivity (hyperactivity) and aggressive behavior, as well as depression
- Conners' Teacher Rating Scales, used to evaluate the child's behavior in the classroom
- Child Behavior Checklist/ Teacher Report Form, which also evaluates classroom behavior
- Child Attention Problems, which monitors behavioral changes when the child is taking medication to treat AD/HD
If results point to AD/HD after a doctor reviews the responses on these tests, the DSM-IV SNAP checklist is often used next to evaluate hyperactivity, inattention and impulsivity to determine the specific type of AD/HD. This test usually is completed by the parent or teacher, although a doctor can also do the evaluation.
(Source: WebMD Health)
August 2004 — According to the National Institute of Mental Health, it is estimated that between 3 and 5 percent of children in the United States — or approximately 2 million children — have Attention Deficit/Hyperactivity Disorder (AD/HD). This means that in a classroom of 25 to 30 children, it is likely that at least one has AD/HD.
“The goal is to teach the child and the family how to work with AD/HD,” says Arnold Feiner, PhD, psychologist on the staff at Memorial Regional Hospital, Memorial Hospital West and Memorial Hospital Pembroke. “With the cooperation of the parents, the teachers and the child, AD/HD is totally treatable.” Dr. Feiner works with children and their parents and teachers to diagnose and treat AD/HD. While he does not prescribe medication, he is well-versed in the options and makes recommendations to physicians. In addition to 35 years as a marriage and family counselor, and 22 years as a licensed psychologist, Dr. Feiner has served as the clinical consultant for the South Broward/North Dade Chapter of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) since its inception in 1987.
A Comprehensive Assessment
Approximately half of Dr. Feiner’s patients have AD/HD, and most of them are children. “It is important to have a differential diagnosis,” says Dr. Feiner. “This means taking into account academic records, medical evaluations, psychological tests, and information from parents, caregivers and teachers, as well as the child.” In addition to a full battery of tests, Dr. Feiner uses a Continuous Performance Test (CPT) to help with the diagnosis. The CPT combines visual and auditory stimuli to measure attentiveness, impulsivity and response rate to computerized, timed stimuli.
“I have seen an interesting phenomenon in the past several years,” adds Dr. Feiner, “Some children have known for a while that something isn’t quite right, and they ask to see someone. AD/HD doesn’t just pop up.” And the treatment is not one-size-fits all. “I work in a multi-modal format. By setting expectations first, then working to meet or exceed them, there will be a clear picture of whether or not a treatment plan is working. This means combining objective data: grades, chore lists and other behaviorally specific targets; therapy with the parents and the child; and a coordinated plan with the child’s teacher.”
Medication Options
Some children require additional intervention in the form of medication. “My role in treatment is to use common sense, strategic planning and non-pharmaceutical methods first, then work with the pediatrician, family physician, child psychiatrist or neurologist if medication is needed,” says Dr. Feiner. “If a patient needs medication, we can come as close to guaranteeing that something will work. And sometimes this means trying more than one medication.”
The most commonly prescribed medications for AD/HD include stimulants like Ritalin, Concerta, Adderall and Dexedrine, which can be found in extended-release formulas that last through the school day and clear the system within 24 hours. The FDA has recently approved a new, extended-release nonstimulant, Strattera, which provides similar results, but needs to build up in the body over a period of several weeks for the best results. (For more information about AD/HD medications, visit www.chadd.org.)
A Positive Approach
Beyond any type of treatment, however, it is most important to remember that you are working with a child who has a full range of normal behavior. “You need to look for uniqueness in these children because they deal with a disproportionate amount of negativity,” says Dr. Feiner. “We need to bend backwards to find their strengths, to give them something to feel good about. It is challenging for everyone involved to work with children who have AD/HD, but it is very rewarding to be a part of their success.”
South Broward/North Dade CHADD meets at 7:30pm the second Wednesday of each month at Memorial Hospital Pembroke, Room 366. For more information, call
(954) 704-1193.
If you think your child might have AD/HD, contact your physician. For referral to a physician, call the Memorial Physician Referral Service at (800) 944-DOCS.