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ADHD: What Parents Need to Know

What is Attention Deficit (Hyperactivity) Disorder or ADHD?
Attention-deficit Hyperactivity Disorder is “a condition of the brain that makes it hard for children to control their behavior”. (1) All kids have problems with their behavior from time to time, but kids with ADHD have behavior problems that interfere with regular life and are continual.  ADHD used to be called Attention-Deficit Disorder or ADD.  ADHD usually lasts your whole life. A lot of adults have ADHD. 
Kids with Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD) can have different kinds of symptoms:

For more on ADHD and Your School-Aged Child, read what the American Academy of Pediatrics has to say in this one-page parent hand-out.

Is ADHD a learning disability?
ADHD and learning disabilities are two different kinds of challenges. But they do often come together. Find out more about learning disabilities and some of the other problems that sometimes come along with ADHD. Your may hear these called by the medical term co-morbidities.

What is attention?
Check out this site that explains the basics of attention, and difficulties with attention.

How common is ADHD?
Attention-Deficit Hyperactivity Disorder is the most common behavior disorder in school-aged kids.  About 8-12% of kids have it (2).

What causes it?
The exact causes of ADHD are not yet known.  Experts think that ADHD is caused by differences in the way messages are sent in the brain.  ADHD seems to run in families, so it may be inherited.

How is ADHD diagnosed?
ADHD is usually only diagnosed in school-aged kids (ages 6-12), because it is hard to diagnose in younger children.  The diagnostic process has many steps, and you, your child's school and other caregivers will all need to provide information about your child's behavior.  To find out about diagnosis, read the American Academy of Pediatrics clinical practice guideline:

How is ADHD treated?
The best treatment for ADHD is usually medication, combined with behavior therapy (including training parents in behavior therapy) and setting things up for your child at home and at school to make it easier to pay attention (3,4).  Because ADHD is a chronic (on-going) condition, treatment must also be on going.  Usually you will have a long-term plan that includes goals for your child.  When all the parts of the treatment plan are in place, and everyone (child, parents, teachers, doctors, caregivers, etc.) works together, treatment will be most effective. 

To find out more about what to expect in the treatment process, read the American Academy of Pediatrics clinical practice guideline:

What if I think my child might have ADHD?
If you think your child may have ADHD, you should have them checked by their primary care provider or a psychiatrist. Sometimes a sight or hearing problem, family stress, worry, a learning disability or communication problems can affect a child's attention and behavior.  You should also get help from your school system. 

What can the school system do for my child?
If your child is struggling in school, ask your school system in writing for an evaluation of your child. They are required to provide it, at no cost to you. The purpose of an evaluation is to find out why your child is not doing well in school.  A team of professionals will work with you to evaluate your child.  If they do not find a problem, you can ask the school system to pay for an Independent Educational Evaluation (IEE).  There are strict rules about this, so you may not get it.  You can also have your child tested again privately, and pay for it yourself.  But check with your school district first to make sure they will accept the private test results.  By law, the school system must consider the results of the second evaluation when deciding if your child can get special services.

If testing shows your child has ADHD, the school system may start your child in a special education program. 

What is special education?
Special education means “educational programming designed specifically for the individual.”  It can really help your child do betterin school.  If your school-aged child qualifies for special education, they will have an Individualized Education Plan (IEP) designed just for them.  kids

What do I need to know about the laws that have to do with special education?  What are our rights?

What do we need to know as my child prepares for college?

What about medication?
There is lots of news lately about medications and kids. Some people think medication is prescribed too much. Others see it working and think it is a great idea. Whatever your feelings, be sure you know the basic facts about ADHD medications. Stimulant medicines like Ritalin, Dexedrine and Adderall have been used for a long time and have a good track record. A newer medication that is not a stimulant, called Strattera, may help some kids who haven't done well on the stimulants.  However, Strattera may have some risks.

There are also other kinds of medicine that your child's doctor may try if the stimulants don't work. Sometimes, your child's doctor may need to try a few different medicines at a few different doses to find the one that works best for your child. You could think of the brain as a black box that we can't see inside. The doctor doesn't know how a medicine will affect the brain until he or she tries it. Nine out of ten kids improve on stimulant medication.

