ADHD & Your Child: Signs & Treatment Options
ADHD: Could My Child Be at Risk?
Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder diagnosed in roughly 10 percent of school-aged children and adolescents. Children may have difficulty paying attention and completing tasks, and can show excessive signs of hyperactivity, impulsiveness, or some combination of these behaviors. ADHD can lead to difficulties in school, work and home life.
ADHD medications such as stimulants, coupled with behavioral therapy, can be very effective in the control of ADHD. Early identification of ADHD is advised. Follow along to learn about ADHD causes, diagnosis, treatments and myths surrounding this condition.
All Kids Seem Hyperactive: How Can You Tell the Difference?
Anyone who has parented a small child will tell you -- short attention spans and high levels of activity are part of a normal childhood. In children with ADHD these behaviors can be excessive, not appropriate based on the their age, and cause disruption, both at school and at home.
Over time, adolescents and teens with ADHD may become less hyperactive, but may still suffer from distraction, poor organization, and low impulse control. These behaviors, especially in adolescents and young adults, can be risky. Young adults with uncontrolled ADHD may be at a greater risk for alcohol and drug abuse, driving violations and accidents, dropping out of school, or job loss.
Signs and Symptoms of ADHD
The signs and symptoms of ADHD, which must have been present for at least 6 months before diagnosis and occur before age 12, may include:
- Difficulty with paying attention
- Can't follow instructions
- Interrupts or talks excessively
- Can be disorganized or careless
- Has trouble playing quietly in a group
- Restless or jittery
- Has trouble focusing on a task at school or home
- Difficulty forming or keeping friendships
What Causes ADHD - Is It a Genetic Disorder?
The causes for ADHD are not fully known, but research is actively ongoing. There does appear to be a link between a family history of ADHD (genetics) and influences from the environment. ADHD is inherited in about 3 out of 4 cases diagnosed (75%).
Some factors have been identified that may contribute to the development of ADHD, these include: low birth weight; fetal exposure to cigarette smoke, alcohol, herbicides, or pesticides; and exposure to toxic lead paint after birth. Additional research is needed to define the exact role of these environmental factors.
ADHD Myth: ADHD is Largely Over-Diagnosed
ADHD is a real disorder that affects up to 10 percent of children. ADHD can have serious end results if left untreated. Some critics claim that there has been overdiagnosis of children with ADHD with excess prescribing of stimulants.
Indeed, as more has been learned about ADHD and how to recognize it, greater rates of diagnosis may have taken place. In addition, legal mandates in the school to increase special services for children may have led some to believe that there are now excessive numbers of children with this diagnosis, when in fact these children are now recognized when previously they may have been ignored. More adults are now being diagnosed, too, probably due to greater ADHD awareness.
How Do I Get My Child Tested for ADHD?
Unlike strep throat, ADHD has no special laboratory test that a physician uses to make a specific diagnosis. A pediatrician or child psychiatrist will make a diagnosis based on interviews with you, your child, and teachers at school. Questions may focus on home and school relationships, attentiveness, hyperactivity, and ability to control emotions. A family history of ADHD, and other physical or emotional symptoms will be assessed.
Most cases of ADHD are diagnosed at age 7 or 8, but symptoms may begin sooner. It is estimated that boys with ADHD outnumber girls two-to-one, but some experts feel that girls may not be diagnosed as often due to less disruptive behaviors.
Consequences of Untreated ADHD
The importance of early and adequate treatment for ADHD is evident in these potential outcomes if ADHD is ignored:
- Increased risk for school failure in both high school and college
- Behavioral problems
- Social problems with peers and family
- Elevated risk due to accidents, alcohol or drug abuse
- Increased chances of depression or anxiety
- Obstacles at work possibly leading to job loss
Psychosocial Treatments: Always a First Line Therapy
Behavioral education for the child and their caregivers should always be considered as a first-line treatment for any case of ADHD. This may also be highly recommended if the child is less than 6 years of age, has mild symptoms, or the family prefers this option over drug therapy.
Included in the education should be information about symptoms and course of ADHD, medical treatments and expected side effects, and local resources for the family and child. Communication should be initiated at the school. Parent-training to learn how to effectively manage ADHD behaviors, and child-focused treatment that fosters social, academic and problem-solving skills are important for success.
Drug Treatment Options for ADHD: Where to Begin?
