Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder diagnosed in childhood and often persisting into adulthood. The CDC defines ADHD:
ADHD is characterized by developmentally inappropriate levels of inattention and hyperactivity resulting in functional impairment in academic, family, and social settings.
Nearly one in five high school age boys in the United States and 11 percent of school-age children over all have received a medical diagnosis of attention deficit hyperactivity disorder, according to new data from the federal Centers for Disease Control and Prevention.
These rates reflect a marked rise over the last decade and could fuel growing concern among many doctors that the A.D.H.D. diagnosis and its medication are overused in American children.
The figures showed that an estimated 6.4 million children ages 4 through 17 had received an A.D.H.D. diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade.
Why are so many children being diagnosed with ADHD nowadays? There seem to be a lot of fingers pointing lately — at schools, accountable through “No Child Left Behind” for acceptable standardized test scores; at teachers, many of whom might appreciate a quiet classroom as their classes grow in size each year; at parents, their seemingly sole desire to have their kids succeed in school and in life (is that bad?); society, with its emphasis on TV, music, cell phones, internet, social media, video games, and on and on; bad food (and the obesity epidemic); pharmaceutical companies, standing to make huge profits from the sale of stimulant medications; and, of course, pediatricians, who, at a minimum, can’t say “no” to parents and schools and, at most, don’t know what they’re doing.
At least no one is blaming the kids.
There are two categories of this disorder: ADHD — inattentive type; and, ADHD – combined type.
The more common type has the features of inattentiveness and hyperactivity combined. Kids with this combined type are usually easier to diagnose. Their level of hyperactivity distracts themselves from learning efficiently, while being otherwise annoying to everyone else — especially teachers and parents, but also to other students who wish to learn in calm and quiet surroundings. Kids with ADHD – combined type have a hard time controlling themselves — their bodies, their minds, their urges. Younger kids with the disorder do not (yet) have the ability to think and consider before doing, leading to impulsiveness and trouble socially.
ADHD – inattentive type is a more difficult diagnosis to make. Hyperactivity is not the primary feature. Incorrectly labeled as aloof, zoned out, or even lazy, these quiet, daydreaming, otherwise non-annoying kids often fly under the radar in the classroom.
When evaluating a child for ADHD, the first and most important step is determining the presence or absence of a specific learning disability which, in and of itself, can cause a significant amount of inattentiveness. Parents and teachers are queried with the use of questionnaires (Vanderbilt and/or Connors) which rate the presence and severity of inattentiveness and hyperactivity, difficulties with conduct and behavior, symptoms of anxiety and depression, and academic and classroom performance. These surveys are scored by the pediatrician, psychologist, or another clinician.
Treatment of ADHD revolves around increasing attentiveness and decreasing hyperactivity, especially in the classroom. Some behavioral modification techniques are necessary in almost all kids with ADHD, as well as modifications within the classroom. Dietary improvements are often required. However, the use of medications — when considered carefully and monitored frequently — produces the most dramatic improvements. Particularly with kids who have ADHD – combined type, it’s not unusual to get calls from parents after just a few days on medication telling us of amazing, positive transformations in their children. It’s harder to assess the effectiveness of medication in those with the inattentive type because without hyperactivity, impulsiveness and behavioral problems are much less common (though lowered self-esteem is just as common in this group).
While it may be that not all kids on ADHD medications actually have ADHD, not all children diagnosed with ADHD need medication. But most kids with ADHD do need medications and they take them because they work! If parents, teachers, and kids all feel like the medication is not helping, or if a child is having side effects, the medication is stopped. There should be no arm twisting, either way.
More ADHD posts on The PediaBlog here.