Mar 8, 2023, 12:44 PM by Dr. Sally Robinson


Keeping Kids Healthy by Dr. Sally Robinson

Almost everyone, whether they have children or not, has heard about Attention Deficit Hyperactivity Disorder (ADHD).  The issue of “not focusing” can be associated with hyperactivity or without hyperactivity. The children with hyperactivity are distracted by everything. The children without hyperactivity are easier to overlook as they are not disruptive but they also have problems with focusing and learning.

ADHD is a neurodevelopmental disorder that causes children to have difficulties with inattention, hyperactivity, impulsivity, regulating moods and organization. Parents and teachers notice these children have trouble paying attention, concentrating, losing things, following directions, sitting still, acting without thinking or getting mad and frustrated easily. According to the American Academy of Child and Adolescent Psychiatry (AACAP), this disorder affects about 10% of school-aged children, about 70% of these children will still have the disorder into adolescence and half will continue into adulthood.  The hyperactivity and impulsivity tends to decrease with age but the problems with inattention last longer and may get worse as school becomes more difficult.

Research has found that ADHD is related to the way certain chemical messengers (neurotransmitters) work in the brain.  It appears that these messengers, dopamine and norepinephrine, are less available to send their messages in certain parts of the brain.  Unfortunately these differences cannot be seen by brain imaging, brain waves or blood tests.

Diagnosing ADHD requires a thorough evaluation of the child’s symptoms which may take a long time. This should include a review of the family’s history of mental health, learning issues and substance abuse.  It should include information from the educational professionals working with the child and testing of the child’s abilities and mental health.

The part of the brain that helps people to organize, plan, pay attention and make decision is the frontal lobe.  Parts of the frontal lobe may mature a few years later in people with ADHD.  It is fairly normal for preschoolers to be very active and have limited attention spans which generally improves in the school aged children. This can be seen in a kindergarten class as the younger children are more active and inattentive than those with older birthdates.  The frontal lobe continues to mature into the twenties.

The AACAP suggests that treatment should be considered as the risks of not treating can have the following effects associated with ADHD: academic underachievement, problems with peers, low self-esteem, depression, anxiety, and substance abuse.  Treatment includes education about ADHD for parents and the child including behavioral modifications and school-based accommodations.  Large studies of school-aged children show that some do not require psychotherapy while others benefit from a combination of parent training/behavioral training plus medication.

ADHD medications are the most successful intervention for ADHD. Three-fourths of children will respond well to one or more of medications which are stimulants (amphetamines, methylphenidate), non-stimulants (clonidine, guanfacine), and second-line non-stimulants (antidepressants).

Successful treatment involves a team of the child, the parents, the educators and the pediatrician.  For all learning is a lifelong process and for some that will include medication.

UTMB Pediatrics - Children's Complex Care 
Also See: Behavioral Health

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