Dr. Peter Jensen, child and adolescent psychologist, answered questions from our community about ADD and ADHD.
Q: What is the difference between ADD and ADHD?
Dr. Jensen: ADD is an older term from previous diagnostic systems. ADHD -- the "H" standing for hyperactivity -- is the more current diagnostic term. It includes children with what was previously called ADD without any hyperactive symptoms, as well as children who have hyperactive symptoms without any inattentive symptoms. Thus, the new diagnostic term ADHD includes three different forms of ADHD: Inattentive only, hyperactive only and inattentive and hyperactive.
Q: I'm a bit confused about the fact that nobody ever talked about ADD 20 or even 10 years ago, and now it's one of the most commonly diagnosed problems for kids. What did people do before this was diagnosed, or is this simply a new problem?
Dr. Jensen: ADHD probably existed many years ago but we rarely made the diagnosis because of lack of information and public acceptance of the disability. Before the diagnosis was made, the same children years ago would have received other labels -- airhead, unmotivated, ne'er-do-well, troublemaker, etc. The diagnosis is a step forward in the right direction and indicates our increased understanding of this problem.
Q: What are the side effects of Ritalin on a 5-year-old boy? Are there any long-term problems associated with it?
Dr. Jensen: Side effects for 5-year-olds are pretty much the same as for 15- and 25-year-olds. They include headaches, stomachaches (particularly if taken without food), loss of appetite, difficulty sleeping, and sometimes irritability. Long-terms effects of Ritalin have been studied by following children over time who have been on medication. These studies do not indicate any significant adverse effects, other than failure to gain weight.
Q: My daughter (7 years old) has recently been diagnosed with ADD. I'm strongly opposed to her going on medication. What are some of the other options for her? Have they been proven to be as successful as Ritalin?
Dr. Jensen: The other major proven treatment is what is called behavior therapy. It is a specialized form of training for parent or teacher, or both, that gives them guidance setting up reward and consequence programs for children. This is not your normal psychotherapy. It's important to ensure that the child's therapist is expertly trained in behavior therapy. Behavior therapy is not as effective as medication, on average, but one-third of children will do very well with this treatment. All will get at least some benefit.
Q: My fifth grade son has been on Ritalin now for 2 years and is greatly improved. How do you know when your child is ready to go off medication? Will they automatically relapse?
Dr. Jensen: It is often a good idea to try the child off medication shortly after the beginning of the school year, after the child has had time to adjust to the new classroom. Many children find over time that they do not need to continue taking medication, as they are better able to control the symptoms themselves. This does take time, however, and not every child is able to go off medication. If a child has an extraordinary teacher or very small classroom environment, it is possible that that child may be able to go off medication when they are in those optimal surroundings. This will vary from child to child, however.
Q: Our son has ADHD and it has a terrible impact on the rest of our family. Are there support groups for the siblings of children with ADHD? We live in Skokie, IL.
Dr. Jensen: Support groups for siblings are sometimes available, but not uniformly across the country. The best source of information on whether such groups might be available is through other parents who might be members of CHADD. You can contact CHADD chapters by going to the Web, www.chadd.org, and looking for the one closest to you. The other option would be to check with your local mental health provider given by your child's pediatrician. They may be aware of other resources for siblings of children with ADHD.
Q: Do all health insurance companies, by and large, cover ADD drugs like Ritalin? What about the behavior program you mentioned?
Dr. Jensen: Most insurance companies will cover medication such as Ritalin. Offhand, I do not know of any exceptions, but I hear from time to time from parents that their particular company may not reimburse them for ADHD medications. The situation with behavior therapy is worse. Very commonly insurance companies will set a limit on the number of therapy sessions and the intensity of behavior therapy may not be available.
Q: Why do you think there is such a controversy around ADD? Do organizations like the American Academy of Pediatrics approve of drugs to treat these problems?
Dr. Jensen: The controversy has to do with the misunderstanding with ADHD and with stigma. Parents and teachers are usually blamed as being the cause: "If only you were a better parent," "if only my child had a better teacher." Many studies have been done to show that medications are both safe and effective. They are not the only treatment however, since behavior therapy has also proven effective. All of the major professional associations, such as pediatricians, psychologists, psychiatrists, educators, as well as independent panels set up by the federal government, have concluded that these medications are effective.
Chat Moderator: Thanks Dr. Jensen for joining us this afternoon and for sharing your expertise on ADHD.
Dr. Jensen: Thank you very much. That was a terrific set of questions and be sure to seek further information on the Web from www.nimh.nih.gov or my own center's Web site at Columbia University, www.kidsmentalhealth.org. Thank you and good luck.
Copyright © 2002. Reprinted with permission from the March 2002 issue of Child magazine.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.