ADHD in children
What is Attention Deficit Hyperactivity Disorder (ADHD)?
ADHD is a disruptive behavior disorder characterized by a combination of inattentiveness, hyperactivity and/or impulsiveness. ADHD may manifest itself in children as young as 3 years of age although symptoms become more apparent as children enter into the structured environment of school. ADHD effects approximately 3% to 5% of preschool and school age children with boys diagnosed three times more often than girls. The cause of ADHD is not known but seems to have at least some genetic component as well as biologic and environmental factors, such as early head trauma, brain injury or other impediments to normal brain development such as premature birth, lead poisoning and prenatal exposure to cigarette smoke, alcohol or harmful drugs.
What are the sign and symptoms of ADHD?
Inattentiveness:
Not attentive to details or makes careless mistakes in schoolwork, work, or other activities
Difficulty sustaining attention in tasks or play activities
Does not seem to listen when spoken to directly
Does not follow through on instructions and fails to finish schoolwork, chores or duties
Has difficulty organizing tasks and activities
Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
Loses things necessary for tasks or activities
Forgetful in daily activities
Hyperactivity:
Often fidgets with hands or feet or squirms in seat
Often leaves seat in classroom or in other situations in which remaining seated is expected
Runs about or climbs excessively in situations in which it is inappropriate
Has difficulty playing or engaging in leisure activities quietly
Often on the go or often acts as if driven by a motor
Talks excessively
Impulsivity:
Often blurts out answers before questions have been completed
Has difficulty awaiting turn
Interrupts or intrudes on others
What are the medications used to treat ADHD?
Stimulants, non-stimulants, antidepressants and antihypertensive agents are used to treat ADHD.
Stimulants:
The most commonly used drugs for ADHD are the stimulants. These drugs are considered first-line agents. Stimulants are effective in treating inattentiveness, impulsivity, and hyperactivity. Specific agents include:
Methylphenidate and related (Ritalin, Concerta, Daytrana, Vynase)
Amphetamines (Adderall, Metadate, Dexadrine, Dextrostat)
Common side-effects of the stimulant class:
Loss of appetite: occurs in 41% of children
Trouble sleeping: 28% occurrence
Irritability/nervousness: 26% occurrence
Nausea: 23% occurrence
Headache: 10% occurrence
Weight loss
Heart problems (rare)
Tics
What happens if my child takes too much of their Stimulant medication?
In any situation such as this, the poison control center at 1-800-222-1222 should be contacted. Do NOT induce vomiting.
Non-Stimulants:
This class only consists of one drug, Atomoxetine (Straterra). In addition to relieving ADHD symptoms, atomoxetine may reduce anxiety.
Common side effects of atomoxetime:
Loss of appetite/weight loss (most common)
Upset stomach, nausea and vomiting
Mood swings, depression, suicidal thoughts
Dizziness
Sedation/Tiredness
Liver problems/jaundice
What happens if my child takes too much of their Non-Stimulant medication?
In any situation such as this, the poison control center at 1-800-222-1222 should be contacted. Do NOT induce vomiting.
Antidepressants:
Antidepressants are considered second line agents for ADHD, and are used in individuals that do not respond to stimulants, experienced intolerable side effects from stimulants or tics developed. Tricyclic antidepressants (TCAs) are useful in treating hyperactivity and inattentiveness, but lack efficacy for impulsiveness. The most commonly used tricyclic antidepressants for ADHD include:
Imipramine
Desipramine
Nortriptyline
Amitriptyline
Common side effects of TCAs:
Fatigue and sedation
Constipation
Dry mouth
Blurred vision
What if my child takes too much of their tricyclic antidepressants?
The poison control center should be contacted immediately at 1-800-222-1222
Do NOT induce vomiting.
Antihypertensives:
Antihypertensives help relieve impulsivity, hyperactivity and aggression caused by ADHD as well as reducing tics and insomnia that may be caused by other ADHD medications. The most commonly used antihypertension drugs are Clonidine (Catapres) and Guanfacine (Tenex) and they are generally used in conjunction with stimulants to treat ADHD.
Common side effects of Clonidine and Guanfacine include::
Sedation
Dry mouth
Blurred vision
Constipation
Heart effects
Neither Clonidine or Guanfacine should be discontinued abruptly, they should be tapered over time under supervision of physician.
What is my child takes too much of their antihypertensive medication?
If it is suspected that the child took too much the poison control center should be contacted immediately at 1-800-222-1222. Do NOT induce vomiting.
Tips for Parenting Children with ADHD
1. Positive reinforcement for positive behavior
2. Follow through with punishments for negative behavior
3. Set up a system to give rewards for good behavior
4. Simplify and shorten directions for activities and chores
5. Keep expectations at achievable level
6. Help the child develop their natural talents
7. Try to keep a routine schedule of daily activities and home life
ADHD counseling and therapy
Children with ADHD often benefit from counseling or behavior therapy, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some children with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling can help both ADHD and the coexisting problem.
Counseling types include:
Psychotherapy. This allows older children with ADHD to talk about issues that bother them, explore negative behavioral
patterns and learn ways to deal with their symptoms.
Behavior therapy. Teachers and parents can learn behavior-changing strategies for dealing with difficult situations.
These strategies may include token reward systems and timeouts.
Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
Social skills training. This can help children learn appropriate social behaviors.
Support groups. Support groups can offer children with ADHD and their parents a network of social support,information
and education.
Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.
Updated 2/11/2010