If your child's doctor prescribes a medication for your child, make sure you ask about the benefits and risks of taking the drug. If your child is just starting medication, you can use this sheet to keep track of how they're doing and share it with your child's doctor at your next office visit.

Remember: if your child takes a medication and their behavior improves, it is really your child's own strengths coming out from behind the ADHD. Give the credit for improvement to the child, not to the drug.

What about alternative and complementary treatments?
You may feel desperate for a "silver bullet" that will cure your child's problem. Some of the alternative treatments may sound reasonable, and may even be developed by doctors or specialists. But if they are not scientifically proven, you risk spending time, money and hope on false promises. On the other hand, you and your child's doctor might decide it's worth it to try a low-risk alternative treatment.

Some treatments that the National Institute of Mental Health and the American Academy of Pediatrics warns have not been proven to work in scientific studies are:

Some alternative treatments, such as mega-vitamins and special supplements, may actually be dangerous to your child. Use caution, and talk with your child's doctor if you are considering alternative and complementary treatments.  Your child's doctor needs to know all treatments being used, as some may interact with prescribed treatments.
biofeedback could be a useful treatment for ADHD (7,8,9,10,11,12,13). Biofeedback has the added benefit of getting kids actively involved in developing their own coping strategies. This can be empowering. However, biofeedback treatment can be expensive, especially if your insurance doesn't cover it.  For more on biofeedback:

What about girls with ADHD? girl with backpack
ADHD seems to be more easily recognized in boys than in girls. Girls with ADHD tend to draw less attention to themselves than boys do, and the “squeaky wheel gets the grease.” Some experts believe that girls with ADHD may act very differently from the typical picture we have of the kid with ADHD.

It's possible that girls with primarily hyperactive-type ADHD act like tomboys. They may be active, messy and disorganized. Girls who have trouble paying attention may act more like daydreamers, and may go unnoticed at school because they are so quiet. Finally, girls with a combination of the two may be hyper-talkative, rather than hyperactive, and also be silly and excitable.

When girls with ADHD fall through the cracks and go undiagnosed, they pay a high price. They may not do well in school and their self-esteem may suffer. They may come to think of themselves as not very bright, quitters or low achievers. If you suspect your daughter may have ADHD, you should find a professional who has experience in diagnosing ADHD in girls, and have your daughter evaluated.

Find out what some of the recent research on girls with ADHD has to say:

What are some tips for parents of kids with ADHD?

How can I help my child improve their behavior?

How should I set up the house and our routine to help my child?

How do I get my child's attention?

What are some tips for parents of younger kids with ADHD?

How can we cope with the challenges of raising a child with ADHD?

How can I help my child do better in school?young school kids with backpacks
Keep in close touch with your child's teacher and work together to make things as consistent as possible between school and home.  Get involved and help the teacher as much as possible.

Sometimes your child's teachers will be very knowledgeable and helpful, and sometimes they will not. Either way, it helps a lot if you learn as much as you can about ADHD, and share with your child's teacher what works best for your child. You may want to share the tips for teachers in the next section (below) with your child's teacher.  For more on working with your child's school:

What can teachers do to help kids with ADHD?
A teacher who understands ADHD and how to work with kids with ADHD will make a big difference in your child's school experience. Teachers need to understand how to use a program of academic instruction, behavioral interventions and classroom accomodations to help kids with ADHD (14). You may need to help your child's teacher learn more about how to work best with your child at school. Some basic tips for modifying the classroom include:

Teachers may appreciate knowing that many resources exist that can help them learn new strategies to teach kids with ADHD. Here are a few:

What about summer plans for my child?

Where can we get information and support?
Websites:

Books:

Organizations:

References

Written and compiled by Kyla Boyse, R.N.  Reviewed by John O’Brien, M.D.
Updated July 2009

U-M Health System Related Sites:
Department of Psychiatry
U-M Pediatrics
Family Medicine

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