Does your child have ADD, ADHD, or both?

This article presents many common symptoms of ADD and ADHD to help parents determine if their child should be further evaluated for these conditions.

Does your child have Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder or both?

People with ADHD show a persistent pattern of inattention or hyperactivity-impulsivity that interferes with functioning or development, according to the Center for Disease Control. If a child exhibits six or more of each of the following patterns of symptoms, they may require further evaluation by a professional, according to the CDC:

Inattention
■Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
■Often has trouble holding attention on tasks or play activities.
■Often does not seem to listen when spoken to directly.
■Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace.
■Often has trouble organizing tasks and activities.
■Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time, such as schoolwork or homework.
■Often loses things necessary for tasks and activities, such as pencils and books.
■Is often easily distracted.
■Is often forgetful in daily activities.

Hyperactivity and Impulsivity
■Often fidgets with or taps hands or feet, or squirms in seat.
■Often leaves seat in situations when remaining seated is expected.
■Often runs about or climbs in situations where it is not appropriate.
■Often unable to play or take part in leisure activities quietly.
■Is often "on the go" acting as if "driven by a motor".
■Often talks excessively.
■Often blurts out an answer before a question has been completed.
■Often has trouble waiting his/her turn.
■Often interrupts or intrudes on others.

Other indications of possible concerns include that several inattentive or hyperactive-impulsive symptoms were present before the child was 12, that symptoms are present in two or more settings, such as at home and school, that the symptoms interfere with socializing, school and work, and that the symptoms are not better explained by another mental disorder, according to the CDC.

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How to tell if your child should be checked for ADD or ADHD

This article gives much information on ADD/ADHD including medicines and other treatment options.

Does the child have ADD/ADHD?
 

Attention Deficit Disorder (ADD) is a medical condition with problems in attention, focus, distraction, organization and impulse control. Attention Deficit Hyperactivity Disorder (ADHD) also has more motor hyperactivity than expected for children of similar age/maturity levels.
 

Valid, reliable screening forms for ADD, such as the Connors Scale or the free Internet-available Vanderbilt Scale, are much more accurate when filled out by multiple teachers observing children in groups, in addition to rating parental and therapist/nurse/doctor observations. These multiple observer’s rating scales do as well as specific “on/off task” computer tests especially now that kids are so familiar with video games.
 

Although we know that certain brain areas mediated by neurotransmitters dopamine and norepinephrine may be the source of impulse and focus problems, we have not been able to translate research into a clear ADD/ADHD test. No brain image, blood or neurological test is currently available. So parents and teachers use observations and rating forms to screen for possible ADD/ADHD.
 

What to try before medicines?
 

How helpful an active parent/school evaluation can be! It is important to find out the child’s academic ability as measured by cognitive and achievement tests. Are there specific areas of underachievement (eg., just the math) or is there general lack of success? It is necessary to diagnose defiant, manipulative, negative-attention-seeking behavior. Does the child do more homework than texting, video games and phone time?
 

Parental supports and consequences for school grades should be clarified. Is the student anxious, frustrated, sick, unable to see well, depressed, hungry, sleepy, worried about home life or using illegal substances? Once a parent/school evaluation has been done, parents and school can try accommodations to help needy students receive tutoring, prompts, sessions with school counselors and better communication with parents. Is there homework, and has the homework been done and brought to school?
 

School accommodations such as a 504 Plan and Individual Education Plan have helped many impatient, disorganized, distracted students, but these plans depend on 100 percent student and parent participation with the school.
 

Medicines for ADD/ADHD
 

Try school evaluations, academic extra help, therapy, and good pediatric evaluation first. Because there are potential benefits and possible major adverse side effects, all custodial “parents” need to be part of the medicine discussion. Today, this may include married, divorced, or never-married parents or custodial relatives.
 

Types of medicines
 

Stimulants are controlled substances. They are written on a special nonrefillable script for medicines with abuse and addiction potential. Each script is follow by the U.S. Department of Justice Drug Enforcement Administration. Urine drug screens and Kasper reports (indicate prescriptions from multiple doctors) follow controlled substance stimulant scripts. Stimulants are increasingly used inappropriately without prescriptions by older students who hope for “cognitive enhancement,” or a quick fix at the last minute as they cram for exams or finish papers.
 

Types of stimulants
 

Methylphenidates are Ritalin, Methylin, Focalin, Metadate, Concerta and Daytrana.
Mixed amphetamines are Dexadrine, Adderall and Vyvanse.
 

Possible adverse side effects
 

1. Cardiac risk, especially for unrecognized pre-existing heart problems.
2. Increased pulse and blood pressure.
3. Appetite suppression and rebound binge eating.
4. G.I. upset.
5. Decreased growth.
6. Transient tics or twitches
7. Insomnia
8. Rare brief psychotic reactions or obsessive over-focus.
 

