Attention Deficit Hyperactivity Disorder, or ADHD
As I sat down to write this article, Daniel came by to offer his assistance. Daniel is 29 years old. He happens to have Down Syndrome. He grew up in our office as a patient and now works here part time. When I told Daniel what I was writing, he offered me some excellent advice. He said that each child comes from a different situation and needs to be treated as an individual.
The American Academy of Pediatrics issued an update to their guidelines for the evaluation of children and adolescents with Attention Deficit Hyperactivity Disorder in the Fall of 2011. The Academy suggests that the evaluation should be initiated when symptoms become apparent in children 4 years of age or older.
The diagnosis of AHDH should follow the DSMIV-TR (Diagnostic and Statistical Manual of Mental Disorders). The evaluation looks for signs of inattentiveness and hyperactivity. It should include information from the family as well as school or daycare or from other activities in which the child may be involved. Vanderbilt University has developed questionnaires to aid in the evaluation.
The child’s primary physician can be an excellent resource to provide a medical home to coordinate the evaluation and provide a treatment plan, including behavioral interventions, counseling and medication when indicated.
As Daniel suggested each patient needs to be evaluated as an individual. The evaluation looks for so called co-morbidities. This means to look at the patient and family’s other circumstances. So an evaluation needs to include signs of oppositional defiance, anxiety, conduct disorder (cruelty to others or animals), anxiety or depression.
It is common for children with ADHD to be at increased risk for associated learning disorders, such as a reading or mathematics disability. An evaluation by a psychologist may be necessary to define any learning disabilities or emotional issues. Sleep disorders (such as sleep apnea) may present as ADHD due to their impairment of concentration. Other physical disabilities such as visual impairment, hearing loss, cerebral palsy, and seizure disorder,, make learning more difficult. A study in China, where eyeglasses are frowned upon, showed that evaluating vision and providing corrective glasses when indicated, was one of the most cost effective educational interventions.
A recent AAP study showed, not surprisingly, that adequate nutrition is important for school success. That was the initial justification for federally funded school breakfast programs for children whose families could not afford adequate nutrition.
Evaluating the family’s strengths and weakness is important to help support the child’s success. It is also important to be sure that the child has a safe home in which to live. For example, if a family member is depressed, it affects the functioning of the entire family. Providing help for the person’s depression, will benefit the entire family.
Examining a child’s ability to function in different environments, such as home, school, friends and other activities, is essential. If the behaviors are not problematic in all environments, one needs to understand what allows the child is successful in some areas, and what interferes in others.
The goal of a complete evaluation is to understand the child or adolescent’s strengths as well as his/her weaknesses. This is essential in order to develop a plan to help the child succeed and thus to be able to feel good about him or herself.
David S. Katz, MD
Kaplan Barron Pediatric Group
Clinical Associate Professor of Pediatrics
University of Louisville