The Scoop on ADHD

In an effort to educate parents and families about mental illness, I have decided to write a series called, "The Scoop."  Every week, I will feature a different psychiatric disorder and discuss 5 - 10 facts about that illness to promote awareness and improve understanding of the condition.  This post focuses on Attention Deficit Hyperactivity Disorder or ADHD. According to the Centers for Disease Control and Prevention, roughly 11% of children ages 4 - 17 years old have ever been diagnosed with ADHD.


The DSM-5 Criteria:  Attention Deficit Hyperactivity Disorder (ADHD)

Symptoms present for at least 6 months and negatively impact academic performance, work, and/or social interactions

Inattention - fails to pay close attention to details or makes careless mistakes, difficulty sustaining attention in tasks, trouble listening,  difficulty following instructions and fails to complete schoolwork or work place duties, difficulty organizing activities, loses things necessary for school or work, forgetful, easily distracted, dislikes or avoids activities that require sustained mental effort (homework, papers/reports) 

Hyperactivity and Impulsivity - fidgets with or taps hands and feet or squirms, trouble remaining seated, runs about or climbs or feels restless, unable to play quietly, often on the go, excessive talking, blurts out, impatient/difficulty waiting their turn, interrupts or intrudes on others


What to Know

1) ADHD is NOT simply a bad, disobedient child who needs  more structure and stricter discipline although such modifications can be helpful.  Focus on increasing desirable behaviors and decreasing negative choices rather than punishing a bad child.

2) Remember when kids were diagnosed with either ADD or ADHD? Well, ADHD used to be divided into two distinct categories - Attention Deficit Disorder or ADD for the inattentive child and Attention Deficit Hyperactivity Disorder or ADHD for the hyperactive and impulsive child. However, when the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders or DSM -5 was published in 2013, ADD and ADHD were combined into 1 disorder with three separate subtypes - predominantly inattentive, predominantly hyperactive and impulsive, and a combined presentation which is most common.

3) Kids with ADHD inattentive type, especially girls, are often missed early on as they appear quiet and calm rather than loud and rambunctious. Nevertheless, these youth are often distracted by external stimuli and may forget to turn in their homework or misplace assignments which can lead to poor grades. 

4) Distractibility and difficulty completing assignments are symptoms that can be seen with a variety of medical and psychiatric illnesses. Medical problems like vision or hearing impairment, chronic insomnia, and seizure disorders and psychiatric illnesses such as Major Depressive Disorder, learning disabilities, and anxiety disorders can mimic depression. Your doctor should evaluate for and rule out other medical and psychiatric conditions prior to making a diagnosis of ADHD. 

5) Many children with ADHD exhibit low frustration tolerance. They are often easily upset, prone to irritability, and sometimes become quite angry and even physically aggressive.  Some will have temper outbursts because they have difficulty regulating their emotions.

6) Many children and adults with ADHD often exhibit problems with executive functioning. Controlled by the front lobe of the brain, executive function refers to the set of skills an individual needs to get things done. This includes tasks such as organizing time, prioritizing tasks, sustaining attention, shifting focus, planning, problem solving, decision making, delaying gratification, multi-tasking, initiating tasks, managing emotions, and exerting self-control. ADHD and executive function work hand-in-hand.

7) Taking stimulant medications such as Adderall, Vyvanse, or Concerta does not increase the risk of substance abuse in teens and adults; but, individuals with ADHD do have a higher risk for developing substance abuse.

8) Using medication to target symptoms in children and teens with ADHD represents only 1 strategy in the treatment of ADHD. Many other non-pharmacologic treatment options exist and should be used in concert with or in lieu of (depending on preference) medications. Additional therapies include vitamins and supplements such as Fish Oil, ADHD coaching and counseling, mindfulness, parent-training and behavioral therapy, and exercise.

9) There is no specific ADHD diet. Many parents attempt to limit sugary foods and drinks or red dyes to reduce symptoms, but research shows minimal effects for the vast majority of children. However, maintaining a healthy diet and regular exercise for children and adults is always a good strategy. 

10) Parents always ask if the medication I prescribe will zombify their child. With 100% certainty, I can proudly assure every parent that I have never turned in child into a ZOMBIE from taking ADHD medication. Sometimes the dosage of the stimulant medication is too strong, and your child appears dull and overly sedated. This is an easy fix - lower the dosage if that makes sense for your child's symptoms or simply try another medication. There are a lot of medication options available. 

11) Here is one last fact as ADHD is so common and parents often have lots of questions. Common side effects related to ADHD medications for which to monitor include decreased appetite and weight loss, sleep disturbances and specifically trouble winding down and falling asleep, headaches, stomachaches, rebound which is when kids become very irritable when the medication wears off, mood changes and irritability, anger, and initial slowed growth over the first 1 - 3 years of treatment though children still reach their intended height.

These are just a few important facts about ADHD. Feel free to post comments and questions, and check back next week for a new post on another psychiatric illness.