Nonstimulant Strattera: It can be used with seizure disorder. Takes one to two months for maximum benefit.
Possible adverse side effects: Similar to stimulants except no tics.
 

Nonstimulants Intuniv (Tenex, Guanfacine) and Kapvay (Clonidine)
Possible adverse side effects:
 

1. Sedation
2. May lower pulse and blood pressure
3. Do not discontinue quickly!
 

Thanks for your attention, and I hope you were not reading this with one hand on your phone and the other on the steering wheel! Our whole society is distracted, hurried, overstimulated and overstressed.
 

First, try to set priorities in your own life. Limit the video games. Turn off the TV. Increase your child’s exercise and active learning time. Second, work with your school, child and therapist. See your child psychiatrist when you are already trying the nonmedical approaches and we will work with you to coordinate nonmedical and possible medical intervention.

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Diagnosing the Wrong Deficit - A Great Read about ADD-ADHD & Sleep from the NYTimes

Diagnosing the Wrong Deficit

By VATSAL G. THAKKAR

IN the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently. But one thing was unusual. His symptoms had started only two years earlier, when he was 31.

Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.

The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.

Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?

For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.

We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago. And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.

A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.

One study, published in 2004 in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 control subjects.

A 2006 study in the journal Pediatrics showed something similar, from the perspective of a surgery clinic. This study included 105 children between ages 5 and 12. Seventy-eight of them were scheduled to have their tonsils removed because they had problems breathing in their sleep, while 27 children scheduled for other operations served as a control group. Researchers measured the participants’ sleep patterns and tested for hyperactivity and inattentiveness, consistent with standard protocols for validating an A.D.H.D. diagnosis.

Of the 78 children getting the tonsillectomies, 28 percent were found to have A.D.H.D., compared with only 7 percent of the control group.  

Even more stunning was what the study’s authors found a year after the surgeries, when they followed up with the children. A full half of the original A.D.H.D. group who received tonsillectomies — 11 of 22 children — no longer met the criteria for the condition. In other words, what had appeared to be A.D.H.D. had been resolved by treating a sleeping problem.

But it’s also possible that A.D.H.D.-like symptoms can persist even after a sleeping problem is resolved. Consider a long-term study of more than 11,000 children in Britain published last year, also in Pediatrics. Mothers were asked about symptoms of sleep-disordered breathing in their infants when they were 6 months old. Then, when the children were 4 and 7 years old, the mothers completed a behavioral questionnaire to gauge their children’s levels of inattention, hyperactivity, anxiety, depression and problems with peers, conduct and social skills.

The study found that children who suffered from sleep-disordered breathing in infancy were more likely to have behavioral difficulties later in life — they were 20 to 60 percent more likely to have behavioral problems at age 4, and 40 to 100 percent more likely to have such problems at age 7. Interestingly, these problems occurred even if the disordered breathing had abated, implying that an infant breathing problem might cause some kind of potentially irreversible neurological injury.

Full article here

The difference between ADD and ADHD

Dennis the Menace may be the most beloved ADHD cartoon character ever! Impulsive and hyperactive, he makes the afflicted Dory, the ever-swimming, easily distracted Regal Blue Tang from "Finding Nemo," look focused. Turns out that attention deficit hyperactivity disorder (ADHD) -- an all-inclusive term that swallowed up attention deficit disorder (ADD) -- comprises a cluster of symptoms from mildly inattentive to disruptively agitated and shows up differently in boys and girls.

ADHD contains three subtypes of behavior: 1) hyperactive-impulsive; 2) inattentive (what was formerly ADD); and 3) hyperactive-impulsive and inattentive combined. A child can have any combination or degree of these behaviors.

One theory that explains why more boys (13 percent) are diagnosed than girls (6 percent) is that girls tend to be less disruptive, more daydreamy and have attention deficit; while boys are hyperactive-impulsive. They're the squeaky wheel!

For all kids, diagnosis requires repeatedly inappropriate behavior and/or chronic inattention and clear differences between a child's behavior and capabilities and those of his or her peers. Adults diagnosed with ADHD must have had their symptoms since childhood.

Both kids and adults are treated with medication and psychotherapy. Treatment protects kids (and adults) from developing antisocial behaviors, addictions, anxiety and eating disorders, particularly binge-eating and obesity.

So, if you (or someone you love) have trouble making friends, holding a job, paying attention or controlling impulses, opt for diagnosis and treatment. It might provide a huge improvement in daily life. And helping yourself, a friend or family member get healthier always makes your RealAge younger.

Read more here: http://www.herald-dispatch.com/news/x1190167523/ADHD-vs-ADD-Whats-the-difference