ADHD by David S Katz, MD
Posted on: 02/11/2012
ADHD
By David S. Katz
As
I sat down to write this article, Daniel came by to offer his
assistance. Daniel is 29 years old. He happens to have Down Syndrome.
He grew up in our office as a patient and now works here part time. When
I told Daniel what I was writing, he offered me some excellent advice.
He said that each child comes from a different situation and needs to
be treated as an individual.
The
American Academy of Pediatrics issued an update to their guidelines for
the evaluation of children and adolescents with Attention Deficit
Hyperactivity Disorder in the Fall of 2011. The Academy suggests that
the evaluation should be initiated when symptoms become apparent in
children 4 years of age or older.
The diagnosis of AHDH should follow the DSMIV-TR (Diagnostic and Statistical
Manual of Mental Disorders). The evaluation looks for signs of
inattentiveness and hyperactivity. It should include
information from the family as well as school or daycare or from other
activities in which the child may be involved. Vanderbilt University
has developed questionnaires to aid in the evaluation.
The
child’s primary physician can be an excellent resource to provide a
medical home to coordinate the evaluation and provide a treatment plan,
including behavioral interventions, counseling and medication when
indicated.
As
Daniel suggested each patient needs to be evaluated as an individual.
The evaluation looks for so called co-morbidities. This means to look
at the patient and family’s other circumstances. So an evaluation
needs to include signs of oppositional defiance, anxiety, conduct
disorder (cruelty to others or animals), anxiety or depression.
It
is common for children with ADHD to be at increased risk for associated
learning disorders, such as a reading or mathematics disability. An
evaluation by a psychologist may be necessary to define any learning
disabilities or emotional issues. Sleep disorders (such as sleep apnea)
may present as ADHD due to their impairment of concentration. Other
physical disabilities such as visual impairment, hearing loss, cerebral
palsy, and seizure disorder,, make learning more difficult. A study in
China, where eyeglasses are frowned upon, showed that evaluating vision
and providing corrective glasses when indicated, was one of the most
cost effective educational interventions.
A
recent AAP study showed, not surprisingly, that adequate nutrition is
important for school success. That was the initial justification for
federally funded school breakfast programs for children whose families
could not afford adequate nutrition.
Evaluating
the family’s strengths and weakness is important to help support the
child’s success. It is also important to be sure that the child has a
safe home in which to live. For example, if a family member is
depressed, it affects the functioning of the entire family. Providing
help for the person’s depression, will benefit the entire family.
Examining
a child’s ability to function in different environments, such as home,
school, friends and other activities, is essential. If the behaviors
are not problematic in all environments, one needs to understand what
allows the child is successful in some areas, and what interferes in
others.
The
goal of a complete evaluation is to understand the child or
adolescent’s strengths as well as his/her weaknesses. This is essential
in order to develop a plan to help the child succeed and thus to be
able to feel good about him or herself.
Some helpful resources for ADHD include:
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-read/index.shtml
http://ldaofky.org/
http://www.allkindsofminds.org/
David S. Katz, MD
Kaplan Barron Pediatric Group
www.kaplanbarron.com
Clinical Associate Professor of Pediatrics
University of Louisville
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