A healthcare provider with expertise in evaluation, diagnosis and treatment of children with ADHD is the best place to start. ADHD can be a complicated condition and behavior and drug treatment are often needed. In addition, dose adjustments are frequent and a healthcare professional can guide drug dosing.
The stimulants, such as methylphenidate, are often the first choice of drug treatment in ADHD. Stimulants are effective in up to 80 percent of patients, and they have been used for the treatment of ADHD for many decades. Stimulants act quickly in children to curb hyperactivity, impulsiveness and improve attention. They may be used in conjunction with patient counseling.
What Are the Choices in Stimulant Medications?
Stimulants are often the first class of drug chosen for ADHD treatment, and include various agents such as:
- methylphenidate: Ritalin, Daytrana, Focalin, Concerta, Metadate ER, Quillivant XR, or Cotempla XR ODT
- the mixed amphetamine salts: Adderall, Mydayis ER, Vyvanse
- the oral dissolving amphetamine tablet Adzenys XR-ODT
- the amphetamine tablet Evekeo
- the extended-release amphetamine liquid formulation Dyanavel XR and Adzenys ER
Stimulants are available in many versions of regular-release and sustained-release formulations to allow dosing that can be specific for a child's needs, such as around school and homework times; long-acting forms taken once-a-day are usually preferred. Keep in mind titration with an immediate-release form may be needed before using some extended-release forms.
Generic versions are available for many of these products, and can render cost-savings in your overall healthcare plan.
ADHD Myth: Bad Parenting Causes ADHD in Children
Parents are not to blame for the occurrence of ADHD in their child. ADHD is a result of altered brain chemistry. Family history and genetics, the environment and certain toxins have been linked with ADHD, and research into its causes are ongoing.
However, parenting style may worsen a child's ADHD symptoms. Parenting behaviors such as being overly critical, demanding, or negative may increase the risk for oppositional defiant disorder and conduct disorders that can accompany ADHD in up to 50 percent of children. Open communication with teachers and healthcare providers, as well as coaching or therapy for parents can be helpful.
My Child Takes an ADHD Drug But Has Trouble Falling Asleep at Night
There is more than a 50 year history of use with stimulants, and their actions and side effects are well-known. In fact, until 2002, stimulants were the only FDA-approved treatment for ADHD. As proven in a groundbreaking clinical trial called the Multi-Modal Treatment Study of Children with ADHD (MTA study), stimulants are the most effective treatment for ADHD as long as doses are monitored and adjusted specifically for each child.
However, side effects, such as difficulty sleeping, reduced appetite and weight loss, headaches and stomach upset can occur and should be reported to your child's doctor if they interfere with the daily routine.
Could My Child Become Addicted to Stimulant Medications?
This is a common question among parents. Parents or caregivers may be concerned that stimulant use in ADHD may lead to future addiction or other forms of drug abuse. In fact, studies suggest that ADHD stimulant treatment decreases the risk of substance abuse and may delay the onset through adolescence. Adolescents with ADHD have also been shown to have fewer car accidents when being treated for ADHD compared to those who are not treated.
In addition, adults with ADHD may be less likely to be involved in drug-related criminal activity, but the lowered risk of substance abuse may not last into adulthood.
Nonstimulants: Atomoxetine (Strattera)
There is no cure for ADHD, but medicines can effectively control many of the symptoms. If stimulants are not an option for your child, your healthcare provider may suggest using a non-stimulant such as atomoxetine (Strattera).
Strattera is in a class of medications called norepinephrine reuptake inhibitors. Atomoxetine, unlike stimulants, may take several weeks for the full effect to be seen, but also has a low abuse potential. Atomoxetine might be an option for teens or college students when there is a concern about stimulant abuse or diversion; if there is an accompanying tic disorder, or if significant anxiety is present.
Alpha-2 Agonists: An Added Option
About 10 to 20 percent of children may not have an optimal effect with stimulants or may have side effects that require a dose or medicine change.
For these children, a class of medications called alpha-2 agonists can be used alone or added to stimulants or atomoxetine (Strattera). Alpha-2 agonists include generic clonidine (Catapres), guanfacine (Tenex), as well as the extended-release versions of clonidine (Kapvay) and guanfacine (Intuniv). Alpha-2 agonists may cause low blood pressure, slow heart rate, and drowsiness as side effects, but may be useful in children with trouble sleeping, aggression, or stimulant-induced tics.
