What is Attention Deficit Hyperactivity Disorder (ADHD, ADD)?
The following definition is given by the National Institute of Mental Health (NIMH):
“Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).”
ADHD has three predominant subtypes:
Children with this subtype are less likely
to act out or have difficulties getting along
with other children. They may sit quietly, but
they are not tuned in to what is going on in
class. Their difficulty is staying focused and
remaining on task. These children would have
previously diagnosed as ADD, attention deficit
disorder without the hyperactivity.
Children with this subtype are the ones more
likely to act out. They have difficulty
controlling behavior, and hyperactivity
(over-activity). In these children symptoms
of inattention may still be present to some degree.
Combined Hyperactive-Impulsive and Inattentive
Children with this subtype have both difficulty
controlling behavior, hyperactivity (over-activity)
and significant difficulty staying focused and
remaining on task.
Who Is At Risk?
ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood. Though symptoms can often occur as early as 3 or 4 years old, the average age of onset is 7 years old.
ADHD affects about 4.1% American adults age 18 years and older in a given year. The disorder affects 9.0% of American children age 13 to 18 years. Boys are four times at risk than girls.
Studies show that the number of children being diagnosed with ADHD is increasing, but it is unclear why.
Children mature at different rates and have different personalities, temperaments, and energy levels. Adults may incorrectly expect children to behave, to concentrate and not be impulsive. But, children are more easily distracted. They have shorter attention spans. Sometimes, these normal factors may be mistaken for ADHD. ADHD symptoms usually appear early in life, often between the ages of 3 and 6, and because symptoms vary from person to person, the disorder can be hard to diagnose. Parents may first notice that their child loses interest in things sooner than other children, or seems constantly “out of control.” Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently “spaces out” in the classroom or on the playground.
The diagnosis of ADHD is multifactorial. First, if any physical problems such as vision or hearing deficits exist, they must be treated. Vision or hearing deficits may cause symptoms which mimic ADHD. I like to obtain a detailed medical and developmental history on the child. How was the mother’s health during the pregnancy? Subtle findings like whether or not the child had hiccups in utero can provide useful information.
It is also important to gather information about the child’s family and social environment. Our community has a large military population. It is not uncommon for a parent to suddenly leave for as little as a few days or as long as several months. This can be stressful for a child and result in changes in behavior or deterioration of school performance.
At Pediatric Urgent Care we use the Vanderbilt Diagnostic Rating to collect data about ADHD symptoms. This tool can also detect symptoms of Oppositional Defiant Disorder (ODD), Conduct Disorder, and anxiety/depression. If these latter conditions are suggested, I will refer the child to be evaluated by a mental health specialist.
Even if there is no suggestion of ODD et al., I still like to have psychological testing done on the child. The Vanderbilt can predict the presence of ADHD with accuracy of greater than 90%, depending on the scores generated. However, ADHD does not always occur alone, and as mentioned above, other conditions can mimic ADHD. Learning disabilities and information processing disorders may present as ADHD symptoms. But the Vanderbilt cannot distinguish between these and ADHD. Psychological tests such as the WISC IV and the NEPSY®-II can detect these problems. Unfortunately, the current trend is to control health care costs…period. So, has become increasingly difficult to have psychological testing done without prior approval from the insurance carrier.