Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder that affects the behavior, attention, and learning of children. Diagnostic criteria for ADHD include symptoms of hyperactivity, impulsivity, and/or inattention that occur in more than one setting (school and home), affect function (eg, academic, social, emotional, etc).
It is a chronic disorder with therapy ranging from behavioral modifications to treatment with medication. Treatment of ADHD may involve behavioral interventions, medication, school-based interventions, or psychologic interventions alone or in combination.
Understanding The Scattered (ADHD) Brain
ADHD is a syndrome with two categories of core symptoms: Hyperactivity/Impulsivity and Inattention. The complaint regarding symptoms of ADHD may originate from the parents, teachers, or other caregivers.
Hyperactive and impulsive behaviors almost always occur together in young children. The predominantly hyperactive-impulsive subtype of ADHD is characterized by the inability to sit still or inhibit behavior. They may include:
Children with the inattentive subtype often are described as having a sluggish learning tempo and frequently appear to be daydreaming or "off task". The typical presenting complaints center difficulty learning and doing poorly in school. Symptoms of inattention may include:
The symptoms of inattention typically are not apparent until the child is eight to nine years of age. This delay may relate to reduced sensitivity of assessment of attention problems or increased variability in the normal development of the cognitive skills.
Should be initiated in children older than 4 years of age who have symptoms of inattention, hyperactivity, or impulsivity or who have complaints frequently associated with ADHD (eg, poor school performance, difficulty making and keeping friends, difficulty with team sports).
The evaluation for possible ADHD includes comprehensive medical, developmental, educational, and psychosocial evaluation.
Comprehensive evaluation is necessary to determine the presence, persistence, and complications determined by the diagnosis of ADHD, and identify other coexisting emotional or behavioral diagnosis.
Re-Evaluation of children with ADHD is warranted whenever symptoms worsen or new symptoms emerge because the differential diagnosis of ADHD is extensive and comorbidity is common.
The symptoms of hyperactivity/impulsivity or inattention must:
Kidz1st can provide you with information regarding where this evaluation can take place.
(see detailed information at the bottom of the page)
Behavioral techniques that are used for children with ADHD include positive reinforcement, time-out, response cost (withdrawing rewards or privileges when unwanted or problem behavior occurs), and token economy (a combination of positive reinforcement and response cost).
Behavior therapy and environmental changes that can be used by parents or teachers to shape the behavior of children with ADHD include:
Additional tips for parents of children age 6 to 12 years are available through the National Initiative for Children's Healthcare Quality toolkit, free with registration.
Standardized training programs for parents of preschool children with disruptive behavior disorders (including symptoms of ADHD) include:
A great resource to help look for counselors can be found at Psychology Today.
Combination therapy uses both behavioral/psychologic interventions and medications. Studies have shown that combination therapy with medications and behavior/psychologic therapy was superior to behavior/psychological therapy alone.
IF ANY OF THESE ARE USED, PLEASE LET US KNOW.
We do not recommend performing pharmacogenetic testing before prescribing medication for ADHD.
We agree with the US Food and Drug Administration and the American Academy of Pediatrics that results of pharmacogenetic tests that are directly marketed to consumers should not be used to make decisions about the appropriateness of a particular medication or dosing of such.
It is important to have realistic, achievable and measurable target goals when treating ADHD. These may change with time and should be created between the parent, patient and school. Some examples of goals are:
As many as one-third of children with ADHD have one or more coexisting conditions (eg, learning disabilities, oppositional defiant disorder, conduct disorder, anxiety disorder, mood disorders, tics, sleep disorders). It is important that those are addressed as well since it may influence the success of treatment of the ADHD
Behavioral and psychologic interventions may be necessary for managing the full spectrum of symptoms. Treatment of sleep problems may improve ADHD symptoms as well.
School-based interventions may include tutoring or resource room support, classroom modifications, accommodations, or behavioral interventions.
Classroom modifications and accommodations may include:
The teacher's completion of a daily report card facilitates the monitoring of symptoms and the need for changes in the treatment plan.
In the United States, ADHD is considered to be a disability under the Individuals with Disabilities Education Act (IDEA [PL-101-476]). Under IDEA, children with ADHD may qualify for special education or related services. Alternatively, they may qualify for appropriate accommodations within the regular classroom setting under Section 504 of the Rehabilitation Act of 1973.
