Attention Deficit and Hyperactivity in Children

One of the most common developmental disorders is Attention Deficit/Hyperactivity Disorder (ADHD), which occurs with a frequency as high as 1/20 children in the US.  It impacts many aspects of behavior and performance, both at school and at home and, in the majority of patients, symptoms persist into adolescence and may even continue into adulthood. Patients tend to dislike tasks that require concentration or organizational skills and may avoid such specific situations.

More than 20 genetic studies provide evidence that ADHD is an inherited disorder. Most children with ADHD have a close relative who also has it.

The National Institute of Mental Health reports that about one-third of fathers who suffered from ADHD during childhood have children with it. Children with affected parents are three times more likely than other children to develop the disorder, and identical twins are both likely to be affected.

The characteristic features of ADHD—inattention, impulsivity, and motor hyperactivity—lead to impaired function in school, work, and social environments.  There is no diagnostic laboratory test for ADHD.  Furthermore, it is important to identify other conditions that may be responsible for symptoms or that coexist with ADHD and require treatment. Hearing and vision assessments should be included in the examination. In my practice, I also explore changes in bowel function and flora, and any allergies that may be causing disruptive behaviors. The most important diagnostic tool is an extensive clinical interview – not merely a routine visit to your general pediatrician.

Once your child has been diagnosed with ADHD, it is important to work with a health care team to develop an effective treatment plan. Medications include stimulants (including amphetamines), non-stimulants, antidepressants, antihypertensives, mood stabilizers and other CNS medications.  An interesting sign that can help determine whether stimulant medications will be effective is for a physician to assess whether the child gets better or worse with even a small dose of caffeine (or even nicotine patches have been advocated in some research). That way, it’s not just “hit or miss” when it comes to which of the myriad drugs to prescribe.

It is important to include behavioral therapy and social training to help minimize the use of medications, and hopefully maximize their effectiveness. The question of refined sugar leading to increase of disruptive behaviors has been debated for years. While scientific literature is generally inconclusive about this contributing factor, there are MANY moms who swear that their kids get “sugar shock” from certain foods. Personally, I am even more concerned about foods which contain a high amount of artificial coloring and flavoring. If there is a “#” (number) in front of the ingredient – it’s not food. Lots of preservatives in certain foods seem to exacerbate the problem in many of our chldren.

Overall, there can be a great deal of improvement in most of the children if the parents follow this suggested course of treatment: find an experienced physician, have a well-thought-out plan, be even more patient and follow the child closely.

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