More Key ADHD Facts
ADHD can make learning difficult.
A child with the disorder needs to be taught other ways of getting information because he can have trouble staying focused long enough for the facts to sink in. His working memory--how much data he can hold at one time--may also be weak. So even though he can understand vocabulary words, he can have trouble recalling and writing them down fast enough on a test. (Kids with ADHD often get extra time to complete tests.)
Dr. Hallowell takes issue with the very name ADHD: "These kids don't have a deficit of attention; they have a wandering of attention. Like a toddler at a picnic, their brain goes wherever it wants to go." In fact, many can actually become hyper-focused on something they're interested in.
It's tricky to diagnose.
"There is still no test that tells us conclusively that a child has ADHD," says Dr. Pearson. This fuels skeptics' belief that children are misdiagnosed. But doctors rely on a comprehensive developmental history, detailed questionnaires, and rating scales that assess a child's behavior and level of impairment over the years. By talking to the child, parents, teachers--and, if necessary, grandparents, babysitters, and even coaches--doctors determine whether her symptoms are normal for a kid her age or whether they're causing serious problems at home or at school. They must also rule out other factors--such as anxiety, a learning disability, depression, or perhaps divorce or an ill family member--that might be triggering symptoms.
There's no cure--but there are effective treatments.
Medication is a critical element of treatment, research has consistently found. Stimulants are the gold standard, especially when combined with behavioral therapy; both help manage the disruptive and inattentive behaviors of ADHD.
Many people question why you'd give a stimulant to a child who is already unable to sit still. But medications such as Ritalin and Adderall stimulate the brain's ability to send signals back and forth in a way that promotes attention and impulse control. Doctors insist it's not just a valid treatment--it's vital. "To hold off on medication for a child who's been diagnosed with ADHD is like asking someone who is nearsighted to try squinting for a year instead of giving him glasses to correct his vision," explains Dr. Hallowell.
But a medicine that works for one child may not work for another. That's why doctors monitor kids closely, adjusting dosages or changing medications altogether until they find one, or a combination, that works.
If stimulants don't work or trigger too many side effects (such as agitation, sleeplessness, anxiety, and tics), which can happen in 20 percent of cases, doctors move to other drugs. These include antidepressants and antihypertensives, which also have a calming effect. However, they take longer to kick in and are not as effective in curbing ADHD behaviors.
"We're not sure why, but many children who can't tolerate a medicine at one age do better with the same medicine a few years later," says Dr. Kurtz. "The brain changes, so parents shouldn't rule out medication forever."
Teaching specific skills helps kids cope.
There's growing evidence that parents, working with their child's school, can help rein in behaviors that make life difficult academically and socially.
In a soon-to-be-released study from NYU Langone Medical Center and Duke Medical School, in Durham, North Carolina, research confirmed what experts had previously only suspected: Certain straightforward steps help kids stay organized, improve their concentration, and finish what they start. This includes dedicating a specific time and place for homework, creating centrally posted checklists every day, using a planner to track assignments, designating a file folder to bring papers to and from school, and taking time to review work at home.
Parents can be trained too.
One particular technique for parents and their children ages 2 to 7 has helped manage the disruptive behavior that comes with ADHD. It's called Parent Child Interaction Therapy (PCIT), and the basic premise is that by coaching parents to monitor and reinforce positive behaviors, ignore mild negative ones, and give commands with calm, consistent follow-through, therapists can help moms and dads manage their reactions and teach critical coping skills. During hour-long sessions each week over a period of months, a therapist advises parents on how to interact with their children. Wearing an earpiece, a parent plays with her child while the therapist watches behind a one-way mirror and suggests specific strategies. "The key is to 'catch' your child being good and applaud those strengths," says Dr. Kurtz. (For help finding a PCIT program near you, e-mail email@example.com.)
Most kids with ADHD still have it as an adult.
"Children outgrow it only in about one third of cases," says Dr. Pearson. "Another third have mild symptoms that may surface only during times of stress; and another third have significant issues into adulthood and need to be treated consistently."
While many kids struggle with inattention and disorganization through their teen years, long-term studies show that they become less hyperactive and impulsive. As they mature, they are also more aware of how they're acting and are better able to use strategies to curb negative behavior