Other Treatments: Bupropion and Tricyclic Antidepressants
While many children have a good response to stimulants, some children can't take stimulants because of health conditions or bothersome sides effects. In these children, antidepressants such as bupropion (Wellbutrin) and desipramine (Norpramin) have been shown to be effective, but are prescribed "off-label", meaning they are not specifically FDA-approved for ADHD.
There are also concerns that there may be a risk of suicidal thinking in children, adolescents, and young adults using nonstimulants like atomoxetine or antidepressants for ADHD. In fact, a boxed warning exists for this issue. It is important to monitor your child for changes in mood or signs of depression or suicide, and discuss these issues with your doctor.
ADHD Myth: All Children Will Eventually Outgrow ADHD
Some children, at their doctors direction, may have a trial reduction or elimination of their medications if their symptoms are improved over a year, dosages have remain stable, or missed doses do not result in symptoms. However, over one-half of adolescents who have ADHD continue to need ADHD treatment in adulthood.
Many adults with ADHD remain undiagnosed and are not able to address their illness; in fact, only 25 percent of adults with ADHD symptoms even seek treatment. Untreated ADHD can leave adults at risk for depression, anxiety, or alcohol and drug abuse. In addition, problems may arise within the workplace, with personal relationships, or with financial or legal issues.
My Child Can't Swallow Pills - Are There Other Options?
Swallowing tablets can be a challenge for many younger children. Easier-to-swallow forms of ADHD medicines are available, for example:
- Skin patches: Daytrana, Catapres
- Liquids: Methylin Solution, ProCentra, Quillavant XR, Dyanavel XR, Adzenys ER
- Chewable pills: Methylin Chewables, Quillichew ER, Vyvanse
- Capsule contents that can be sprinkled on applesauce and swallowed (but don't chew the beads): Metadate CD, Ritalin LA, Focalin XR, Adderall XR, Mydayis ER
- Capsule contents that may be sprinkled in water and taken immediately: Vyvanse
- Orally-dissolving dose forms: Cotempla XR-ODT, Adzenys XR-ODT
ADHD Myth: People with ADHD are Lazy
Actually, the minds of children and adults with ADHD are working very hard -- far from being lazy. However, organizing information in their brains takes extra steps. Adequately completing a task in a timely fashion, and staying focused while doing it, is not as easy for people with ADHD. Some experts suggest that a part of the brain in those with ADHD works harder but less efficiently than those without ADHD.
Options also need to be created for people with ADHD to work "differently", not "harder", so that they can focus; for example, external tools such as alarms, creating lists, and developing written charts for decision-making.
Special Considerations: Potential Abuse of Stimulants by Others
As children get older, they may become more responsible for handing and administering their own medications. A risk of addiction has not been shown to occur in people with ADHD who use stimulants appropriately. However, there is the risk that family members, friends, classmates or others may attempt to gain access to the stimulant medication for abuse. A 2016 study pointed out that most teens who abuse ADHD stimulants get them from someone else. However, some teens who were prescribed stimulants were taking higher doses. Researchers also found that teens were smoking, snorting or sniffing the medication.
To safeguard medications, children and teenager's ADHD medications should be monitored, and caregivers or school personnel should safeguard and administer. At home, keep medications locked in a childproof container and deliver stimulant medication first-hand to the school nurse.
Finished: ADHD and Your Child: Signs and Treatment Options
- National Institute of Mental Health. NIMH Practical Clinical Trials. Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study. Accessed July 31, 2017 at http://www.nimh.nih.gov/funding/clinical-research/practical/mta/multimodal-treatment-of-attention-deficit-hyperactivity-disorder-mta-study.shtml
- Most Teens Who Abuse ADHD Meds Get Them From Others. Drugs.com (online). March 8, 2016. Accessed July 31, 2017 at https://www.drugs.com/news/most-teens-abuse-adhd-meds-them-others-60423.html
- Attention-deficit/hyperactivity disorder (ADHD). Treatment. Updated August 11, 2016. Accessed July 31, 2017, 2016 at https://www.cdc.gov/ncbddd/adhd/treatment.html
- Vyvanse Product Labeling. Accessed July 31, 2017 at http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/021977lbl.pdf
- National Institute of Mental Health. Attention Deficit Hyperactivity Disorder (ADHD). Accessed July 31, 2017 at http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
- American Academy of Child and Adolescent Psychiatry and American Psychiatric Association. ADHD. Parents Medication Guide. Accessed July 31, 2017 at http://www.parentsmedguide.org/ParentGuide_English.pdf