Your Special Child - January 2012

Could it be ADHD?

By Amy Landsman

Wondering if your child might have attention deficit hyperactivity disorder, more commonly known as ADHD? Here are a few clues to look for.
Kids with ADHD typically have a hard time paying attention. Often, they don’t seem to listen, and they’re easily distracted, whether playing or doing schoolwork. They may be in constant motion, too, apt to squirm and fidget in their seats—if they stay in their seats at all. Also, in general, they have a difficult time taking turns and frequently interrupt others.
Of course, just about all kids act that way every now and again, but kids with ADHD do so more often than not, both at home and in school.
However, do not simply assume your very active child has ADHD. If you’re concerned, have the child's school system or pediatrician—or a psychologist or psychiatrist—conduct an evaluation.
“A lot of times, when someone comes to us for an evaluation for ADHD, it’s mainly because the child is very disruptive or aggressive, plus or minus they’ve been having problems with learning at school,” says Gloria Reeves, a psychiatrist and assistant professor at the University of Maryland School of Medicine, in the Division of Child and Adolescent Psychiatry. “Unfortunately, those complaints are pretty nonspecific. ... There are a lot of things you need to evaluate in disruptive kids.”
An evaluation for ADHD will include information on how the child behaves at home and school as well as in the clinician’s office.

Inattentive vs. Hyperactive
There are two primary types of ADHD.
Children who are easily distracted or disorganized and have trouble following instructions may be diagnosed as “inattentive.” Those who fidget and talk a lot, interrupt or grab things from others, or seem unable to wait in line or listen to directions may be diagnosed as having hyperactive-impulsive disorder.
“The hyperactive type is far more associated with boys,” says Sharyn Rhodes, who was an associate professor of Special Education at Loyola University Maryland for 29 years and is on the national board of the nonprofit group CHADD, or Children and Adults with Hyperactivity/Attention Deficit Disorder.
Rhodes says about an equal number of boys and girls have ADHD. However, since girls tend to be inattentive—and, therefore, often less disruptive than hyperactive boys—they usually are diagnosed later than boys. Children can be diagnosed with ADHD as young as age 4.
The Centers for Disease Control and Prevention reports that “research does not support the popularly held views that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty or family chaos,” although those variables “might make symptoms worse.”
Current thinking on the subject emphasizes that kids with ADHD don't deliberately behave badly or disruptively. It’s differences in their brains that create problems with impulse control.
Dr. Mark Mahone, director of neuropsychology at the Kennedy Krieger Institute in Baltimore, is the lead author of a new study that found differences in the brain development of preschool children with ADHD symptoms compared to the brain development of those without. Using neuroimaging, Mahone found that the region of the brain important for cognition and motor control was smaller in the children with ADHD symptoms.
Mahone plans to follow the children for three years to record how their brains are developing over time. He ultimately hopes that earlier identification and treatment of children with attention problems in preschool will help minimize the long-term impact of ADHD.

Coexisting Conditions
According to the National Resource Center on ADHD, a program of CHADD, many children with ADHD have coexisting conditions, such as learning disabilities, mood disorders, or tics.
“There are a lot of things you need to evaluate to see if ADHD is the primary problem,” says Reeves, “or if there are other problems co-occurring with ADHD.”
She points to “kids who have learning disabilities, kids who have speech and language problems, children dealing with domestic violence where they may be reenacting aggressive behavior, and kids who have significant anxieties or worries.”
While the thought of having a child with ADHD might feel overwhelming to parents, Reeves wants them to remember that most kids with the disorder are creative, out-of-the-box thinkers and, additionally, that the hyperactive aspect tends to “ameliorate over time.”
Moreover, notes Mahone, when diagnosed and appropriately treated, “People with ADHD tend to have pretty good outcomes.” BC

For a more complete list of signs and symptoms of ADHD, go online to PubMed Health, at www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002518.

For More Information
CHADD
(or Children and Adults with Hyperactivity/Attention Deficit Disorder), www.chadd.org. This national website will direct you to a local chapter.
The Maryland Coalition of Families for Children’s Mental Health, Columbia, 888-607-3637, www.mdcoalition.org.

© Baltimore’s Child Inc. January 2011