ADHD: Lifelong Condition, Lifelong Medication?
from Family.com

When your child has strep throat, the decision to give him antibiotics is a pretty straightforward matter. But when your child is diagnosed with ADHD, attention deficit hyperactivity disorder, the situation is much more complex and confusing. Questions must be raised about long-term issues as well as short-term treatment.

You may put your child on medication and it may help, but what can you expect over the long-term? Will he be on medication forever? What's known about long-term side effects? How will his condition and medication affect his future as he grows into an adult? Will therapy and behavioral treatments have any impact on his long-term outcome?

WHAT IS ADHD?

While there are parents and health professionals who deny the existence or diagnosis of ADHD, most in the mainstream medical community. view it as a neurological condition with a strong genetic component. The clinical diagnosis requires that at least eight of fourteen possible symptoms be present for at least six months, and that those symptoms first appear before age seven.

The symptoms are better described as characteristic behaviors, rather than physiological symptoms. They fall into three general categories:

* Inattention
* Hyperactivity
* Impulsivity

There is no cure for ADHD. Doctors generally think in terms of lessening the symptoms and managing the condition with a treatment program that allows the child to live a fully functional and normal life.

DIAGNOSING ADHD

This article is primarily about managing ADHD after diagnosis, but there are some questions about diagnosis which pertain to that issue. Since about 1990, diagnosis of ADHD has multiplied to the point where it's estimated that up to 6% of American children have this disorder.

ADHD (or simply ADD, for attention deficit disorder) has gotten into the popular language and culture. To put it bluntly, the disorder has become almost trendy and some people say it's being widely over diagnosed and misdiagnosed as a result. Parents, teachers, child care providers and even some doctors may observe a partial profile of one or two symptoms in a young child and jump to a hasty conclusion that the child has an attention disorder.

A number of problems may cause behaviors which are similar to those of ADHD. According to the National Institutes of Mental Health, these include:

* Learning disabilities
* Seizures
* Hearing problems caused by ear infections
* Psychological problems, such as anxiety or depression

But there mav be others as well. These mav not affect large numbers of children or be responsible for a great deal of misdiagnosis, but they warrant consideration when evaluating a child for ADHD.

* Lead poisoning
* Tourette's syndrome and a few other genetic diseases
* Overactive thyroid
* Emotional or physical abuse, psychological trauma or severe neglect

You may hear of other possible sources of ADHD-like symptoms, such as food allergies, refined sugar sensitivity to food additives and more. Over the years, scientific studies have not validated these as being sources of ADHD, nor has treating these factors been proven to help children with the condition.

That said, it's important to note that research studies look at percentages and they seek to find what's true for most children. Your child may be the one in a thousand who does develop symptoms from sugar or food additives and those symptoms may contribute to a diagnosis of ADHD. Each child and each family situation is an individual, and medicine is often an art-not as precise a science as we would like it to be. Pulling clean and simple answers out of a textbook is not always possible.

THE LINK BETWEEN DIAGNOSIS AND MANAGEMENT

As parents contemplate the long-term treatment and management issues for their ADHD child, they
should feel completely confident that the diagnosis was correct. If you have a child or teenager with ADHD who's on medication, it may be worthwhile to review the diagnostic process, even if it was several years ago. This may not be necessary if one or both parents had symptoms of attention disorder.

Make sure the doctor was experienced in diagnosing ADHD and spent a considerable amount of time evaluating all the factors that should be included according to medical guidelines. I'm not suggesting that your child necessarily be re-evaluated or that pediatricians and psychiatrists are competent to make the appropriate diagnosis. But on the off-chance that your child received a hurried diagnosis that may have overlooked something, it really doesn't hurt to check.

Nancy Snyderman, MD., F.A.C.S. 
August 1999

This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a heath problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you
may have regarding your conditions