Management of ADHD in Children
Management of ADHD in Children. This week, I am attending a conference on primary care. One of the lectures was titled “Management of ADHD in Children.” This is a critical topic for both primary care providers (such as pediatricians) and the parents who take their children to visit them. ADHD is a common problem that impacts millions of children every year. If it is not caught early, it can lead to issues with discipline, academic performance, and social interactions. Some of the key statistics on this disorder from the conference include:
- ADHD impacts about 5 percent of children in the United States
- It is twice as common in boys as in girls
- Boys are more likely to have “impulsive” symptoms on presentation
- It is more common in white children than in other ethnicities
Finally, most children with this disorder will eventually outgrow it. How is this disorder diagnosed? How is it treated?
What is ADHD?
Years ago, ADHD and ADD were two separate disorders. ADD has been phased out and ADHD is the only diagnosis that remains. ADHD stands for Attention-Deficit-Hyperactivity-Disorder. According to the DSM-5, the guidelines regarding mental health conditions, ADHD is defined as:
- Inattention or hyperactivity that lasts for more than 6 months
- Along with more than 6 symptoms
- Which leads to an impact on the child’s functional learning and development
Lastly, the bullet points above mention “six or more symptoms.” What are these symptoms?
ADHD can present in many different ways. No two children with this disorder are alike. Broadly, there are two different types of ADHD. These are the inattentive variety and the hyperactive variety. Children can have a combined disorder as well. The inattentive symptoms include:
- The child makes careless mistakes
- He or she cannot stay focused in class
- He or she does not listen when spoken to
- The student is unable to finish his or her work
- The child loses things easily
- He or she is often forgetful
There is also the hyperactive subtype. These symptoms include:
- The child fidgets constantly, such as tapping the hands or feet
- He or she often squirms in his or her seat at school
- The student gets out of his or her seat at inappropriate times
- He or she runs around and climbs on things that are not meant to be climbed on (such as people)
- The child dislikes quiet activities
- Parents often say that their child is “driven by a motor”
Typically, these symptoms present at a young age (before 12 years old) and must be present in two or more settings. Most pediatricians diagnose ADHD using Vanderbilt forms. These are questionnaires that both parents and teachers will fill out. This confirms the presence of these symptoms in two or more settings. The “teacher” could be a schoolteacher but also a music teacher, coach, or another mentor.
Once a child has been diagnosed with ADHD, treatment can start. The treatment of this disorder is dependent on a combined approach with behavioral therapy and medical management. Examples of behavioral therapy include:
- The institution of a 504 plan at school
- Seeing a guidance counselor regularly
- Having consistent boundaries and limits at home
- Taking small breaks during the day
- Creating small, attainable goals
- Using incentives and rewards with positive reinforcement
Medical management typically starts with methylphenidate (Ritalin). This medication has a half-life of about 4 hours. Other options include:
- Intermediate-acting medications that last about 6 hours, such as Adderall and Metadate ER
- Long-acting medications such as Adderall XR, Focalin XR, and Vyvanse, which last about 10 hours
Lastly, every child will respond to these medications differently. The medication needs to be watched closely to see if the dose needs to be changed. In some cases, children will try multiple medications before finding one that works. Furthermore, the side effects include appetite suppression, trouble sleeping, and possible cardiac side effects. Therefore, children should have a screening EKG before starting ADHD medications.
Contact a Local Pediatrician
Finally, untreated ADHD is enough to tear a family apart. When a child has ADHD, they are often difficult to control, struggle to make friends, and experience a severe social stigma. Importantly, parents who are unsure of what to do should reach out to a local pediatrician. This is a common problem that all pediatricians are trained to deal with. Do not hesitate to reach out and ask for help. There are lots of treatment options and most children will outgrow their symptoms. In the meantime, children should receive proper treatment. This will ensure that they stay on track academically, develop socially, and meet all of their developmental milestones.
David Randolph, MD
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