ADHD:Before putting your child on Medications(Most important is number 9 )

The brain is the most interesting and the most difficult organ to handle. When something like ADHD is diagnosed in a child, parents feel distraught. But don’t worry. With timely intervention, good results are possible. What you must understand is that ADHD has a complex relationship with childhood stressors . All present and future treatments need behavioral training, family therapy, and medication, with weight being given to all. Before you start medicines and expect things to get better quickly, you need to know a few things.

ADHD The Summary

ADHD is a spectrum of disorder. The earlier the diagnosis, better is the long-term quality of life. While some children with associated psychiatric and developmental challenges are at the deep end of the spectrum. Many children with behavioral therapy, family support, medication will lead a productive life.

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#1 What is ADHD?

Attention-deficit/hyperactivity disorder or ADHD is the most common neurobehavioral disorder of childhood. That’s the bad news. The good news is it is also the most extensively studied mental disorder of childhood.

#2 What are the challenges the child may face?

• Academic underachievement
• Recurrent and persistent  interpersonal relationship problems .
• Issues of low self-esteem are very common.

#3 What other health problems may be associated?

The doctor will screen for

• Learning disability
• Language disorders
• Emotional issues
• Behavioral problems
• Psychiatric problem
• Vision
• Hearing

#4 What are the symptoms of ADHD: when you should visit a doctor?

If any of the following are there for more than 6 months in a child and is causing challenges of development, social, emotional academic. The symptoms broadly fall into categories of inattention and hyperactivity.

• Making careless mistakes, lacking attention to details. Not listening when spoken to directly. Not finishing activities and unable to follow through instructions. Disorganized.
• Avoids activities needing sustained attention. Child misplaces things necessary for activities. Occasionally misplacing pencil or rubber is normal and not unusual in young children. Try to stop  this habit by giving them a particular place to keep all their stuff next to the study table.
• Hyperactivity involves excessive fidgety movements. The child is unable to indulge in quiet play. Talks excessively
• Impulsivity: Not able to wait for a turn.Talks in between others etc

ADHD is a challenge to diagnose in preschoolers because distractibility and inattention are often present at this age. Different categories of ADHD is diagnosed, depending on criteria and needs a trained pediatrician.

#5 What causes ADHD?

The causes are complex and multifactorial. It is often the net result of several associated and simultaneous factors influencing brain development. There is a strong genetic role in ADHD. There is also a correlation with reduced dopamine level in the brain as a causative factors.

Maternal factors

• Birth complications such as toxemia, prolonged labor, complicated delivery.
• Maternal drug use
• Maternal smoking and alcohol use during pregnancy
• Exposure to lead prenatal or postnatal.

Child factors

• Food coloring and preservatives
• Brain trauma
• Abnormal brain structure on child increases the risk of ADHD

Family factors

• Psychosocial family stressors may cause or exacerbate symptoms of ADHD.
• Family stress
• Abuse
• Neglect
• A close blood relative with  ADHD, mood or anxiety disorders, learning disability, antisocial disorder, or alcohol or substance abuse.

#6 How will ADHD be diagnosed?

Diagnosis needs the opinion of a pediatrician, child psychiatrist, clinical psychologist. It involves detailed history, physical examination, lab test and interview with caregivers.

The doctor also screens for vision or hearing problems and test for elevated lead levels. The latter is more important when a child comes in children with some or all of the symptoms if these children are exposed to lead poisoning.There are no diagnostic tests available to identify ADHD in children at present.

#6   Treatment

• Psychosocial Therapy/Behavioural therapy
• Drugs
• Family therapy.

The detailed treatment protocols are beyond the scope of this article but medication depends on main symptoms presented. Psychostimulant medications, including methylphenidate (Ritalin, Concerta, Metadate, Focalin, Daytrana)Amphetamine, and/or various amphetamine and dextroamphetamine preparations (Dexedrine, Adderall, Vyvanse).

While generally well-tolerated in most children, Adderall and Vyvanse side effects most commonly include a loss of appetite, stomach pain, irritability and difficulty falling asleep. A longer list of side effects does occur in some children, although the more serious ones are rare.

Most of the drugs will have some side effects, which will be explained by your doctor.

#7 Behavioural management alone will not be enough. It is also a long-term goal.

Once the diagnosis of ADHD has been established, the parents and children are educated about  ADHD’s effect on learning, behavior, self-esteem, social skills, and family function. The doctor helps the family improve the child’s interpersonal relationships, study skills, and reduce disruptive behaviors.

#8 Untreated ADHD  Risks

• Increased  risk-taking behaviors (sexual activity, delinquency, substance abuse)
• Educational underachievement.
• Employment difficulties.
• Relationship difficulties.

#9 Prevention of ADHD

Parent training, training of caregivers and school teachers help in the early detection and treatment of ADHD. This has a big role to play in improving the quality of life in affected children. Early screening for Vision, Hearing and psychiatric problems will help in the effective treatment of children with ADHD. Long-term adverse effects of untreated and ineffectively treated children with ADHD is avoidable with early intervention. Detection of elevated lead levels in children who present with the symptoms is a part of the diagnostic arsenal.

Also if you are a young woman reading this and you want to be a mom later in life, you may want to avoid drugs, cigarettes, and alcohol. A future human’s quality of life may depend on it.

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Reference

1)DSM-IV DIAGNOSTIC CRITERIA FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER American Psychiatric Association: a Diagnostic and statistical manual of mental disorders, fourth edition, text revision, Washington, DC, 2000, American Psychiatric Association. Copyright 2000 American Psychiatric Association)

2)Nelson Textbook of Pediatrics

3)Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence
Raphaelle Beau-Lejdstrom,1 Ian Douglas,2 Stephen J W Evans,2 and Liam Smeeth

4)Attention deficit hyperactivity disorder (ADHD): What can help children and teenagers who have ADHD?https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079159/

Disclaimer: This post is written by  Dr.AbhijitMisra  MBBS, MD Pediatric Medicine and is meant for public knowledge and awareness and is in no way a replacement for physical consultation with a Doctor. Kindly consult your doctor for all health queries and before starting any medication. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or another healthcare provider. The information provided here is for informational purposes only. This may not cover all possible drug interactions or all FDA warnings or alerts. Please check with a physician if you have health questions or concerns about interactions or go to the FDA for a comprehensive list of FDA warnings. Although we attempt to provide accurate and up-to-date information, no guarantee is made to that effect.

Disclosure: This is a sponsored post but all opinions are mine and appropriately referenced.

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