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Old 04-24-03, 07:13 PM
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Article: ADHD affects 3% to 5% of school-age youngsters

Wednesday, April 23, 2003
ADHD affects 3% to 5% of school-age youngsters
Treatment varies according to how child responds to therapy or medication.

The Orange County Register

It is the most commonly diagnosed disorder of childhood. Attention-deficit/hyperactivity disorder, or ADHD, affects about 3 percent to 5 percent of school-age children and occurs three times more often in boys than in girls.

Here, questions and answers about ADHD:

Q. What is ADHD?
A. It is a medical condition in which a child shows chronic and frequent signs of inattention, impulsiveness and hyperactivity. Some signs typically surface before a child is 7 years old. Until a few years ago, it used to be called attention-deficit disorder with or without hyperactivity, or ADD.

Q. What are the types of ADHD and their symptoms?
A. There are three types of ADHD, according to the American Academy of Pediatrics:

Inattentive: Fails to give close attention to details or makes careless mistakes. Has difficulty sustaining attention. Does not appear to listen. Struggles to follow through on instructions. Has difficulty with organization. Avoids or dislikes tasks requiring sustained mental effort. Loses things. Is easily distracted. Is forgetful in daily activities.

Hyperactive-impulsive: Fidgets with hands or feet or squirms in chair. Has difficulty remaining seated. Runs about or climbs excessively. Difficulty engaging in activities quietly. Acts as if driven by a motor. Talks excessively. Blurts out answers before questions have been completed. Has difficulty waiting or taking turns. Interrupts or intrudes upon others.

Combined type: Meets inattentive and hyperactive/impulsive criteria.

Q. What causes ADHD?
A. The exact causes aren't known, but researchers are exploring both genetic and environmental possibilities.

Q. How is ADHD diagnosed?
A. With well-tested diagnostic interview methods, according to a report from the National Institute of Mental Health, or NIMH. A health-care provider considers history and observable behaviors in the child's home, school or day care. Input can come from parents, day-care providers and teachers. There is no independent test for ADHD. But the health-care provider looks at whether a child's symptoms:

have been going on for at least six months
are more frequent and more severe than what is common for kids of the same age
are present in at least two places such as home and school< BR> affect a child's social interaction and academic performance

Q. How is ADHD treated?
A. Typically, with behavioral methods or medications or a combination. An NIMH study of 600 elementary schoolchildren across multiple sites showed that nine out of 10 children improved substantially on one of these treatments. While the medications were extremely beneficial to most children, medications alone may not necessarily be the best strategy for many children. Children who had accompanying problems such as anxiety and stressful home circumstances over and above the ADHD symptoms, appeared to benefit the most from combined treatment.

Q. What are behavioral treatments?
A. They include the following: psychotherapy, cognitive-behavioral therapy, social skills training, support groups, and parent and educator skills training. Parents, teachers and the child with ADHD learn behavior management strategies and approaches for handling problems.

"Behavioral treatments are mostly about providing clear structure and very clear expectations," said Craig Childress, clinical psychologist at Children's Hospital of Orange County in Orange. "These help the child learn the rules and that there are consequences both negative and positive. Children with ADHD live very much in the moment and present. They don't think about things that happened before or the consequences or what's going to happen. It takes children with ADHD time to learn that certain behaviors have certain consequences. It's not that they don't want to learn it. It just takes them repetition. A lot of consistency is helpful."

Q. What are medications to treat ADHD?
A. Psychostimulant medications, including methylphenidate, commonly known as Ritalin, and amphetamines such as Dexedrine and Adderall, are the most commonly prescribed treatments. Antidepressants may be used as a second line of treatments for children who respond poorly to stimulants, have unacceptable side effects, or who have other conditions such as tics, anxiety, or mood disorders.

Studies have shown that medications can be effective in many cases, said Dr. Marc Lerner, developmental pediatrician at UCI Medical Center in Orange. If stimulants don't work, doctors might try amphetamines next. This medicinal approach can take a few months, he said.

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