DIAGNOSIS AND TREATMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER

The cause of attention deficit hyperactivity disorder (ADHD) is unknown, and there is no single specific diagnostic test to identify this disorder. To correctly establish the diagnosis of ADHD requires the use not only of medical but also of special psychological, educational, and social resources. Many children diagnosed with ADHD actually have problems that are primarily caused or worsened by inadequate teachers, unsuitable educational settings, or by problems with their parents. Similarly, many adults diagnosed with ADHD may have interpersonal problems that need to be dealt with by psychotherapy.

The diagnosis of ADHD in a child must be based on a complete history and evaluation of the patient and not solely on the presence of the required number of characteristics listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). If you are worried that your child may have ADHD, tell your child’s school that you want an evaluation as part of an individualized education program (IEP). The school is required by law to provide a free and timely evaluation and appropriate interventions. Also, talk to your child’s doctor about getting ADHD checklist forms for you, other caregivers, and your child’s teachers to complete.

The diagnosis of ADHD implies the presence of symptoms of hyperactivity—impulsivity or inattention that cause impairment and that were present before the age of seven. The symptoms must be persistent, must be more severe than is typically observed in individuals at a comparable level of development, must cause clinically significant impairment—for example, in social, academic, or occupational functioning—and must be present in two or more settings, such as school (or work) and home. The symptoms must not be better accounted for by another mental disorder.[1]

About 85% of children with ADHD respond to stimulants. Stimulants have the potential to be abused, and their common street names are “speed” or “uppers.” We do not know why, but people with ADHD paradoxically become less hyper when given stimulant medications. Common adverse effects include headache, stomach pain, and decreased appetite. Stimulants are also marketed as appetite suppressants. Some children do not grow well while on ADHD medications because of the decrease in appetite. If that happens with your child, talk to your child’s doctor about strategies to help your child eat better, such as timing meals to coincide with when the medication is wearing off or taking drug breaks on weekends and holidays.

The stimulant methylphenidate may assist in focusing, sustaining attention and lessening impulsiveness, reducing aggression, and combating other problems in children with ADHD.[2],[3]

In addition to the more well-known occurrence of ADHD in children, the disorder affects an estimated 2% or more of adults. In adults, it can cause educational as well as occupational and interpersonal problems. Although the origin of adult ADHD is in childhood, and many cases are diagnosed then, for many other people the diagnosis is not made until adulthood. It is likely that some physicians taking care only of adults will not be as aware of the problem as pediatricians or family practitioners. The correct diagnosis in adults shares many of the elements of diagnosis in children, including efforts to determine patterns of behavior when the adult was younger, and a psychiatric and developmental history and physical exam to rule out other causes of ADHD such as thyroid disease and other neurological problems. Whereas in children, frequent symptoms are hyperactivity and impulsiveness, in adults the more common findings include procrastination, lack of motivation, mood liability, and low self-esteem, as well as the frequent occurrence of anxiety and depression.[4]