What You May Not Know about ADHD

By Ahmed Khan, MD 
@AhmedRazaKhanMD

Attention-Deficit/Hyperactivity Disorder (ADHD) is an illness that affects many people living in this country. It's reported that 7-10% of Americans have ADHD - a disorder that alters one’s attention and concentration in a negative manner. 

Oftentimes, parents and children conceptualize this lack of attention and concentration leading solely to problems at work and school. Unfortunately, ADHD has a number of adverse health outcomes that you may not be aware of. Hopefully my post will help you understand the various adverse health outcomes associated with ADHD.

Substance Use and Smoking: Several studies show a significantly increased rate of substance abuse disorders and smoking in patients with ADHD. This could be due to the increased impulsivity apparent in many people with ADHD.

Sleep Problems: It's pretty clear that ADHD leads to dysregulation of sleep. This is often displayed by resisting sleep at bedtime, difficulty falling asleep once in bed, and problems awaking in the morning.

Car Accidents: Did you know people with ADHD have a higher risk of traffic violations and car accidents? Some studies found this to be due to increased risk-taking behavior and poor frustration tolerance.

Physical Injuries: Studies have also revealed children with ADHD can have almost twice the injury rate as those without it (20.4% vs. 11.5%). A study looking at an insurance data base of over 100,000 people, from children to adults aged 64, found that those with ADHD had 1.55 times greater chance of injury versus those without ADHD.

Risky Sexual Activity: Studies suggest that the impulsivity, poor self-esteem, and risk-taking behaviors that are prevalent in people with ADHD can lead some to engage in risky sexual behavior and increase their risk of receiving and transmitting sexually-transmitted diseases.

Obesity: There is no direct correlation between ADHD and obesity yet, but some studies show that children with ADHD are more likely to be obese than those without it. This could be due to various reasons, but researchers are looking at genetic similarities between the two conditions which could provide more insight in near future. 

So, did you learn something new about the often misunderstood ADHD? I hope my post provided you with a better idea of the toll that ADHD can take on one's life. With a thorough diagnosis and proper treatment by a trained psychiatrist, a person with ADHD can greatly limit these adverse events and, many times, avoid such negative health issues all together. 

Tweet

What I wish I knew when my daughter was first diagnosed with autism

Guest post by Carolyn Chambers

Greetings! My name is Carolyn, and I’m the mother of two daughters, Kirsten (10 years old) and Kellie (9 years old). Kellie was diagnosed with autism in January of 2008 at the age of 4. My first marriage ended shortly after my daughter got her diagnosis. I ventured into single mom-hood while navigating through the often overwhelming unknowns of what to do when you have a child with autism. There was no “Autism for Dummies” book back then, though after doing a quick Google search, I see there’s one available now. I ultimately had to figure out how to best help my daughter mostly on my own and began researching, reading, networking, and engaging with other parents as well as picking the brains of the many professionals who I had the honor to work with thanks to autism.

The best parent connection that I made was with a former friend from high school who later became my wonderful and supportive husband! One of our mutual friends advocated that we “reconnect” through Facebook since we both have daughters on the autism spectrum.

Which brings me to one of the top tips I can offer to parents who have recently gone through having a child diagnosed with autism: get connected with other parents, so you can learn from their experiences.

Join a parent support group like TACA (Talk About Curing Autism). Personally, this has been my #1 and what helped my daughter the most. I learned so much from other parents’ advice on best therapy providers, doctors, school districts, behavioral-type of programs, treatments, interventions, problem solving, etc. And, as a bonus, I made some life-long friends through the support groups.

You should also attend autism conferences; that’s where you’re going to discover the newest cutting edge treatments and therapies as well as learn about the latest research in development. It’s your chance to be immersed with experts and professionals (and another opportunity to network with parents!).

But be prepared to be confused with all of the conflicting information and advice that’s out there. Researching and consulting with experienced parents and doctors will prove priceless.

