Diagnosis+and+Medication

=This page is dedicated to information about the diagnosis of ADHD and the medications that are out there for ADHD treatment, and also research supporting and against the use of these medications. =

[] This first link gives a very general summary of ADHD, diagnosis, and treatment. It is important to keep in mind that this information seems biased in favor of using medication for treatment. Medicine can also have adverse affects and could numb your child's creativity and personality, and many adults with ADHD decide they prefer to go without medication. There are studies that do offer alternative suggestions for treatment. We have directly posted the information below for your convenience but feel free to browse the link for more information.

MedlinePlus Topics
[|Attention Deficit Hyperactivity Disorder] ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development. 

Causes
Imaging studies suggest that the brains of children with ADHD are different from those of other children. These children handle neurotransmitters (including dopamine, serotonin, and adrenaline) differently from their peers. ADHD may run in families, but it is not clear exactly what causes it. Whatever the cause may be, it seems to be set in motion early in life as the brain is developing. Depression, lack of sleep, learning disabilities, tic disorders, and behavior problems may be confused with, or appear with, ADHD. Every child suspected of having ADHD should have a careful evaluation to determine what is contributing to the behaviors that are causing concern. ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 - 5% of school aged children. ADHD is diagnosed much more often in boys than in girls. Most children with ADHD also have at least one other developmental or behavioral problem. They may also have another psychiatric problem, such as depression or [|bipolar disorder]. 

Symptoms
The symptoms of ADHD are divided into inattentiveness, and hyperactivity and impulsivity. Some children with ADHD primarily have the inattentive type, some the hyperactive-impulsive type, and some the combined type. Those with the inattentive type are less disruptive and are more likely to miss being diagnosed with ADHD. Inattention symptoms: Hyperactivity symptoms: Impulsivity symptoms: 
 * 1) Fails to give close attention to details or makes careless mistakes in schoolwork
 * 2) Has difficulty sustaining attention in tasks or play
 * 3) Does not seem to listen when spoken to directly
 * 4) Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
 * 5) Has difficulty organizing tasks and activities
 * 6) Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
 * 7) Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
 * 8) Is easily distracted
 * 9) Is often forgetful in daily activities
 * 1) Fidgets with hands or feet or squirms in seat
 * 2) Leaves seat when remaining seated is expected
 * 3) Runs about or climbs in inappropriate situations
 * 4) Has difficulty playing quietly
 * 5) Is often "on the go," acts as if "driven by a motor," talks excessively
 * 1) Blurts out answers before questions have been completed
 * 2) Has difficulty awaiting turn
 * 3) Interrupts or intrudes on others (butts into conversations or games)

Exams and Tests
Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue. The diagnosis is based on very specific symptoms, which must be present in more than one setting. In older children, ADHD is in partial remission when they still have symptoms but no longer meet the full definition of the disorder. The child should have an evaluation by a doctor if ADHD is suspected. Evaluation may include: 
 * Children should have at least 6 attention symptoms or 6 hyperactivity/impulsivity symptoms, with some symptoms present before age 7.
 * The symptoms must be present for at least 6 months, seen in two or more settings, and not caused by another problem.
 * The symptoms must be severe enough to cause significant difficulties in many settings, including home, school, and in relationships with peers.
 * Parent and teacher questionnaires (for example, Connors, Burks)
 * Psychological evaluation of the child AND family, including [|IQ testing] and psychological testing
 * Complete developmental, mental, nutritional, physical, and psychosocial examination

