Attention-Deficit Hyperactivi... Health Article

Diagnosis

The first step in determining if a child has ADHD is to consult with a pediatrician, a doctor who treats children. The pediatrician can make an initial evaluation of the child's developmental maturity compared to other children in his or her age group. The doctor also should perform a comprehensive physical examination to rule out any organic causes of ADHD symptoms, such as an overactive thyroid or vision or hearing problems.

If no organic problem can be found, a psychologist, psychiatrist, neurologist, neuropsychologist, or learning specialist typically is consulted to perform a comprehensive ADHD assessment. A complete medical, family, social, psychiatric, and educational history is compiled from existing medical and school records and from interviews with parents and teachers. Interviews also may be conducted with the child, depending on his or her age. Along with these interviews, several clinical inventories also may be used, such as the Conners Rating Scales (Teacher's Questionnaire and Parent's Questionnaire), Child Behavior Checklist (CBCL), and the Achenbach Child Behavior Rating Scales. These inventories provide valuable information on the child's behavior in different settings and situations. In addition, the Wender Utah Rating Scale has been adapted for use in diagnosing ADHD in adults.

It is important to note that mental disorders such as depression and anxiety disorder can cause symptoms similar to ADHD. A complete and comprehensive psychiatric assessment is critical to differentiate ADHD from other possible mood and behavioral disorders. Bipolar disorder, for example, may be misdiagnosed as ADHD.

Public schools are required by federal law to offer free ADHD testing upon request. A pediatrician also can provide a referral to a psychologist or pediatric specialist for ADHD assessment. Parents should check with their insurance plans to see if these services are covered.

Treatment

A 2003 survey showed that approximately 54% of parents reported using complementary or alternative medicine treatments for their children in the previous year. Some parents reported turning to these therapies because doctors don't always agree on the ADHD diagnosis and cannot adequately explain how allopathic drug treatments calm people and improve mental focus. Behavior modification therapy uses a reward system to reinforce good behavior as well as task completion and can be used both in the classroom and at home. A tangible reward such as a sticker may be given to the child every time he completes a task or behaves in an acceptable manner. A chart system may be used to display the stickers and visually illustrate the child's progress. When a certain number of stickers are collected, the child may trade them in for a bigger reward such as a trip to the zoo or a day at the beach. The reward system stays in place until the good behavior becomes ingrained.

A variation of this technique, cognitive-behavioral therapy, works to decrease impulsive behavior by getting the child to recognize the connection between thoughts and behavior, and to change behavior by changing negative thinking patterns.

Individual psychotherapy can help ADHD children build self-esteem, give them a place to discuss their worries and anxieties, and help them gain insight into their behavior and feelings. Family therapy also may be beneficial in helping family members develop coping skills and work through feelings of guilt or anger they may be experiencing.

ADHD children perform better within a familiar, consistent, and structured routine with positive reinforcements for good behavior and real consequences for bad. Family, friends, and caretakers should be educated on the special needs and behaviors of the ADHD child. Communication between parents and teachers is especially critical to ensuring an ADHD child has an appropriate learning environment.

A number of alternative treatments exist for ADHD. Although there is a lack of controlled studies to prove their efficacy, proponents report that they are successful in controlling symptoms in some ADHD patients. Some of the more popular alternative treatments are listed.

• Electroencephalograph (EEG) biofeedback. By measuring brain wave activity and teaching the ADHD patient which type of brain wave is associated with attention, EEG biofeedback attempts to train patients to generate the desired brain wave activity.
• Dietary therapy. Based in part on the Feingold food allergy diet, dietary therapy focuses on a nutritional plan that is high in protein and complex carbohydrates and free of white sugar and salicylate-containing foods such as strawberries, tomatoes, and grapes.
• Herbal therapy. Herbal therapy uses a variety of natural remedies to address the symptoms of ADHD. Ginkgo (Gingko biloba) is used for memory and mental sharpness and chamomile (Matricaria recutita) extract is used for calming. The safety of herbal remedies has not been demonstrated in controlled studies. For example, it is known that gingko may affect blood coagulation, but controlled studies have not yet evaluated the risk of the effect.
• Vitamin and mineral supplements. Some vitamin and mineral supplements that are thought to be effective by some alternative practitioners include calcium, zinc, magnesium, iron, inositol, trace minerals, blue-green algae. Also recommended are the combined amino acids GABA, glycine, taurine, L-glutamine, L-phenylalanine, and L-tyrosine. In 2003, a study reported that a combination of omega-3 and omega-6 fatty acids supplements may help with cognitive and behavioral symptoms of ADHD.
• Homeopathic medicine. This is probably the most effective alternative therapy for ADD and ADHD because it treats the whole person at a core level. Constitutional homeopathic care is most appropriate and requires consulting with a well-trained homeopath who has experience working with ADD and ADHD individuals.
• Auricular acupuncture. A small study in 1997 indicated that this type of acupuncture therapy might be effective in some children.