Paying close attention to your child’s diet is another helpful tip I’ve received and wanted to share with you. You are what you eat! Learn about all of the special diets out there that are said to benefit children with autism and ADHD. At the very least, cut out the junk food, processed, and artificial ingredients. This is something all parents and caregivers should do for their kids regardless of an autism diagnosis. Understand how the digestive system is connected to what goes on in the brain. There’s plenty of science-based knowledge out there supporting the importance of nutrition. Be sure to ask other parents about what diets have been most successful for their children with autism.

Be wary of “miracle cures.” The curse of being proactive when it comes to researching possible interventions for your child is being exposed to all the countless “treatments” that make too good to be true promises and drain your wallet. Me being an information junkie, I don’t mind reading about some of these “treatments” with a grain of salt. But before considering any treatment, even the ones that are less “out there,” remember to research them thoroughly and speak with as many parents as possible who have tried that sort of treatment. Any treatment you proceed with should be done under an experienced doctor’s guidance.

I have more tips to share, so, please come back next week to read the second part of my post.

Tweet

ADHD: Can My Kid Just Outgrow It?

By R. Scott Benson, MD


Won't he just outgrow it? This is the wish of every parent – that a little time, a little more love, or discipline, or happy thoughts will solve what might be a serious problem. And I hear this question often from parents of pre-schoolers who are having behavior problems in pre-K programs or daycare settings.

But we can’t wait. And now there is even more research to support the importance of a careful evaluation and treatment when indicated. This month’s Archives of General Psychiatry reports the results of a long term study of children who were diagnosed with ADHD between the ages of 4 and 6 years old. There was a control group of children without ADHD. As adolescents the children with the early diagnosis of ADHD had higher rates of depression and suicidal thoughts. Fortunately, there were no suicides in this study. Benjamin Lahey, Ph.D., the study director is a professor of health studies and psychiatry at the University of Chicago. He said the study “reinforces our belief that parents of young children with ADHD should pay close attention to their child’s behavior and its consequences and seek treatment to prevent possible long-term problems.”

So the better question is “What treatment is recommended for pre-schoolers?” And we have good science to help answer that question. Carefully managed studies have shown that pre-school children and their families should have at least 12 weeks of behavior management training as a first level of care. And this is not just any behavior management. At a conference in Florida, Dr. Regina Bussing recommended that families should consider a number of behavior training programs – the Positive Parenting Program, The Incredible Years, and Parent Child Interaction Therapy. These are intense programs that are very different from a few words of advice from a well-meaning pediatrician or the do-it-yourself manuals that are so prevalent in the bookstores.

Let us know of other successful behavior training programs in your community, and we will post those links here.

Mental Illness in School: No Child Left Behind?

By Molly McVoy, M.D.

How much do I tell my child’s teacher about her depression? About his bipolar disorder? About her ADHD? Will he fall behind if the teacher doesn’t know? Will she be judged if I tell the school? When do I get testing, an IEP, special Ed? What do those mean?

Parents of children with psychiatric illness struggle with these questions and many others. Often, there are no easy answers. A child’s success at school may be one of the best predictors of future success. Giving a child and his/her family the best tools to succeed in school is one of my top priorities as a child psychiatrist.

When deciding how much to tell your child’s school about his/her psychiatric illness, consider your child’s ability to function at school rather than his/her specific type of illness. You are not required to tell the school anything; that is up to you as a parent. If telling your child’s teacher about his/her psychiatric illness will give him/her a better chance to do well, then consider telling the teacher. If your child’s illness is affecting his/her day to day functioning and behavior at school, then consider telling the teacher. Teachers are your partners in helping your child succeed. If the illness is relatively well controlled and is not affecting his/her daily behavior at school, the school may not need to know. For more information, visit the American Academy of Child and Adolescent Psychiatry.

When it comes to accessing special education services, most schools and teachers want to do everything they can to help your child. I usually recommend families listen to the principal and teachers.They are the experts in education. However, if you are dissatisfied with the educational services you are receiving, my next recommendation is know your rights, know your state’s laws. Every state must provide a free education that meets the needs of each child – no matter what those needs are. What varies widely, however, is how each state manages that requirement. The U.S. Department of Education website has basic information on your rights as a parent and offers links to each state.html. Know your state law, know your rights. Come armed with that information and work with your doctor and school for your child to succeed!

