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Sunday 24 September 2006

Range of symptoms define ADHD

By: Lubna Somjee

Fall is here and students are back in school. Children are naturally curious about learning, however, some end up becoming frustrated because of difficulties they have.

There are various issues that have the potential to impede academic progress. When undiagnosed, these issues can potentially drain that natural curiosity and excitement about school. One of these challenges is attention deficit hyperactivity disorder or ADHD.

ADHD becomes apparent during childhood, although certainly many are diagnosed during adolescence and adulthood.

It is estimated between 3 percent and 5 percent of children have ADHD. Unfortunately, when overlooked, children can go on to have difficulties with academics and peer relationships. Additionally, a minority of individuals with ADHD are at higher risk for oppositional behaviors, low self-esteem, mood or anxiety disorders and substance abuse. It becomes important to assess for ADHD early on.

Currently, there are three subtypes of ADHD. These include predominantly hyperactive-impulsive type; predominantly inattentive type; and combined type.

Hyperactivity

Children who are hyperactive are on the go. They may get up and leave their seats, run or climb in situations that are not considered appropriate. They may find themselves fidgeting and squirming during dinner or other times when they are expected to sit still. Parents often note that their children talk incessantly and have difficulty with "quiet time."

Impulsive

Children who are impulsive may do or say things without thinking about the consequences. They have difficulty working for long-term rewards and instead focus on short-term gratification. It may be difficult for them to wait their turn in lines or games, and may also consistently interrupt conversations.

Inattentive

Children who are inattentive may be forgetful. Examples include leaving homework assignments at school or forgetting to take completed assignments to school. Individuals may be easily distracted from doing tasks and will often require direct supervision to complete them. They are also prone to daydreaming.

The symptoms of ADHD have to appear prior to age 7 and have to consistently and significantly affect at least two areas of the person's life. This could include school, home life or social functioning.

ADHD can be very difficult to diagnose. This disorder, as with any psychological disorder, is based on more than checking off symptoms on a list. The symptoms listed above can also be due to psychological, sleep, neurological or medical disorders. Additionally, not everyone who has difficulty with concentration, is on the go or impulsive has ADHD.

As mentioned before, the disorder can be underdiagnosed, but it can be over-diagnosed as well. It is important that the evaluation be done by appropriate professionals to assess whether the symptoms in question are ADHD, related to another disorder or part of natural functioning.

Evaluation

Psychologists, psychiatrists, psychiatric nurse practitioners, pediatricians and neurologists are experts who can diagnose ADHD through various assessments. However, each professional can have widely varying degrees of experience with ADHD, and the professional you see should have specific experience and training.

The evaluation will consist of different things depending on the professional. If the assessment is done by a psychologist, the initial step will be to take your child to the pediatrician to rule out anything medical that may be contributing to symptoms.

The evaluation by the psychologist will consist of different components. A comprehensive interview with your child is usually the first step. This will be done in conjunction with one or more parents who will also be interviewed. The interview will consist of questions focusing on ADHD and psychological disorders that can often be confused with ADHD. Additional questions about family, symptom history, medical, developmental history and social functioning will also be assessed. Information will be gathered from teachers to assess your child's functioning at school. Tests will be administered to determine the diagnosis of ADHD alongside various behavioral checklists. It is important to know tests alone should not be the determining factors in diagnosing ADHD without a thorough clinical interview.

Depending on the symptoms, it may be determined your child needs a full psychological or neuropsychological battery of tests. These would also be done by a psychologist or neuropsychologist, who specializes in these types of assessments, including intelligence testing or learning disability testing.

Once your child is assessed, feedback will be provided, including diagnoses (if there is one) and treatment planning. If your child is found to have one of the subtypes of ADHD, the psychologists' assessment can be provided to your child's school in order to provide accommodations and/or special education services.

Treatment

The first step, in many cases, is to provide your child with information about ADHD, behavioral strategies and psychotherapy to help them manage within and outside the classroom. This can be helpful in building up confidence that is sometimes lost when children are struggling with ADHD. Psychotherapy will also include parents so they can learn strategies to manage various behaviors. Support groups for parents and children can be a helpful adjunct.

Depending on the severity, medications can also be very helpful in managing the symptoms. However, medications work differently with each child and patience is key to finding a medication that works best.

If you have specific questions, find a health-care professional with training and experience with ADHD. There are treatment options and it is a matter of being diagnosed appropriately so you can find what works best for your child.

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