ADHD – Enhancing our Understanding
As a pediatrician, I constantly receive and review new information and updates on the spectrum of ADHD in children and adolescents. Making an accurate diagnosis and treatment plan using the best evidence-based information (with support of AAP guidelines and updates) is an important professional responsibility for me.
A recent practice guidelines article appeared in the New England Journal of Medicine (2/27/14) which had some very appropriate key points which I felt were worth sharing:
1) ADHD is the most common neurobehavioral disorder in children with occurrence rates between 5-10 %. ADHD has been found to be a more chronic and persistent condition than previously thought with 1/3 to 1/2 of patients diagnosed in childhood still exhibiting functional problems beyond school age.
2) Diagnostic evaluation relies heavily on “validated” parent and teacher rating scales (we use the Vanderbilt scale) that assesses behavior in different situations and at different times (ADHD symptoms, by definition, should occur in more than one setting and have been present for at least 6 months).
3) Coexisting conditions and problems are common and very important to identify and include learning disorders, “internalizing disorders” such as anxiety and depression and “externalizing disorders” such as oppositional defiance and conduct disorders.
4) A treatment plan must be developed that addresses overall functioning of the child and not solely focused on “core” symptoms.
5) Stimulant medication has been shown to positively affect core ADHD symptoms (better than behavioral management alone) but behavioral management improves overall functioning and, therefore, a treatment plan that looks comprehensively at patient overall functioning is associated with the best outcomes.
Personally, I cannot emphasize the importance of making an accurate diagnosis and developing a treatment plan specific to that patient and his/ her functioning difficulties. Remember that medicine alone treats and hopefully will improve some core symptoms of ADHD but medicine, alone, is not enough! Our goal is to strive for a better overall functioning student – not only academically but socially. Understand that a behavioral plan is as critical to success as medication.
Also – knowledge is empowering and educating yourself as a parent about ADHD is vitally important to both you and your child! The AAP has strived to make diagnosis and management of ADHD objective and understandable. I keep copies of the AAP pamphlet on ADHD available at no charge. I have also purchased copies of the AAP book on ADHD which is available at cost for those families needing or desiring more detailed information. Also, our website under Health Links has ADHD references in addition to other practical information on the subject through the AAP’s HealthyChildren.org site.