Fidgeting in the classroom or grabbing toys at a birthday party might be excused as typical behaviors in a kindergartener. In excess, these behaviors might also indicate Attention Deficit Hyperactivity Disorder, a condition affecting 5 to 7 percent of all children in the United States.
While any child can have bouts of hyperactivity, an ADHD child's level dramatically exceeds the levels for his age. Parents may complain that the child "never sits still" or seems to "never stop." At the same time, sluggish children who appear to be daydreamers can also have ADHD.
Pediatricians offer a good starting point for diagnosing ADHD. They can assess the youngster or they can refer parents to appropriate specialists such as child psychiatrists or psychologists, behavioral neurologists, or developmental/behavioral pediatricians, if needed.
There is no single test that confirms the diagnosis of ADHD. Rather, the pediatrician or specialist relies on a series of standardized questions directed at both parent and teachers. They identify the predominance of three distinguishing characteristics: inattention, hyperactivity and impulsivity.
As this condition is felt to be inborn, these traits appear early in life, usually before age 7. They also tend to be pervasive, excessive and continuous — not merely a response to a temporary situation, such as the death of a parent or grandparent, a parent's job loss or a divorce. Even dysfunctional family issues, including alcoholism or abuse, can lead children to act out in ways that resemble ADHD, but are not.
In the classroom, children with ADHD may not focus or be able to focus long enough to complete assignments or follow instructions. For instance, they may tackle only one or two math problems before resorting to scribbling. On the playground they might alienate playmates because their impulsivity overrides the rules of their game.
As a result, these children suffer academically and in self-esteem, and the consequences can be long-lasting.
Rarely, undetected medical problems such as a hyperthyroid, lead toxicity or small (petit mal) seizures might be causing similar symptoms of ADHD. Vision or hearing impairment also need to be excluded. And anxiety, depression or bipolar disorder might present themselves as inattentiveness, detachment or impulsive moodiness.
More commonly, doctors and other specialists must distinguish between ADHD, which is a neuro-biologic disorder, and learning disabilities, which are mental processes that interfere with standard educational development, particularly written language and math processes. A classic learning disability like dyslexia, for example, may result in a child being inattentive, though, again, they do not have ADHD.
The good news for children with ADHD is that once an accurate diagnosis pinpoints their condition, with educational accommodation and parental support they can reach the same developmental milestones as other youngsters.
Stimulants (Ritalin or Adderall) and non-stimulants (Strattera) can help alleviate symptoms of ADHD, but medications should be considered as only one tactic in a comprehensive treatment strategy.
In fact, in all studies assessing treatment for ADHD, researchers have found that the best approaches combine education, cognitive therapies (counseling), behavior modification and medication.
School curricula can be adjusted to meet the needs of an individual child with ADHD (as outlined in the Americans with Disabilities Act), but steady communication between the child's parents and teachers is actually the most crucial element in that student's academic achievement.
When families work closely with teachers, pediatricians, counselors — and each other — they make it possible for children with ADHD to be successful in school and in their lives.
Dr. Nackley is a pediatrician with Bay Valley Medical Group and is affiliated with Eden Medical Center, both located in Castro Valley. He can be reached at (510) 581-2559.