ADHD

• Attention-deficit/hyperactivity disorder (ADHD) is the most common psychiatric disorder diagnosed in children (anxiety disorders are more common, but not recognized as often).
• 5% of school age children are affected
• Approximately 50% of children with ADHD will “grow out of it” to the point that they do not need medication as an adult.
• In the combined type of ADHD (inattention plus hyperactivity & impulsivity), the symptoms have been noticed usually since children could walk, but parents tend to seek treatment around 8-10 years of age when they need to function in school.
• Some youth have the inattention subtype without hyperactivity and impulsivity.  These youth can often be confused with children who have anxiety and can’t focus on school work. 

Symptoms:

In the DSM-5, there are nine symptoms of inattention and nine symptoms of hyperactivity/impulsivity.  These are listed in the checklists that can be downloaded below.  Diagnostic interviewing and observation by an experienced clinician remain the best methods for assessment. 

Screening:

Standardized checklists from caregivers and teachers are very useful for covering all symptoms comprehensively and for tracking progress.  There are many good checklists. A free one is the NICHQ Vanderbilt scale.  Parent and teacher forms can be downloaded below.  A score of about 30 or higher on questions #1-18 indicate a diagnosis of ADHD.  A score of about 15 or higher on just items #1-9 indicate the inattentive subtype.

Computerized tests of attention can help to quantify inattention but can give false positives.  Computerized tests can be one component that complements other tests in a battery, and can also be useful in some cases to provide objective evidence to skeptical parents.

When To Refer

While research shows that treatment for ADHD appears to be on the rise, treatment for ADHD is too often delayed by reluctance to admit that help is needed.  Treatment is regularly postponed until children have fallen behind in grades and received numerous disciplinary actions at school.  By this time they have been overwhelmed and exhausted by trying to keep up in school.  

Treatment:

Research has shown that medication is very effective in most children.  About 75% of patients respond to first medication tried.  An additional 20% will respond to a change in medication.  The “stimulant” medications are the most effective.  The two stimulant classes are the methylphenidate and amphetamine groups.  There are many other non-stimulant medications which tend to be less helpful.  You can download a list of available ADHD meds and doses below.

Multimodal therapy, combined medication and behavioral treatment, may have added benefits for many youth with concurrent emotional, mood, or anxiety problems.

Does Stimulant Medication Hinder Growth?

Longitudinal research has suggested that long-term use may reduce overall height by an average of one inch, but other studies have indicated that children do reach normal height and weight.

Does Stimulant Medication Lead to Drug Abuse?

Research indicates that medication intervention does not lead to future substance abuse.  In fact, untreated ADHD may be a greater risk for future substance use than stimulant-treated ADHD.

Does Stimulant Medication Cause Tics?

Many years of practice and research has shown that stimulants do not cause tics in the vast majority of patients.  Cases have been reported however of individuals in which tics emerged or worsened on stimulants.  If this happens, other medications may be tried.

Will Children Grow Out of ADHD?

Longitudinal research has shown that about 50% will be able to manage their symptoms without medication in adulthood, and about 50% continue to benefit from medication.  

Does An Omega-3 Fatty Acid Supplement Work?

A meta-analysis of 11 studies published in 2011 concluded that it does help some children but the effect is less than half of the effect of the recommended prescription medicines, so this is not a replacement for usual treatment.  A company has been heavily marketing Vayarin, a "medical food product dispensed by prescription," for ADHD but it is not FDA-approved for ADHD.  Omega-3 fatty acids may be a worthwhile supplement for some children and attractive to parents who wish to delay prescription medication. 
 

Parent resources:

www.chadd.org

- Updated April 17, 2019.