Treatment
The American Academy of Pediatrics has guidelines for treating ADHD: MEDICATIONS Children who receive both behavioral treatment and medication often do the best. There are now several different classes of ADHD medications that may be used alone or in combination. Psychostimulants (also known as stimulants) are the most commonly used ADHD drgus. Although these drugs are called stimulants, they actually have a calming effect on people with ADHD. These drugs include: The Food and Drug Administration (FDA) has approved the nonstimulant drug atomoxetine (Strattera) for use in ADHD. It may be as effective as stimulants, and may be less likely to be misused. Some ADHD medicines have been linked to rare sudden death in children with heart problems. Talk to your doctor about which drug is best for your child. BEHAVIOR THERAPY Both before and after a child is diagnosed, there is stress on the family. Families can experience blame, anger, and frustration. Talk therapy for both the child and family can help everyone overcome these feelings and move forward. Parents should use a system of rewards and consequences to help guide their child's behavior. It is important to learn to handle disruptive behaviors. Support groups can help you connect with others who have similar problems. Other tips to help your child with ADHD include: ADHD can be a frustrating problem. Alternative remedies have become popular, including herbs, supplements, and chiropractic manipulation. However, there is little or no solid evidence for many remedies marketed to parents. 
 * Set specific, appropriate target goals to guide therapy.
 * Start medication and behavior therapy.
 * When treatment has not met the target goals, re-evaluate the original diagnosis, the possible presence of other conditions, and how well the treatment plan has been implemented.
 * Follow-up regularly with the doctor to check on goals, results, and any side effects of medications. During these check-ups, information should be gathered from parents, teachers, and the child.
 * Amphetamine-dextroamphetamine (Adderall)
 * Dexmethylphenidate (Focalin)
 * Dextroamphetamine (Dexedrine, Dextrostat)
 * Lisdexamfetamine (Vyvanse)
 * Methylphenidate (Ritalin, Concerta, Metadate, Daytrana)
 * Communicate regularly with the child's teacher.
 * Keep a consistent daily schedule, including regular times for homework, meals, and outdoor activities. Make changes to the schedule in advance and not at the last moment.
 * Limit distractions in the child's environment.
 * Make sure the child gets a healthy, varied diet, with plenty of fiber and basic nutrients.
 * Make sure the child gets enough sleep.
 * Praise and reward good behavior.
 * Provide clear and consistent rules for the child.

Outlook (Prognosis)
ADHD is a long-term, chronic condition. If it is not treated appropriately, ADHD may lead to: About half of children with ADHD will continue to have troublesome symptoms of inattention or impulsivity as adults. However, adults are often more capable of controlling behavior and masking difficulties. 
 * Drug and alcohol abuse
 * Failure in school
 * Problems keeping a job
 * Trouble with the law

When to Contact a Medical Professional
Call your doctor if you or your child's school personnel suspect ADHD. You should also tell your doctor about any: 
 * Difficulties at home, school, and in relationships with peers
 * Medication side effects
 * Signs of depression

Prevention
Although there is no proven way to prevent ADHD, early identification and treatment can prevent many of the problems associated with ADHD. 

Alternative Names
ADD; ADHD; Childhood hyperkinesis 

Update Date: 2/22/2010
Updated by: David B. Merrill, MD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

===This next article suggests an alternative approach to medicinal treatment of ADHD. Please do not take offense to the article, as it takes an approach that is biased towards blaming parents for behavioral management of ADHD kids. We know this is NOT the case, but are simply posting for the suggestions offered as alternatives to medication. ​===

[] =[|Non-Drug Alternatives for ADHD Proven Effective]= By John M Grohol PsyD

Contrary to popular thinking, [|medications] for child [|attention deficit disorder] ([|ADHD]) are not always the best first-line treatment. Instead, parents should seek out behavioral treatments according to new research presented this past weekend at the annual convention of the American Psychological Association.

That’s because while medications address ADHD symptoms such as restlessness and fidgeting in a classroom, they don’t address the impairments caused by ADHD. Those include a lack of successful interactions with peers, deficits in reading and math skills, and difficult relations with parents and family members.

..So what are some behavioral interventions parents can try out in the home? Pelham suggests the following: ... In combination with psychotherapeutic behavioral interventions, you can treat many children (if not most) with these techniques and keep medication to a minimum. Some children can even be treated for ADHD without any medication whatsoever. Michael Phelps, the USA Olympic-gold swimmer, was diagnosed with ADHD as a child. After taking medications, he chose to discontinue them and worked on his symptoms on his own. Read the full article: [|Therapy as First-line Treatment for ADHD]
 * 1) Rules for the home
 * 2) Ignore mild inappropriate behaviors and praise appropriate behaviors (choose your battles)
 * 3) Appropriate commands:
 * Obtain the child’s attention: say the child’s name
 * Use command not question language
 * Be specific
 * Command is brief and appropriate to the child’s developmental level
 * State consequences and follow through
 * 1) Daily charts (e.g., School, Home Daily Report Cards)
 * 2) Premack contingencies (e.g., watch TV or phone time contingent upon homework completion)
 * 3) Time out from positive reinforcement/work chores
 * 4) Point/token system with both reward and cost components
 * 5) Level system
 * 6) Homework hour
 * 7) Contracting/negotiating with adolescents