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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.

Making the Diagnosis continued...

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.

More than 200 scientific studies have found the medications effective, although the stimulants can cause reduced appetite, sleeping difficulties, and tics, such as excessive blinking or facial grimacing.

The FDA recently approved Strattera, a nonstimulant drug that affects the brain chemical norepinephrine and helps improve ADHD symptoms -- but without the stimulant side effects. Strattera can cause abdominal pain, headache, reduced appetite, dry mouth, and insomnia. This drug, along with the stimulants already mentioned, is FDA-approved for children, Stein says.

Antidepressants are also sometimes prescribed because they can help decrease impulsivity, hyperactivity, and aggression. Even though these drugs are not specifically approved for ADHD, doctors sometimes prescribe them "off label."

More than 70% of children do well on the stimulants or Strattera, says Stein. And of the 30% who don't -- those whose symptoms do not improve or who have side effects such as nervousness or insomnia -- half of those will do well on other medications such as antidepressants.

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