Andrew
10-01-03, 08:00 PM
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Don't overlook ADHD in your adolescent
Attention deficit hyperactivity disorder is common and usually diagnosed in children between 6 and 12 years of age. As opposed to a widely held belief, most children do not "outgrow'' ADHD. Adults usually learn to compensate for their symptoms and indeed, many use it to their advantage in career choices.
Adolescents, on the other hand, frequently will have symptoms of hyperactivity diminish (if it was present in the first place) and retain the other characteristic traits, such as inattention, inability to focus, poor organizational skills, poor study skills and restlessness. Without hyperactivity, this condition is called attention deficit disorder or ADD. Like most conditions and medical diseases, the signs of ADHD or ADD vary widely, ranging from slightly disabling to quite severe.
For several reasons, it is important to identify adolescents with ADHD or ADD. As a group, children with ADHD/ADD do worse in school, which may lead to school failure. In addition, because they sense they are different or because they may experience failure or peer rejection due to uncontrolled symptoms, these teens often have a low self-esteem. Statistically, adolescents with ADHD/ADD are at increased risk for antisocial behaviors such as crimes and drug use. Lastly, many adolescents suffer from other conditions at the same time (e.g., learning disability, anxiety and depression), so being clued into one condition helps in the diagnosis of other conditions that potentially are more devastating.
Diagnosing ADHD/ADD may be difficult as there is no single test that accurately makes the diagnosis. (This is where you need to speak with your physician or to a mental health worker for guidance). However, if a diagnosis is made, treatment usually requires a combination of educational, behavioral and medical approaches. Because of space limitations, I can only briefly touch on these.
Drs. Mark Stein and Martin Baren, both national experts in the field, nicely summarize the major tips in the August, 2003 issue of Contemporary Pediatrics. These include: providing written instructions, preferential seating close to the teacher and increased time for examinations; reducing the amount of written work; rewarding performance rather than speed; and breaking down long-term assignments into shorter ones.
Medication still is the best hope of reducing or controlling ADHD/ADD symptoms. Until recently, there was essentially only one option: stimulants. The breakthrough in that category was making them long-acting so that they would be given only once a day rather than two or three times.
Although effective in about 80 percent of the children, and side effects usually were minimal, many parents were reluctant to use this classification of medication because their dangers were overstated. Last year, a new medication option (brand name Strattera) became available. It is a nonstimulant. As with the newer stimulant medications, it, too, is long-acting so that it is taken only once daily and it is safe.
There is no question that it is effective when compared to a placebo, but it has not yet been proved that it is as effective as the new, long-acting stimulants such as Concerta, Adderall XR, and Metadate CD.
Robert A. Dershewitz, M.D., Sc.M., FAAP, is a pediatrician at Healthy Kids Care Center in Munster and is affiliated with The Community Hospital in Munster. He also is editor of Ambulatory Pediatric Care, a major textbook in Pediatrics and Associate Editor of Journal Watch, an international medical newsletter.
Don't overlook ADHD in your adolescent
Attention deficit hyperactivity disorder is common and usually diagnosed in children between 6 and 12 years of age. As opposed to a widely held belief, most children do not "outgrow'' ADHD. Adults usually learn to compensate for their symptoms and indeed, many use it to their advantage in career choices.
Adolescents, on the other hand, frequently will have symptoms of hyperactivity diminish (if it was present in the first place) and retain the other characteristic traits, such as inattention, inability to focus, poor organizational skills, poor study skills and restlessness. Without hyperactivity, this condition is called attention deficit disorder or ADD. Like most conditions and medical diseases, the signs of ADHD or ADD vary widely, ranging from slightly disabling to quite severe.
For several reasons, it is important to identify adolescents with ADHD or ADD. As a group, children with ADHD/ADD do worse in school, which may lead to school failure. In addition, because they sense they are different or because they may experience failure or peer rejection due to uncontrolled symptoms, these teens often have a low self-esteem. Statistically, adolescents with ADHD/ADD are at increased risk for antisocial behaviors such as crimes and drug use. Lastly, many adolescents suffer from other conditions at the same time (e.g., learning disability, anxiety and depression), so being clued into one condition helps in the diagnosis of other conditions that potentially are more devastating.
Diagnosing ADHD/ADD may be difficult as there is no single test that accurately makes the diagnosis. (This is where you need to speak with your physician or to a mental health worker for guidance). However, if a diagnosis is made, treatment usually requires a combination of educational, behavioral and medical approaches. Because of space limitations, I can only briefly touch on these.
Drs. Mark Stein and Martin Baren, both national experts in the field, nicely summarize the major tips in the August, 2003 issue of Contemporary Pediatrics. These include: providing written instructions, preferential seating close to the teacher and increased time for examinations; reducing the amount of written work; rewarding performance rather than speed; and breaking down long-term assignments into shorter ones.
Medication still is the best hope of reducing or controlling ADHD/ADD symptoms. Until recently, there was essentially only one option: stimulants. The breakthrough in that category was making them long-acting so that they would be given only once a day rather than two or three times.
Although effective in about 80 percent of the children, and side effects usually were minimal, many parents were reluctant to use this classification of medication because their dangers were overstated. Last year, a new medication option (brand name Strattera) became available. It is a nonstimulant. As with the newer stimulant medications, it, too, is long-acting so that it is taken only once daily and it is safe.
There is no question that it is effective when compared to a placebo, but it has not yet been proved that it is as effective as the new, long-acting stimulants such as Concerta, Adderall XR, and Metadate CD.
Robert A. Dershewitz, M.D., Sc.M., FAAP, is a pediatrician at Healthy Kids Care Center in Munster and is affiliated with The Community Hospital in Munster. He also is editor of Ambulatory Pediatric Care, a major textbook in Pediatrics and Associate Editor of Journal Watch, an international medical newsletter.