Adult ADHD? Not just a diagnosis for kids

By Felicia Wong, M.D.

There have been several posts addressing ADHD in children on our blog, but did you know that ADHD can affect adults as well? An interesting article in the Wall Street Journal discusses adult attention-deficit/hyperactivity (ADHD) disorder, a condition that may affect up to 10 million Americans, only 4.4 percent of whom know it.

According to government data, an estimated eight percent of U.S. children have ADHD, and some 50 percent outgrow it. But what happens to those who don’t?


It was only in 1980 that therapists began to recognize that ADHD could persist in adults, and even now, getting an accurate diagnosis is tricky. It is controversial topic that has people taking sides. Some experts think that too many adults (and children) are being medicated for ADHD, often by doctors who have little knowledge or experience with this disorder. Others argue that those adults who have experienced functional impairment could benefit from ADHD medications and behavioral therapy.


Some adults whose ADHD is left untreated can encounter negative consequences including high incidence of substance abuse, automobile accidents, difficulty staying employed and maintaining relationships. Yet, adults with ADHD can also be highly intelligent, energetic, charismatic and creative. Those with ADHD may have the ability to focus intently on a narrow range of topics that interest them.


Many adults with ADHD have developed skills to compensate for their distractibility. Some excel in school at an early age, and don’t run into any problems until college/ grad school or starting at a challenging new job. Suddenly, their coping mechanisms are not as effective anymore.

An excerpt from the Wall Street Journal article:

We see people from all of the professions who have managed to succeed despite the limitations,  but they have often done it at significant cost," says Dr. Solanto. "They don't have time to enjoy life. They don't get their work done in the course of a day. They have to stay late after hours, or they are doing without sleep, frantically trying to meet deadlines. It ultimately takes a toll on their wellbeing and a toll on the people around them.

Adult ADHD is tricky to diagnosis and deciding whether to get help for it can be difficult as well. The symptoms that traditionally describe ADHD: restlessness, impatience, procrastination, chronic lateness, and difficulty getting organized, focusing, and finishing tasks are common in busy adults. But how can one tell if it’s just stress, or too much caffeine that is causing their symptoms? What about the stigma and perceptions associated with ADHD? What does it mean to suddenly discover at the age of 40, that you have ADHD?


The key word in determining whether an evaluation should be considered is impairment. As Dr. Jaksa from the article puts it, "Everyone gets distracted. Who's not late occasionally? But if you are chronically late, you lose your job and maybe your friends as well."


Experts say that those who suspect they have ADHD should have a thorough evaluation, with a psychologist or psychiatrist who specializes in the disorder, looking at how they functioned in early childhood, in school and social settings and personal relationships. Once ADHD is diagnosed, most experts recommend treatment with both medication and behavioral therapy.


Here are some adult ADHD key points:


• Adult ADHD can be comorbid with bipolar disorder, anxiety, and depression, further complicating diagnosis and treatment.


• For adults diagnosed with the condition, treatment can consist of behavioral therapy, medication, or both.


• People who think they may have ADHD should be evaluated by a psychiatrist who understands the disorder.


A recent study published in the August 25 issue of the Journal of the American Medical Association, cognitive behavioral therapy (CBT), "a form of psychotherapy that focuses on changing patterns of thought and behavior that are counterproductive, can help" adults with ADHD. For more information on that study and recent news about Adult ADHD – please visit the following links:


Los Angeles Times (8/24, Healy)


CNN (8/24, Landau)


HealthDay (8/24, Gardner)


Reuters (8/25, Pittman)


WebMD (8/24, Hendrick)


Tweet

Mental Health Checkup: Mood, Concentration, Balance, Energy

By Gina Duncan, M.D.

I’m rounding out my list of topics to consider in a personal mental health checkup. Keep in mind, this list is not exhaustive. It’s meant to provide a starting point to help you examine how you’re doing emotionally and mentally.

