ADHD in Children: Symptoms and Treatment Options

Description

Attention deficit hyperactivity disorder (ADHD) is an increasingly common childhood neurobehavioral disorder. While many people refer to the disorder as Attention Deficit Disorder (ADD), the “official” terminology is ADHD, according to the Attention Deficit Disorder Association.
The symptoms of ADHD include impulsivity, difficulty paying attention, and hyperactivity that are developmentally inappropriate, and can continue on through adulthood for 30 percent to 50 percent of those affected. In childhood, ADHD is often mistaken for emotional or disciplinary problems.

Symptoms
The National Institute of Mental Health lists the following as common symptoms of inattention, hyperactivity, and impulsivity in children. While many children display variations of these behaviors during their development, they are more frequent and severe in ADHD kids. 

To be diagnosed with ADHD, a child must have symptoms for six or more months and display symptoms to a greater degree than their peers.
Causes
According to the NIMH, research suggests that genes play a large role in determining a child’s likelihood of developing ADHD.  However, it is possible that other factors might be related, such as environmental factors in utero, food and sugar intake, and if the child has had brain injuries,  and premature birth.

Treatment
ADHD is usually treated with psychotherapy and stimulants - medications that help increase a patient’s levels of dopamine. Dopamine is a brain chemical, or neurotransmitter, associated with pleasure. Gradually increasing doses of stimulants mimic the natural production of dopamine in the brain, producing a calming effect on children with the disorder.

Because every child responds differently to treatment, only a doctor can determine the best course. Usually, a psychiatrist makes the diagnosis, but, depending on the licensing requirements of the patient’s state, clinical psychologists, psychiatric nurse practitioners, or advanced nurse specialists can also diagnose the disorder.
The NIMH lists the following as common ADHD medications for children, some of which are approved for children as young as age 3 (although giving stimulant/ADHD drugs to children so young is controversial.). Three drugs approved for age 3 and up are Adderall, Dexedrine, and Dextrostat (amphetamines or dextroamphetimines).  Other stimulants approved for age 6 and up that are commonly used to treat ADHD include these additional amphetamines  (Adderall XR and Vyvanse  and methylphenidate (Concerta, Focalin XR, Daytrana patch, and Ritalin).   Straterra  (atomoxetine) is a newer “non-stimulant” drug that was approved in 2002.  These drugs are controlled substances because they can be abused or lead to dependence. 
Side effects  of the ADHD drugs often include decreased appetite, sleep problems, anxiety, and irritability, and dependence, as the drugs can be habit-forming.  Some children also report mild stomachaches or headaches. Growth and weight gain while taking medications may need to be very closely monitored, as young children taking stimulants might have slower than average growth rates..

An Increasingly Common Disorder

According to the 2007 National Survey of Children’s Health administered by the CDC (Center for Disease Control’s National Center on Birth Defects and Developmental Disabilities),  9.5% - or 5.4 million – of American children were diagnosed with ADHD by a parent. This number represents a 21.8% increase in parental diagnoses over the four years since the first survey was given. In addition, for reasons that are still unknown, boys are diagnosed more frequently than girls with the disorder (13.2% compared to 5.6%, according to the study).

Nearly one in every 10 children in the US is now diagnosed with ADHD, U.S. health officials report. 
A million more children were diagnosed with ADHD in 2007 as compared to 2003.
About half of these children ( 2.7 million)  take medication for the condition, the CDC survey of parents of 4- to 17-year-olds found. (November 12, 2010 from CDC 's Morbidity and Mortality Weekly Report)
Among older teens, the rate of ADHD soared by an even greater amount, by 42 percent, the CDC researchers found.  The report also cites a 53 percent increase in ADHD diagnosis since 2003 among Hispanics .

Do more kids of the 2000’s really face more severe neurological problems than the kids of the 1990s or 1970s?
An ADHD expert comments that "One would hope that such findings might give the mental health field pause to wonder and worry about why we are seeing increases in virtually all psychiatric conditions -- autism, depression, ADHD, bipolar in children -- for instance, what does this say about our society?" commented  John D. Ranseen, an associate professor of psychiatry at the University of Kentucky College of Medicine to Healthday News after the CDC report.
"The rapid rise in diagnosis is not necessarily equivalent to a rise in the actual condition, and must be due in part to cultural factors -- a willingness to label certain symptoms as indicating ADHD, increased cultural acceptance of doing so and increased dissemination of information labeling ADHD as a "condition.”"

Abuse of ADHD Medications
While attention-deficit hyperactivity disorder (ADHD) is a real and pervasive condition, new research suggests that there are a large number of kids and adults who successfully fake the condition either to get drugs or gain special privileges in school.  It is easy enough to read up on the symptoms, present those to a doctor, and get a diagnosis and  a prescription.
One review of the literature turned up prevalence rates of “faking” to get ADHD drug prescriptions of between  8 percent to 35 percent. 
A University of Kentucky study involving three groups of college students: one group (without ADHD) that responded to questions honestly, one group without ADHD  that was allowed to review information on the Internet on the ADHD condition for about 5 minutes and asked to fake their symptoms, and one “control” group with legitimate ADHD diagnosis .  Almost all of the students who were “faking” were successful at their goal of being diagnosed with ADHD.

Problems from Abuse of Stimulant ADHD Medicines:
Side effects when taking these medications can include increasing blood pressure, tachycardia [abnormal heartbeat], anxiety symptoms, and dependency.
According to the National Institute of Drug Abuse, stimulant medications can be abused for both “performance enhancement” (by increasing weight loss, wastefulness, and focus) and recreational purposes (by getting a person “high”).
The NIDA’s annual Monitoring the Future survey estimates drug use among American 8th-, 10th-, and 12th-graders. In 2008, according to the survey, Ritalin was used for non-medical purposes by 1.6 percent of 8th-graders, 2.9 percent of 10th-graders, and 3.4 percent of 12th-graders.

Sources:: The Attention Deficit Disorder Association, Increasing Prevalence of Parent-Reported Attention-Deficit/Hyperactivity Disorder Among Children --- United States, 2003 and 2007
(MMWR), National Institute of Mental Health, CDC ADHD Data, (Nov. 12 issue of the CDC's Morbidity and Mortality Weekly Report) Monitoring the Future survey http://monitoringthefuture.org/http://uknow.uky.edu/content/adhd-fakers-routinely-fool-doctors-get-drugs (U of KY study) , HealthDay News.
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Other useful information:

Consumer Reports best buy drugs for ADHD drugs chart
http://www.consumerreports.org/health/best-buy-drugs/adhd.htm

http://oas.samhsa.gov/2k9/adderall/adderall.htm National Survey on Drug Use and Health (2009) on college students' abuse of Adderall. from Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).

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