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Health Matters 6/14: ADHD common in children

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By Bert Mandelbaum, M.D.

Attention-deficit hyperactivity disorder, or ADHD, is one of the most commonly diagnosed disorders in children.

The Centers for Disease Control and Prevention estimates 11% of American children ages 4-17 have the disorder, which can result in children who are overactive, inattentive and impulsive.

Children with ADHD are more likely to experience a range of problems that can make social situations more difficult or school more challenging.

Typical Child Behavior or ADHD?

ADHD is a neurologic disorder and, although the cause and risk factors are unknown, current research points to genetics as an important component.

Often it can be hard to differentiate between ADHD symptoms and typical child behavior, particularly among high-energy children. However, while all children have trouble focusing at times, those with ADHD experience symptoms that persist over time and cause difficulties at school, home and in personal relationships.

Signs of ADHD in children can include:

  • Daydreaming
  • Forgetfulness
  • Talking too much
  • Making careless mistakes or taking risks
  • Inability to control impulses
  • Difficulty taking turns
  • Conflicts with friends and family
  • Hyperactive, fidgety or squirmy

Obtaining a Diagnosis

There are three types of ADHD that may be diagnosed based on a child’s symptoms.

  • Predominantly Inattentive. Characterized by difficulty following instructions, paying attention to details, organizing or finishing a task. Children with this type of ADHD are easily distracted.
  • Predominantly Hyperactive-Impulsive. Characterized by restlessness, impulsive behaviors, like grabbing things from people, or speaking at inappropriate times. Children with this type of ADHD often have trouble sitting still and are fidgety.
  • With this diagnosis, the above symptoms are equally present in the child.

If you suspect your child may have ADHD, make an appointment with your pediatrician and explain your concerns.

While there is no single test for diagnosing ADHD, your pediatrician will likely start with a medical exam that includes hearing and vision tests to rule out other problems that could have symptoms similar to those of ADHD.

Additionally, certain other mental health problems, such as anxiety, depression and learning disabilities, can present with similar symptoms to ADHD. In some cases, your child may be referred to a mental health professional for further evaluation.

ADHD is diagnosed in cases where children show a persistent pattern of inattention and/or hyperactivity that interferes with their functioning.

Successful Management

Receiving the news your child has ADHD can be scary and overwhelming for parents. It is important to remember ADHD is relatively common and can be successfully managed.

Your child’s doctor will work with you and your child to develop a treatment plan that fits your family’s needs.

For children 6 and younger, the American Academy of Pediatrics (AAP) recommends doctors first prescribe behavior therapy. For children older than 6, the AAP recommends behavior therapy and medication be administered concurrently.

Behavior therapy is aimed at reinforcing positive behaviors and eliminating negative ones. Behavior therapy is proven to be effective for young children with ADHD. Often parents receive training simultaneously on how to manage their child’s behavior and strengthen the parent child relationship.

There are several types of FDA-approved medications currently used to treat ADHD in children: stimulants and non-stimulants. Despite their name, stimulants can have a calming effect on some hyperactive children because they increase dopamine levels in the brain, a neurotransmitter associated with motivation and attention. There are also non-stimulants that are proven to treat symptoms of ADHD and can be used in children who do not tolerate stimulants.

Some students who are diagnosed with ADHD are eligible for special services or accommodations at school, as stipulated under the Individuals with Disabilities in Education Act (ACT). Your pediatrician can work with you and the school to ensure your child is receiving the school support services they need.

Additionally, there may be lifestyle changes that have an impact on your child’s behavior.

  • Reinforce positive behaviors. Praise your child for a job well done. Set goals for your child that are realistic and attainable, and offer a reward when a goal is achieved.
  • Make time for exercise. Exercise encourages the production of dopamine, which improves attention and focus. Give your child plenty of time to run around.
  • Adopt a healthy lifestyle. In addition to regular exercise, eating healthy and getting enough sleep can help your child regulate ADHD symptoms. Serve foods high in fiber, such as fruits, vegetables, beans, legumes and whole grains. It is recommended children younger than 5 get 10-13 hours of sleep each night and that children 6 and older sleep eight – 11 hours each night.
  • Avoid distractions. Children with ADHD often have trouble multitasking. Turn off the TV and limit noise when your child is engaged in activities that require concentration, such as homework.

If you are concerned your child might have ADHD, talk to your pediatrician. There are various strategies to support children and adolescents with the disorder so they can lead a successful life.

To find a pediatrician associated with Penn Medicine Princeton Health call 888-742-7496 or visit princetonhcs.org.

Bert Mandelbaum, M.D., is board certified in pediatrics and chairman of the Department of Pediatrics at Penn Medicine Princeton Health.

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