Mood — Do your moods feel pretty stable, or are you experiencing significant mood swings (either highs or lows)? Are you crying more than usual? Feeling persistently depressed for two weeks or more and any thoughts of suicide could indicate clinical depression.

Concentration — Are you able to focus on the task at hand, whether at work or at home, and get it done in a timely manner? Or, do you find yourself overrun with missed deadlines and undone chores? Often the first sign that our concentration is waning is when our productivity goes down. Poor concentration is a hallmark of attention deficit hyperactivity disorder (ADHD) but it can also be a symptom of depression and anxiety and should not be overlooked.

Balance — Is there an appropriate balance between your home life and your work life? Between family time with your kids and “date nights” for you and your spouse? Are you getting in some “me-time”, including physical exercise and spiritual pursuits? Achieving perfect balance in your life is probably not possible, but that doesn’t mean it’s not worth striving for! Juggling too many responsibilities is a prime way to end up stressed out and unhealthy.

Energy — Do you feel that you have the energy to do the things you need and want to do? Fatigue can be a sign of depression, anxiety and other mental illnesses, but it can also be a symptom of many physical illnesses including cancer, diabetes and sleep apnea. If you find that you are feeling unusually fatigued or have other concerning symptoms, it is important that you contact your doctor right away.

In my next blog entry, the last in this series, I’ll provide a statement to help you consider whether you are thriving or just coping.

School's in Session - Lesson 1: ADHD

By Gariane Phillips Gunter, M.D.


School started just a month or so ago, but some parents may have already received calls about their child’s “behavior." An article published in USA Today reported on a study conducted at Michigan State University which stated that kids who are the youngest in their grades are 60% more likely to be diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) than the oldest children.


My goal for this blog posting is not to validate nor dispute this data but to offer facts about the diagnosis of ADHD. First and foremost, the diagnosis of ADHD should only be made by a trained professional after a thorough assessment of the child and collateral information.


The main features of ADHD include hyperactivity, impulsiveness, and an inability to sustain attention or concentration. These symptoms occur at levels that cause significant distress, impairment, and are far more severe than typically found in children of similar ages and developmental levels. More common in boys than in girls, ADHD often develops before age seven, but is usually diagnosed between ages eight and ten.


Children with ADHD:


• Have difficulty finishing any activity that requires focus  
• Don't seem to listen
• Are excessively active, running, or climbing at inappropriate times, squirming in or jumping out of their seats
• Are very easily distracted
• Talk incessantly, often blurting out responses before questions are finished
• Have serious difficulty waiting their turn in games or groups
• May have specific learning disabilities


Treatment can include the use of medications, psychotherapy, and special educational programs to help a child keep up academically. Psychotherapy enables children to cope with their disorder and the reaction of others to it. An essential component of psychotherapy involves the work of the child psychiatrist with both the child and the parents to develop techniques for behavior management. 


If your child is diagnosed with ADHD there are effective treatments and medications available to help him or her have a successful year at school. Please contact your child's doctor for further guidance.

Won’t they do other drugs?

By R. Scott Benson, M.D.

This is a question I get every time I talk with a family about medication treatment for their child with attention deficit hyperactivity disorder (ADHD). And the best answer has been “some will, some won’t”.

But at the APA meeting in New Orleans there was a report from the research group at the Mass General in Boston. They have been able to suggest answers to a lot of question about the outcome of children with ADHD. There is a higher rate of substance use problems in adolescents and adults who have a diagnosis of ADHD. But in this 10 year follow-up of children they asked “What are the predictors?”

Their data confirmed that a diagnosis of ADHD was associated with an increased incidence of drug and alcohol problems. But the finding of severe conduct problems in these children was even more highly associated with future substance use problems.

The take home message for me is that medication alone will not be sufficient to address the severe problems that many children with ADHD present. Parent training, especially for those with severely disruptive behaviors, is a necessary, integral part of their treatment.

When the treatment didn’t work.

By R. Scott Benson, M.D.

