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Attention Deficit Hyperactivity Disorder (ADHD) has been recognised for almost a century and is the most extensively researched neurological disorder affecting children. However, there is still widespread misunderstanding about the condition: many believe that ADHD is simply a result of poor parenting, and some question whether the disease exists at all (1).
Nevertheless, the detrimental social, academic and even economic consequences of ADHD cannot be denied. Improved understanding about the symptoms and consequences of the disorder and the treatments that have proven effective, is vital in order to best help the child with ADHD (1,2,3).
ADHD affects up to 10% of school-aged children regardless of population group or economic class. Up to 60% of these children will continue to display symptoms of the disorder well into adulthood (1).
The exact cause of ADHD is still unknown, but experts are certain that it is hereditary (many of these children have a first-degree relative with the same problem), and that sufferers have an imbalance of neurotransmitters (chemical messengers) in the brain (4,5). Poor parenting, excess sugar, food allergies and too much TV do not result in children developing ADHD, although in some cases, they may exacerbate the symptoms (6).
Left untreated, the majority of children with ADHD will be at risk of developing low self-esteem, schooling difficulties, and even anti-social behaviour. Teenagers with ADHD are three times more likely to fail one or more grades, and be suspended or expelled during their school years. They are also more likely to smoke and experiment with drugs (1).
Symptoms
The symptoms of ADHD tend to vary according to age, but the four main ones are medically known as hyperactivity, inattention, impulsivity and distractibility (5). Parents of these children may describe them as fidgety, forgetful, incapable of following instructions, disorganised, and unable to wait their turn (6).
There is no single test to determine whether a child has ADHD. Instead, the child’s doctor will take a detailed history, talking to the parents, teachers and child if he/she is old enough (1,4,5). Using a specific, scientifically-verified set of criteria, the child’s symptoms and any associated difficulties are assessed, and other conditions are ruled out (1,5). Details such as how long the child has displayed these symptoms, if they are present in various settings (e.g. home, school, social situations), if the symptoms appeared before the child turned seven, and if they cause significant academic and/or social impairment, will help towards making an accurate diagnosis of ADHD (1).
The treatment of ADHD is multi-faceted and may include behavioural modification, psychotherapy and medication (1,4,5). Although much has been written about dietary interventions in the management of ADHD, none have been clinically proven, and more research is necessary before definitive recommendations can be made by the scientific community (4). Educating parents, teachers and family members about the condition and showing them ways to implement behavioural techniques such as rewards or time-out systems are key, but need to be done consistently in order to be effective (1).
Medication
The cornerstone of ADHD therapy is medication (1,4,5,6,7). Nine out of 10 children respond to medication, and half of those who do not improve with initial therapy respond to a different type of medicine (6). Even when behavioural changes are successful, the addition of medication provides further improvement in ADHD symptoms (1).
There are two types of medication available - stimulants and non-stimulants (1). Stimulants, such as methylphenidate, are the most widely used and tend to be the medication of choice for children or adolescents with ADHD. Non-stimulants are generally used only if stimulant medication has not worked adequately or if the child develops side effects (1).
Although there has been a lot of negative media attention focused on stimulants in the past, these medications have been extensively studied (in fact, more is known about these stimulants than any other medication prescribed to children!) (1). Because they have been scientifically proven to be effective in adults and children over six years old, and because of their minimal side effects, stimulants remain the cornerstone for the treatment of ADHD (1).
Methylphenidate has been rigorously tested and proven to provide an immediate, dramatic improvement in the main symptoms of ADHD, such as hyperactivity, inattention and impulsivity. Treatment also improves verbal and physical aggression, concentration, and social interactions with peers, parents and teachers. This not only leads to better academic performance, but also a more confident and happy child. Contrary to popular belief, methylphenidate is not addictive if used appropriately and does not lead to substance abuse. In fact, there is evidence to show that treating ADHD with stimulants may actually prevent substance abuse (both drug and alcohol) later in life (1,7).
Treatment should always be tailored according to the individual child’s needs. Regular check-ups and treatment reviews will ensure that the child is receiving the best possible care (1).
ADHD may seem frightening and its consequences devastating, but the reality is that there is much that parents can do to address the symptoms and help their children to cope better. Early identification, diagnosis and treatment can help these children to reach their full potential. (Novartis, September 2009)
References
1. Adesman AR. The Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Pediatric Patients. Primary Care Companion J Clin Psychiatry 2001; 3: 66-77.
2. McLeod JD, Fettes DL, Jensen PS, et al. Public Knowledge, Belief, and Treatment Preferences Concerning Attention-Deficit Hyperactivity Disorder. Psychiatric Serv. 2007; 58(5): 626-631.
3. Matza LS, Paramore C, Prasad M. A review of the economic burden of ADHD. Cost Effectiveness and Resource Allocation 2005; 3(5): 1-9.
4. Smoot LC, Boothby LA, Gillett RC. Clinical Assessment and Treatment of ADHD in Children. J Clin Pract Oct 2007; 61(10) :1730-8.
5. Gottesman MM. Helping Parents Make Sense of ADHD Diagnosis and Treatment. J Pediatr Health Care ; 17(3) :149-53. Available from URL: http://www.medscape.com/viewarticle/453700_print. Accessed 8 July 2009.
6. Mental Health America. Fact Sheet: AD/HD and Kids. Available from URL: http://www.nmha.org.go/information/get-info/ad/hd/ad/hd-and-kids. Accessed 8 July 2009.
7. Voeller KKS. Attention-Deficit Hyperactivity Disorder (ADHD). Available from URL: http://www.medscape.com/viewarticle/495640_print. Accessed 8 July 2009.
Reviewed by Dr A van der Walt, MMed (Paed) BSc Hon (Human Genetics), February 2015.
