Welcome Back to School: Does My Kid Have ADHD?

08/30/2016

Healthy Living - August 30, 2016
Mark Allen, MD - Acadia Hospital 
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The school year is upon us. For some, the beginning of the school year can be a tough adjustment as the unstructured playland of summer has ended. Some children have more needs than others, but how can parents identify if their child has ADHD and then advocate appropriately?

Ask yourself. Does this sound like your child?
  • Makes careless mistake in homework or gives poor attention to detail
  • Has difficulty maintaining attention in tasks or play
  • Does not listen when spoken to directly
  • Has difficulty following instructions
  • Is poorly organized
  • Avoids tasks requiring sustained mental effort
  • Loses items necessary for tasks and activities
  • Is easily distractible
  • Is forgetful in daily activities
  • Is often fidgety
  • Has difficulty staying seated
  • Runs or climbs excessively at inappropriate times
  • Has difficulty engaging in leisure activities quietly
  • Is hyperactive or appears driven as if by a motor
  • Talks excessively
  • Blurts out responses or answers to questions before the questions have been full asked
  • Has difficulty awaiting turn
  • Interrupts or intrudes upon others
If you answered “yes” to  6 or more in either category, your child may have ADHD, and it would be a good idea to talk to your pediatrician to assess the necessity for a referral to a mental health professional.

Many parents ask about having their child “tested” for ADHD.  There is no single test to identify ADHD.

It is a “clinical” diagnosis, in that multiple factors are considered.  The diagnosis of ADHD is multifactorial and relies upon the following:
  • thorough clinical interview of the child
  • collateral interviews with individuals who see the child in numerous settings
  • an early age of onset of at least some of the symptoms (by age 12)
  • symptoms in more than one setting (school and home)
  • The clinical interview should include a diagnostic assessment of the primary complaint and a review of other possible explanations for the observed symptoms.  More specifically, the clinician should assess not only for inattention, hyperactivity, and impulsivity, but also mood, anxiety, psychosis, trauma, vocal and motor tics, and substance abuse.
Although there is no “test” to establish the diagnosis of ADHD, neuropsychological testing is often useful in measuring symptom severity.

Quick facts:
  • The first symptom of ADHD most often reported is hyperactivity.  Thus, the “inattentive ones” are often missed.
  • Between 3-7% of schoolchildren are affected, with males being more commonly affected
  • Children/adolescents with untreated ADHD are at a much higher risk of developing substance abuse when they reach adulthood – those treated with stimulants have much lower rates of substance abuse
  • The natural history of ADHD follows the “rule of thirds”:
    • 1/3 demonstrate symptom resolution and are not terribly bothered in adulthood
    • 1/3 continue to experience inattention into adulthood
    • 1/3 continue to experience symptoms in all domains (hyperactivity, impulsivity, inattention) and to suffer other related difficulties, such as oppositional defiance, conduct-disordered behavior, excessively poor academic achievement, substance abuse, and perhaps even antisocial traits as adults
Treatment for ADHD typically involves three primary considerations:
  • Medication
  • Behavioral therapy
  • Educational support (IEP and/or 504 plan)
Tips for Parents:
  • Wait at least 2-4 weeks into the school year to see how your child is adjusting to his or her new environment and allow the teacher get to know your child.
  • Be proactive in seeking help from the child’s school.
  • To obtain an evaluation for a possible IEP, a parent needs to write a letter to the school district requesting an evaluation of his or her child’s learning.