Does My Kid Have ADHD?

By Marguerite Lamb, REDBOOK

Children should be high-energy-bouncing, climbing, running, jumping, bodies in perpetual motion. But when does typical kid behavior cross the line into ADHD territory? Find the answers to your questions here.

What does ADHD look like?
There are three distinct types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, or combined type (an amalgam of the first two). Kids who are predominantly inattentive have great difficulty focusing on details: They're disorganized and forgetful; they lose things and make careless mistakes; they're easily distracted and have trouble following directions.

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A child who's predominantly hyperactive-impulsive is always on the go: He fidgets and squirms; he runs and climbs when and where it isn't appropriate; he has difficulty playing quietly, blurts out answers, interrupts others, and has trouble taking turns.

Of course, all kids exhibit some of these symptoms some of the time. But a child with ADHD displays most of these symptoms most of the time, in many different settings, beginning before age 7, and in ways that are age-inappropriate and socially and academically debilitating.

Still, not all ADHD is easy to spot: Girls, in particular, tend to suffer from the inattentive subtype. "They appear as though they're daydreaming," notes Todd. "Since they don't cause disruptions, they more often go undiagnosed." Nor are children with ADHD always unfocused. "I don't know a single ADHD kid who can't focus on a stimulating video game," adds Todd. "But the true test is, can they focus when doing the mundane, uninteresting things? Which, let's face it, is a large part of school life."

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Who's at risk?
Although any child can develop ADHD, those with a family history are at highest risk. "Genes play a role in about 75 percent of ADHD cases, which means it's about as heritable as height," says Desiree Murray, Ph.D., associate director of the Duke University Medical Center ADHD program. Gender also matters, with boys being two to three times as likely as girls to have ADHD, though experts don't fully understand why. Other associations include prenatal exposure to cigarette smoke, insufficient oxygen during birth, lead poisoning, low socioeconomic status, or having a parent with depression or other mental-health issues.

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Scientists are still unsure how these factors may affect the brain in ways that contribute to ADHD. They do know that the frontal lobe-a brain region involved in part with planning and problem solving-is 10 percent smaller in individuals with ADHD than in those without. "And ADHD sufferers appear to have lower activity in the brain regions associated with inhibition and attention," says Murray.

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Could it be something else?
Many other conditions can look like ADHD, so it's vital that your child be thoroughly evaluated before you accept a diagnosis (see "Diagnosing ADHD: What to Expect," later in this article). For instance, kids who are chronically sleep deprived due to sleep apnea or other nighttime issues are reported to have higher levels of inattention and hyperactivity. So are those who have had frequent ear infections, a common cause of correctable hearing loss that can lead to ADHD-like inattentive or disruptive behaviors, or those who have a visual problem called convergence insufficiency, which literally makes it hard for the child to focus.

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If the pediatrician rules out the above physical factors, experts recommend a psychological evaluation as the next step: Roughly half of all kids with ADHD have at least one other behavior disorder that requires attention, and many common culprits-such as anxiety or a learning disability-are easy to mistake for ADHD. While most pediatricians and family doctors today can diagnose textbook ADHD, it may take a child psychologist or psychiatrist to pinpoint and treat these other mental-health concerns.

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What are the treatment options?
Some parents of kids with ADHD find that incorporating certain lifestyle changes can help manage symptoms. But only two treatments are proved to work in studies: stimulant medication and behavioral therapy.

For up to 80 percent of kids with ADHD, these drugs are effective. They work by "turning on" brain areas involved in attention span and impulse control. Though generally safe, stimulants work differently for different children, so finding the right one is often a matter of careful trials. For instance, short-acting formulas (e.g., Ritalin and Dexedrine) can wear off between doses, so many parents prefer newer longer-acting forms like Concerta and Adderall XR. Another option is the Daytrana patch. "You can remove the patch at any time to stop the medication, and the patch can be a real plus if your child dislikes taking pills or has trouble absorbing the medication," says Steven Pliszka, M.D., chief of child and adolescent psychiatry at the University of Texas Health Science Center in San Antonio.

Stimulants can also cause headaches and irritability, and they may raise the risk for sudden cardiac death or psychotic episodes in children with preexisting heart conditions or psychotic disorders. For kids who can't take stimulants, there's Strattera, the only non-stimulant ADHD medication approved by the FDA. But it doesn't seem to be as effective as the stimulants, and in very rare cases, Strattera may trigger suicidal thoughts.

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BT hinges on teaching parents, in training sessions, how to use rewards and consequences to effectively set limits for their children and encourage positive behaviors. "Kids with ADHD have almost superparenting needs-they require strategies and skills that most parents wouldn't come by naturally," says Murray.

While research indicates that BT alone may not be as effective for treating core symptoms of ADHD as medication alone, some kids-particularly those who also have anxiety-seem to respond equally well to behavioral and drug treatments. Studies suggest, however, that the optimal treatment for all children with ADHD is a combination of BT and drugs. "This is particularly true for children who are under intense pressure at home or school, or those who are dealing with a coexisting condition such as depression or anxiety that can't be addressed with drugs alone," says Peter S. Jensen, M.D., director of REACH (The Resource for Advancing Children's Health) in New York City.

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Diagnosing ADHD: What to Expect
There is no concrete test for ADHD, so getting a diagnosis is a multistep process requiring time and patience. Your pediatrician (or a child psychiatrist or psychologist) will start by taking a medical history and may perform a physical exam of your child. She'll collect information about your child's behavior from you, your child's teachers, and any other primary caregivers. In addition, your doctor will interview your child and may have him take tests to assess for any learning disabilities.

Based on the results, your doctor may refer you to another specialist (such as a neurologist, ophthalmologist, or audiologist) to rule out or treat any other health concerns. If your child is diagnosed with ADHD, your doctor will work with your family to develop a treatment plan.

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Your ADHD Daily Survival Guide
Living with ADHD or other attention problems is a daily challenge for children and their loved ones. The following tactics can help alleviate stress for the entire family:

1. Praise specific behaviors that you'd like repeated
. For example: "You did a great job putting your Pokémon cards away." Children with ADHD tend to receive less positive reinforcement, yet it's a more effective motivator than criticism.

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2. Look your child in the eye and deliver step-by-step directions.
This way, you'll know that your child is listening, which may keep you from having to repeat yourself endlessly-a habit that only encourages your child to tune you out.

3. Reward good behaviors-and punish bad ones-immediately.
Kids with ADHD quickly lose the connection between their actions and delayed consequences.

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4. Provide concrete incentives.
Children with ADHD may want to do well because it feels good, but they're easily distracted by external temptation. Offer more tangible motivation, such as the promise of extra Game Boy time, to keep them on track.

5. Keep to a structured routine.
Kids with ADHD can't organize themselves, so the more predictable your child's world, the more predictable his behavior will likely be.

Read more: Kids and ADHD - Redbook

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Reprinted with permission of Hearst Communications, Inc.