Understanding ADHD -- Diagnosis and Treatment

How Is ADHD Diagnosed?

ADHD is a complex condition and is sometimes difficult to diagnose.

There is no single test for ADHD. Doctors diagnose ADHD in children and teens after discussing symptoms at length with the child, parents, and teachers and observing the child's behaviors. The doctor will also gather information about any similar problems that run in the family and consider all possible causes.

To confirm a diagnosis of ADHD or learning differences, a battery of tests may be given to assess a child's neurological and psychological status. The tests should be given by a pediatrician or mental health provider with experience in diagnosing and treating ADHD . The tests include:

  • A medical and social history of both the child and the family.
  • A physical exam and neurological assessment that includes screenings of vision , hearing, and verbal and motor skills. More tests may be given if there is a possibility that hyperactivity is related to some other physical problem.
  • An evaluation of intelligence, aptitude, personality traits, or processing skills. These evaluations are often done with input from the parents and teachers if the child is of school age.
  • A noninvasive scan -- called the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System -- that measures theta and beta brain waves. The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it.

 

What Are the Treatments for ADHD?

The most effective treatment for ADHD is thought to be a combination of medication and psychological and behavioral therapies. Close cooperation among therapists, doctors, teachers, and parents is very important, and team meetings help.

Stimulants. Although there is considerable controversy about their possible overuse, stimulants are the most commonly prescribed medications for treating ADHD. Stimulants often decrease hyperactivity and improve concentration. They include amphetamine salt combo (Adderall), dextroamphetamine (Dexedrine, Focalin), lisdexamfetamine (Vyvanse), methylphenidate (Concerta, Ritalin), andmethylphenidate HCI (Quillivant XR).The newest formulations allow children to take the medicine only once a day. Methylphenidate (Daytrana) is a stimulant that comes in the form of a skin patch that is applied once a day and worn for about 9 hours. The patch has been known to cause permanent skin discoloration so should be monitored.

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A doctor needs to monitor the dosage of the stimulant medication closely, both to determine the most effective level of drug and to watch for any side effects. Generally, most side effects of stimulants are mild and may include decreased appetite, stomach aches, sleep problems, headaches , and an increase in anxiety .

However, in rare cases, stimulants can have more serious side effects. For instance, some are linked to a higher risk of heart problems and sudden death in children with preexisting heart disease. They may also worsen psychiatric conditions like depression or anxiety or cause a psychotic reaction in some individuals. Before your kids start taking an ADHD medicine, talk to your doctor about the risks and benefits.

Non-stimulants. Atomoxetine ( Strattera ) and clonidine ( Catapres and Kapvay) are two non-stimulant drugs for ADHD. Another drug, approved for children aged 6 to 17, is guanfacine (Intuniv), which uses the same active ingredient as guanfacinehydrochloride (Tenex), a blood pressure medicine that has been used as an ADHD treatment.

Of course, these drugs have their own side effects and risks, and your doctor will want to watch for problems. In 2005, the FDA issued a public health advisory about rare reports of suicidal thinking in children and adolescents taking Strattera.

Other drugs. In some cases, doctors may try prescribing other antidepressant medications, such as drugs called SSRIs, bupropion (Wellbutrin), venlafaxine (Effexor) or others.

Psychological therapy. Of the psychological therapies, behavior modification may be the most commonly recommended for children. It can be quite effective, particularly if the therapist helps parents learn techniques to help the child's behavior. It is often combined with specific educational interventions, such as help with learning skills. Psychotherapy, including cognitive behavioral therapy is a valuable option, particularly if the child has low self-esteem, depression or anxiety.

9 Lifestyle Tips

These tips may help your child -- and you:

  1. Join a support group. Organizations include Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
  2. Boost your child's self-esteem. Because a child with ADHD may have difficulty processing directions and other information, he or she is apt to be bombarded with corrections, leaving him with a low opinion of himself. Do whatever you can to boost your child's self-esteem.
  3. Praise and reward good behavior promptly.
  4. Be consistent with discipline, and make sure other caregivers follow your methods.
  5. Make instructions simple and specific ("Brush your teeth. Now, get dressed."), instead of general ("Get ready for school.").
  6. Encourage your child's special strengths, particularly in sports and out-of-school activities.
  7. Set and follow routines for meals, bedtime, play, and other activities.
  8. Make time for play and exercise -- outside in a natural setting if possible. Don't let homework or screen time monopolize all of your child's time after school.
  9. Simplify your child's room to minimize distractions, such as toys and improve organization.

 

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on November 13, 2015

Sources

SOURCES: 

Heart Rhythm Society. 

American Academy of Pediatrics. 

National Institute of Mental Health. 

Attention Deficit Disorder Association. 

The American Academy of Family Physicians. 

Medscape: "Once-Daily Guanfacine Approved to Treat ADHD." 

Intuniv web site.

Attention Deficit Disorder Resources: "Medication Management for Adults with ADHD." 

Strattera web site. 

National Institute of Mental Health: "Questions Raised about Stimulants and Sudden Death." 

HelpGuide.org: "ADD & ADHD Medications." 

News release, Pfizer.

FDA: "FDA permits marketing of first brain wave test to help assess children and teens for ADHD."

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