Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused, difficulty paying attention, difficulty controlling behavior, and hyperactivity (over-activity).

ADHD has three subtypes:

• Predominantly hyperactive-impulsive- the majority of the symptoms (six or more) are categorically hyperactive and/or impulsive; only a few symptoms of inattention are present.
• Predominantly inattentive- the majority of the symptoms (six or more) are categorically  inattentive; fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
• Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.

• Combined hyperactive-impulsive and inattentive- six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.

Most children have ADHD, Combined Type. ADHD is one of the most common childhood disorders and can continue through adolescence and into adulthood. The average age of onset is 7 years old.

Signs & Symptoms

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

Children who have symptoms of inattention may:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.

Children who have symptoms of hyperactivity may:

• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.

Children who have symptoms of impulsivity may:

• Be very impatient
• Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
• Have difficulty waiting for things they want or waiting their turns in games
• Often interrupt conversations or others' activities.

Diagnosis

No single test can diagnose a child as having ADHD. Instead, a licensed health professional needs to gather information about the child, and his or her behavior and environment. A family may want to first talk with the child's pediatrician. Some pediatricians can assess the child themselves, but many will refer the family to a mental health specialist with experience in childhood mental disorders such as ADHD. The pediatrician or mental health specialist will first try to rule out other possibilities for the symptoms. For example, certain situations, events, or health conditions may cause temporary behaviors in a child that seem like ADHD. If I diagnose your child with ADHD, I will refer you to an area Clinical Psychologist for further testing to confirm the diagnosis.

Causes

Scientists are not sure what causes ADHD, although there are lots of studies looking at genetics (whether or not there is a specific gene that  runs in families); studies looking at environmental factors such as cigarette smoking and drinking alcohol during pregnancy and preschoolers exposed to lead paint in daycares in old buildings; studies looking at whether refined sugar causes ADHD or makes symptoms worse; and, studies looking at a possible link between consumption of certain food additives like artificial colors or preservatives. Again, scientists are not sure.

Treatment

Treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments.

Treatments can relieve many of the disorder's symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. 

• Medication: the most common type of medication used for treating ADHD is called a "stimulant." Although it may seem unusual to treat ADHD with a medication considered a stimulant, it actually has a calming effect on children with ADHD. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination.

However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. One child might have side effects with a certain medication, while another child may not. Sometimes several different medications or dosages must be tried before finding one that works for a particular child. Any child taking medications must be monitored closely and carefully by caregivers and doctors (primary care physicians or psychiatrists).

• Psychotherapy- different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Therapists may teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.

What Parents Can Do to Help

Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential and to succeed in school. Before a child is diagnosed, frustration, blame, and anger may have built up within a family. Parents and children may need special help to overcome bad feelings. Mental health professionals can educate parents about ADHD and how it impacts a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.

Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child's behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage. In some cases, the use of "time-outs" may be used when the child's behavior gets out of control. In a time-out, the child is removed from the upsetting situation and sits alone for a short time to calm down.

Parents are also encouraged to share a pleasant or relaxing activity with the child, to notice and point out what the child does well, and to praise the child's strengths and abilities. Parents may also benefit from learning stress-management techniques to increase their own ability to deal with frustration, so that they can respond calmly to their child's behavior.

Sometimes, the whole family may need therapy. Therapists can help family members find better ways to handle disruptive behaviors and to encourage behavior changes. 

• Durham Bulls Baseball Game at the Durham Bulls Athletic Park, 409 Blackwell Street, Durham 27701, see www.durhambulls.com for the schedule and for ticket prices ($9.99, $14.99, $19.99- depending on where you reserve your seat)
• American Tobacco- Downtown Durham, 300 Blackwell Street, Durham, NC 27701. Enjoy the night atmosphere! Walk and talk or sit in the rocking chairs around the water feature (behind Cuban Revolution Restaurant). Great for couples and/or families. Check out the schedule for free music on the lawn, http://www.americantobaccocampus.com/
• Duke Lemur Center, 3705 Erwin Road at NC Highway 751, Durham, NC 27705. Go visit and learn about the monkeys! Adults, $12; Children (3-12), $9. See http://lemur.duke.edu/visit/tours/ for more information or call (919) 401-7240.
• Eno River State Park, 6101 Cole Mill Road, Durham, NC 27705: Main Access Area: Fews Ford Road off Cole Mill Road. This is one of my favorite spots for hiking, seeing the waterfalls, and picnicking with my family. You may canoe, fish, camp, picnic, and/or hike. See http://www.ncparks.gov/Visit/parks/enri/activities.php or call (919) 383-1686 for more information.
• Museum of Life and Science, 433 W. Murray Avenue, Durham, NC 27704. This place is amazing!!! I love to visit this museum with my nieces. There is a butterfly house (and you know I love butterflies), an interactive play area, a dinosaur trail with a fossil dig, an insectarium full of exotic insects, and an Explore the Wild area with live black bears, wolves, and lemurs. Children (3-12), $10; Adults, $14.50. Please see  http://lifeandscience.org/ or call (919)220-5429 for information.

If you are saying, "that's not my thing"....change...let's try a new thing!:)

Dinner Conversation Topics:

• What's your favorite game to play outside in the summer?
• What's your favorite thing about being a kid?
• What's your favorite thing to do with the whole family?
• Which ice cream do you like better: chocolate or vanilla?
• What's your favorite month of the year?
• What's your favorite thing to do if you get to stay up late?
• Is there anything you know more about than your parents do?
• If you gave up TV for a month, what would you miss the most?
• Do you prefer old things with memories or new things with possibilities?
• If you could pack just three things to take to a desert island, what would you take?

Did You Know?

• Take your bananas apart when you get home from the store. If you leave them connected at the stem, they ripen faster.
• Add a couple of teaspoons of water to the pan when frying/browning ground beef. It will help pull the grease away from the meat while cooking.

RECIPE

Brown Meatloaf

3 eggs

1 can condensed French Onion Soup (undiluted)

1 small package Pepperidge Farm Herb Seasoned Stuffing

2 lbs. ground beef

Mix and mold into a loaf and bake 1-hour at 350 degrees