PhotoWhen is a child's behavior the product of just being a kid and when is it evidence of something else, like Attention Deficit Hyperactivity Disorder (ADHD)? That's what a lot of parents would like to know.

According to the Centers for Disease Control and Prevention (CDC), people with ADHD may have trouble paying attention, controlling impulsive behaviors or be overly active. Critics who argue that ADHD is overly diagnosed and medications overly prescribed, point out that sounds a lot like the way most kids behave.

Doctors agree that for these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development. Parents and their pediatricians need to look at a lot of data.

According to the National Institutes of Health (NIH), ADHD is the most commonly diagnosed behavioral disorder among children. It affects up to five percent of school aged children, boys more than girls.

Genetic factors

It may run in the family. What's not exactly clear is what causes it. What is known is that it begins early in life, when the brain is still developing. Other problems, such as depression, learning disabilities and behavior problems are commonly confused with ADHD.

According to the CDC. research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos. The agency says these things might make symptoms worse, especially in certain people. But the evidence is not strong enough to conclude that they are the main causes of ADHD.

Deciding if a child has ADHD should be a several step process. There is no single test to diagnose it.

One step of the process involves having a medical exam, including hearing and vision tests, to rule out other problems with symptoms like ADHD. Another part of the process may include a checklist for rating ADHD symptoms and taking a history of the child from parents, teachers, and sometimes, the child.

Three types

PhotoThere are three types of ADHD – lack of attention, hyperactivity and impulsive behavior – with lack of attention making up the bulk of the diagnosed cases.

For parents and their pediatricians, it can be a delicate balance. Often times difficult children are incorrently labeled with ADHD. At the same time, may children with the disorder go undiagnosed.

The American Academy of Pediatrics (AAP) has issued guidelines for diagnosis. As a baseline, the group says symptoms must be visible in more than one environment and children should have at least six attention symptoms or six hyperactivity/impulsivity symptoms, with some symptoms present before age seven. They should also be present for longer than six months.

Problems in adulthood

Another thing about ADHD, if a child has the disorder they never “out grow” it. While they can manage its symptoms they continue to have the disorder as adults, which can raise a whole host of other troubling issues.

Recently, researchers at the Mayo Clinic conducted a major study, following up with children diagnosed with ADHD to see how they are doing as adults. The study found that ADHD often doesn’t go away and that children with ADHD are more likely to have other psychiatric disorders as adults.

They also appear more likely to commit suicide and to be incarcerated as adults, the study found.

“Only 37.5 percent of the children we contacted as adults were free of these really worrisome outcomes,” says lead investigator William Barbaresi, M.D., of Boston Children’s Hospital, who started the study when he was at Mayo. “That’s a sobering statistic that speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults.”

Two hundred thirty-two people  diagnosed with ADHD as children  took part in the study. The researchers found that 29 percent of them said they still had ADHD symptoms as adults. Of the group, 57 percent had at least one other psychiatric disorder as adults. The most common were substance abuse/dependence, antisocial personality disorder, hypomanic episodes, generalized anxiety and major depression.

“We suffer from the misconception that ADHD is just an annoying childhood disorder that’s overtreated,” Barbaresi said. “This couldn’t be further from the truth. We need to have a chronic disease approach to ADHD as we do for diabetes. The system of care has to be designed for the long haul.”

In fact, Barbaresi thinks the situation is worse than the study suggests. Most of those in the study were middle class and the products of good educations. He thinks the findings are actually a “best case scenario.”

What to do

If you think your child is displaying ADHD symptoms, Barbaresi advises you to seek a proper diagnosis. If found to have ADHD, then make sure your children are in high-quality treatment — and remain in treatment as they enter adolescence.

Children also should be assessed for learning disabilities and monitored for conditions associated with ADHD, including substance use, depression and anxiety, Barbaresi said.

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