In addition, the Americans with Disabilities Act may provide individuals with ADHD reasonable accommodations in secular private schools and post-secondary education The completion of a daily report card or a "communication book" to facilitate communication between the parents and the teachers may be suggested as an accommodation under a 504 plan.
Once a diagnosis is made, regular monitoring of the effectiveness of treatment is important. Frequent communication between the teacher, parents and health care provider is necessary to ensure optimal treatment and success for the child.
Once your child has completed the evaluation and the diagnosis of ADHD has been made, you are ready for your child to have his initial ADHD visit with Dr. Operti-Considine.
Because of the intricate treatment of ADHD, it is important that your child is up to date with his annual exam. This will be extremely helpful in making the best treatment recommendation by having updated and complete information on your child.
Please know that ADHD treatment and management is a group effort which involves the parent, the teachers, the child/adolescent and the doctor. Open communication and understanding is a MUST for us to be able to help your child be the best they can be. We will STRONGLY encourage you to sign your child in our office portal. This will allow for direct an open communication between parents and our office which can be used for refill requests, questions, updates and much more. (Reminder - NOT TO BE USED IN CASE OF AN EMERGENCY)
Once medication management is established and well controlled, office visits every 3-6 months will be done. At these visits, valid follow up questionnaires completed by your child’s teacher and parent will be reviewed to help identify response to therapy, any side effects of medication as well as any other concerns. When medication is being changed, more frequent follow ups may be necessary.
Since the medication used for ADHD is a controlled substance, a maximum of 30 days of treatment may be requested at a time. The prescriptions can be e-prescribed and should be requested through our portal. It is recommended that 4-5 days prior to needing a new prescription, a message with the request is sent through the portal. If not able to, please contact our office for further instructions. Once the refill has been sent to the pharmacy you will receive a response through our portal confirming the script has been sent. If such message is not received please contact our office for follow up.
If your child is not up to date with the well exams and requested medication rechecks, refills of the medications will not be provided.
We strive to treat and manage our patients with evidence-based research recommendations. The internet provides a vast amount of anecdotal and non-research based material regarding ADHD.
The websites below offer evidence based information regarding ADHD. Please refer to them for more information.
When we agree to a trial of medication for ADHD in a school-aged child or adolescent (≥6 years), we suggest a stimulant as the first-line medicine.
Stimulants are preferred to other medications because they have a rapid onset of action and long record of safety and efficacy.
Selective norepinephrine reuptake inhibitors (Strattera, Qelbree) are alternatives. Strattera is less effective than stimulants but well tolerated.
Alpha-2-adrenergic agonists (guafenicin/Intuniv, or clonidine) usually are used when children respond poorly to medications above. By themselves they are less effective than stimulants.
They are sometimes used together with a stimulant to maximize the effect of the stimulant when a higher dose is not tolerated, or can be used to help patients with sleep or other behavioral issues.
At least 80 percent of school-aged children and adolescents will respond to one of the stimulants.
In addition to improvement with the main symptoms of ADHD, treatment with stimulants can also improves family interactions, aggressive behavior, and academic productivity and accuracy.
Stimulant medications do not significantly affect learning problems, reduced social skills, oppositional behavior, or emotional problems that are secondary to or coexist with ADHD.
However, stimulant medications may facilitate the treatment of these problems by controlling the core symptoms of ADHD. In addition, the use of stimulant medications may improve self-esteem.
The choice of the initial medication depends upon a number of factors, including:
Generic drugs are less expensive than brand-names but not available for all formulations. Some have more than one manufacterer. If generics are used and your child responds well to them, we encouraged that you become familiar with the name and look of the capsule or tablet.
Pharmacies and insurances sometimes make changes unbeknowns to us and you which could be associated to a difference response in your child.
When children or adolescents who are being treated with stimulant medications develop adverse effects, It is important to gather as much information as possible in order to help us determine if these are related to the medication or time it is given,; or is related to other factors, i.e. stressors, or other pre-existing issues.
Mild adverse effects may resolve with time or can be addressed by adjusting the dose, time of administration, or formulation of stimulant.
Tips for initial management of common adverse effects of stimulant medications are provided below:
Monday - Wednesday:
Thursday:
Friday:
8:00 AM - 7:00 PM
8:00 AM - 6:00 PM
8:00 AM - 5:00 PM
Saturday: 8:00 AM - 12:00 PM
(as needed)
Monday - Thursday:
Friday:
8:00 AM - 6:00 PM
8:00 AM - 5:00 PM
