If the approach of the upcoming school year has you dreading the challenges your child faces of sitting still, paying attention, organizing tasks, completing school work, getting along with classmates and other expectations, you may want to have your child evaluated for attention deficit hyperactivity disorder (ADHD).
ADHD is a chronic biological condition that, if not properly treated, can cause a child to have long-term problems in school performance, job success, as well as social and emotional development. ADHD also can have a profound disruptive impact on family life. The good news is that there are ways to manage this condition that will bring out the best in the child and lead family members to a closer relationship.
Determining True ADHD
The first challenge parents face is getting a proper diagnosis, and the best place to start is a pediatrician's office. "Many pediatricians today have taken full advantage of the wealth of scientific research data to educate themselves on ADHD so we can successfully diagnose and treat this disorder," says Randy Sterkel, MD, a St. Louis Children's Hospital pediatrician.
To make an accurate diagnosis, Dr. Sterkel first sends parents home with a comprehensive questionnaire and rating scale that probes for symptoms. He also sends a similar questionnaire to the child's teachers. The questionnaire follows the guidelines established by the Attention Deficit Disorder Association (ADDA) for determining a diagnosis of ADHD. "Before a diagnosis is made, we must assess whether the child has had these symptoms of inattention, hyperactivity and impulsiveness in two or more settings, such as home, school, church, and other social encounters. Generally, if six or more of the following symptoms have existed for at least six months and have damaged a child's ability to develop normally, a pediatrician may consider ADHD treatment:
Inattention
- often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
- often has difficulty sustaining attention in tasks and play activities
- often does not seem to listen when spoken to directly
- often does not follow through on instructions and fails to finish schoolwork or chores
- often has difficulty organizing tasks and activities
- often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
- often loses things necessary for tasks or activities (toys, school assignments, pencils, books, tools)
- is often easily distracted
- is often forgetful in daily activities
Hyperactivity
- often fidgets with hands or feet or squirms in seat
- often leaves seat in classroom or in other situations in which remaining seated is expected
- often runs about or climbs excessively in situations in which it is inappropriate
- often has difficulty playing quietly
- is often "on the go" or often acts as if "driven by a motor"
- often talks excessively
Impulsivity
- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others
Treating the Whole Family
There is conclusive scientific evidence that, for school-age children over age 5, medication given under the supervision of the child's doctors can make a significant difference. But treatment doesn't stop with filling a prescription.
"Proper treatment for ADHD includes close follow up," Dr. Sterkel says. "The pediatrician and the parent must work closely together to monitor not only the child's behavior, but his weight, blood pressure and other health factors that may be affected by the medication." In addition, Dr. Sterkel recommends that all patients with the diagnosis of ADHD see a pediatric counselor or psychologist with experience in treating the condition. "There is excellent evidence to suggest that a combination of medication and counseling works better than medication or counseling alone."
"Our immediate goal is to help parents and other caregivers understand what the child needs and how they can structure the environment for the child to excel," says Russell Hoffmann, PhD, child psychologist at St. Louis Children's Hospital and vice president of learning and development at BJC Healthcare.
Dr. Hoffman teaches families to simplify communication and apply positive reinforcements to change negative habitual behavior. He says the aim is to both rebuild the parent/child relationship and find ways to build on the inherent strengths of the child.
"Most children with ADHD are naturally spontaneous," Dr. Hoffmann says. "They often 'move on' quickly after being upset. And, for the most part, they are naturally outgoing. These are often overlooked strengths of children with ADHD, but are very valuable traits that can carry a person far in life."
Dr. Sterkel adds that uncovering these strengths and watching a child improve through successful treatment of ADHD is one of the most rewarding aspects of his pediatric practice. "Every part of a child's life improves when his ADHD is successfully treated."
