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ADHD in Children Health Center

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ADHD: An Update on Diagnosis and Treatment for Kids

Diagnosing attention deficit hyperactivity disorder (ADHD) is sometimes controversial. But for children with the condition, treatment options are working.

Drug Warnings continued...

"The real question is whether there is any risk for children without heart problems," says Andrew Adesman, MD, chief of developmental and behavioral pediatrics at the Schneider Children's Hospital, Lake Success, N.Y.

As for the possible link to suicides, the ADHD drug Strattera is under special scrutiny. In late 2005, the FDA issued a public health advisory after reports of suicidal thoughts in five kids and a suicide attempt by one child in a clinical trial involving 2,200 participants. The advisory cautioned doctors and parents to watch for any behavior changes in children who were on the drug.

Parents such as the Ryanses worry about misdiagnoses and overprescribing, and experts concede that both can happen. But, Adesman says, overprescribing and misdiagnosis are more likely to happen if the evaluation is not thorough and is not done by a health care professional experienced in diagnosing and treating the condition.

What Is ADHD?

Kids diagnosed with ADHD -- which was once known as attention deficit disorder (ADD), or hyperactivity -- have trouble focusing on tasks, sitting still, and paying attention. While most parents have occasionally wished that their child would calm down and focus, ADHD behavior is more frequent and extreme. The condition is diagnosed three times more often in boys than girls.

ADHD is now the most common neurobehavioral disorder of childhood, according to the American Academy of Pediatrics. "That doesn't mean [every child] needs treatment," says Martin T. Stein, MD, professor of pediatrics at University of California-San Diego. But, he adds, "It is very treatable."

Making the Diagnosis

ADHD tends to run in families, says Stein, who co-chaired the American Academy of Pediatrics committee that developed guidelines for diagnosing and treating ADHD. "It refers to three behaviors that cause impairment: hyperactivity, impulsiveness, and inattention."

According to Stein, the health care professional who is evaluating the child should do a thorough medical exam, being careful to rule out other problems that might explain the behavior, such as hearing or vision problems. Then he or she must take a history of symptoms from an established list from the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. (See also the "Signs of ADHD," below.)

After his testing, Jeremiah was diagnosed with the type of ADHD marked by hyperactivity and impulsiveness. And his symptomatic behaviors -- impatience and hitting other children -- are typical, says Adesman. "Cutting the [teacher's] hair is more extreme," he says of Jeremiah's experience, "although it is not uncommon for the child to cut his own hair."

Drug Treatment

Jeremiah's doctor recommended a combination of behavior modification therapy and medication, a typical approach to treating ADHD.

Psychostimulants - or simply stimulants, such as Ritalin, Adderall, and Concerta -- are most commonly prescribed. Experts believe they work by helping the network of nerve cells in the brain communicate better with each other and increase chemicals that "arouse" the parts of the brain that help people pay attention and control impulses. The drugs don't cure the condition but rather help control the symptoms that are causing problems.

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