Once I realized how depressed his mother was I understood why the treatment for her son’s behavior problems had not worked. And there was nothing new about this scenario.

A study of the treatments for ADHD found that for most children the treatments were very effective – improvements in academic performance, peer and family relationship, and self-image. But in the group of children who did not get better, when the treatment didn’t work, there were high rates of depression in mothers.

The impact of depression on parents and parenting was the focus of a study from the National Research Council and the Institute of Medicine. Their report, Depression in Parents, Parenting, and Children, is available on-line. 7.5 million parents are affected with depression each year but fewer than a third receive any treatment. In addition to the stigma of seeking treatment there are practical barriers to care that need to be addressed. The children who are affected are treated in separate health care settings by professionals who are not prepared to look at the whole family. Many families face financial barriers to care since many health plans are not designed for the coordinated care these families need.

The family in my practice was struggling with their second grader and his behavior problems at school. The parents done all of the right things. They had been working with his teachers since kindergarten. They had tried a variety of behavior plans at home. There was no improvement, and his grades were falling in spite of good ability. Their pediatrician confirmed his attention problems and reluctantly they agreed to a trial of medicine.

There was not much improvement even with a higher dose. And there were unpleasant side effects with a second medicine. So she recommended a psychiatric evaluation.

The behaviors were typical of ADHD. But his mother gave a clue to the problem as she teared up, talking about the stress she was under with his problems and guilty feelings about not having enough time for her husband and other children. At a separate interview she described typical symptoms of depression. She had been in treatment during college but stopped treatment when she was first pregnant. I was able to make a referral to a colleague and as her mood improved her interaction with her children improved. And the smiley faces began appearing in the daily planner.

Let’s Pay Attention: Some Facts on ADHD

By Gariane Phillips Gunter, M.D.

What is ADHD?

There is a lot of talk in the media, schools and community about ADHD, but what exactly is it? ADHD which stands for Attention-Deficit/Hyperactivity Disorder is one of the most common mental disorders affecting children. ADHD is a brain condition that is often first identified in school-aged children when it causes a disruption in the classroom or problems with school work. An estimated 3 to 7 percent of school –aged children have symptoms of ADHD.


What are the Symptoms?

Many of the symptoms of ADHD such as high activity levels, difficulty remaining still for long periods of time and limited attention spans are common in young children in general. However, the difference in children with ADHD is that their hyperactivity and inattention are noticeably greater than expected for their age and interfere with functioning in more than one environment i.e. at school, at home or with friends.

A child with ADHD may:

*squirm and fidget

*daydream a lot

*have difficulty following instructions

*appear not to listen when spoken to

*not be able to stay seated

*talk too much or interrupt

*be easily distracted

What Causes ADHD?

The specific causes of ADHD are not yet determined however there is evidence that genetics do play a part. Other factors that may contribute include being born prematurely, brain injury, and the mother smoking, using alcohol or having extreme stress during the pregnancy.

What is the Treatment?

The most effective treatment for ADHD is the combination of behavioral therapy as well as medication if needed.

What can Parents do to Help?

Children with ADHD perform much better with structure, established routines and clear expectations. It can be helpful to:

• Maintain routines

• Make sure instructions are understood-use simple words to describe

• Focus on your child when talking to them

• Maintain communication with the child’s teacher

• Model calm behavior

• Focus on effort and reward good behavior

What are the Consequences if Left Untreated?

Sadly, if left untreated, children with ADHD are at greater risk for potentially serious consequences including school failure and dropout, social difficulties, family problems, alcohol and drug abuse and depression. These problems or the consequences of them can persist into adulthood, including relationship and employment problems.

Does my Child have ADHD?

Simply having the above symptoms does not mean that a child has ADHD as these symptoms can be normal childhood behavior or could be due to another disorder. Symptoms differ from child to child and there is no lab test for ADHD.

Diagnosis involves gathering information from parents, teachers, and others often filling out checklists and a medical evaluation to rule out medical problems. If you feel that your child is at risk, talk to your doctor about your concerns.