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ADHD - Television InterviewAttention Deficit Hyperactivity Disorder (ADHD)
From the TV Program: Across the Fence
Maureen Wilson
Tape: 6.15.06
Air: 6.20.06
[Judy] Good afternoon … and thanks for joining us … I’m Judy Simpson. We hear a lot these days about children having the condition Attention Deficit Hyperactivity Disorder – or A-D-H-D. There are a lot of questions about ADHD – including, whether such a condition actually exists – is it over-diagnosed or under-diagnosed? There are also questions about treatment options, as well as medications. So today on the program we’re going to sort through some of the fact and fiction regarding ADHD.
[guest] Joining me is Maureen Wilson. Maureen is a Licensed Clinical Social Worker from Family Psychiatry Associates, which is affiliated with Central Vermont Medical Center in Berlin. Maureen works as a therapist with children, adolescents and families – and many of her clients are affected by Attention-Deficit Hyperactivity Disorder.
[Judy] Thank you for being with us this afternoon! Some people have heard this called ADHD, or sometimes ADD. Why are we hearing more about this – is it because it’s occurring more frequently?
[guest] The incidence of ADHD is reported to be 3-7% of school age children and boys are diagnosed 3-4 times more often than girls are. ADHD has been reported to be a condition of the brain that makes it difficult for children to control some behaviors. Let me give you a little bit of historical perspective. In 1902, in the medical science literature, there was a description of a condition, which is very close to our description today of ADHD and in 1937, Dr. Bradley in Providence, Rhode Island treated behavior and attention problems with a stimulant. Therefore, we have been treating this condition for at least 40 years plus. Over that time span, there have been multiple studies and research done about ADHD and treatment, we have accumulated a lot of scientific evidence about ADHD, which really has provided us with tools to better diagnose ADHD.
[Judy] What is it like for someone to have ADHD?
[guest] Let me tell you about some of the things I see in my office when a child comes in. They may be running in the waiting room, or having trouble sitting in a chair, climb over and under chairs, talking a lot, interrupting often. They would probably play with most things they can find in my office. I have heard analogies describing ADHD as similar to driving a car in the rain with windshield wipers that do not work and you cannot see well. Or listening to a radio station with static and you cannot follow what is being said. Parents will sometimes describe that their child does not listen to them, they hear only the first thing that they ask them to do, or they may walk by their brother or sister and just slap them for no apparent reason.
[Judy] Can you describe the symptoms of ADHD?
[guest] There are three types of ADHD: hyperactive impulsive type, inattentive type and combined type, which is the most commonly diagnosed. The hyperactive impulsive type would include such symptoms as fidgeting, squirming, trouble sitting still, runs and climbs excessively and inappropriately, difficulty playing quietly, talks excessively blurts out answers, which certainly would be problematic in school, difficulty waiting their turn, and often interrupts. For the inattentive type, one would find the following: often sees careless mistakes, difficulty sustaining attention, does not listen when spoken to, does not follow through on chores, homework, duties and this is not attributable to the child being oppositional, trouble organizing tasks and activities, dislikes or will avoid a task that needs sustained attention, often loses things, easily distracted by stimuli or activities that might be going on around them, very forgetful with daily activities. So this is a child that if you put them in a cubicle to do their work, they probably would do perfectly well, put them in a classroom with a lot of stimulation around them and it is very difficult for them to focus and to pay attention.
[Judy] As you note the symptoms, it seems like you’re describing behaviors that many children have?!
[guest] Children often have any number of these behaviors, but generally, it is more specifically related to something that might be going on. When we are talking about ADHD, the symptoms happen in more than one kind of situation, multiple settings and they are much more serious in nature. The symptoms and behaviors would have a very significant impact on how that child functions in different areas of their life such as school, home, family and peer relationships.
[Judy] So, if a parent thought their child might have ADHD, how would they go about finding out?
[guest] I think that always a good starting point is their primary care physician. It is very important to rule out any other conditions that might exist, such as medical problems, anxiety, which can mimic some of the symptoms, depression or trauma.
[Judy] What is involved in the process of making the diagnosis of ADHD? Are there tests used? What happens in an evaluation?
[guest] Let me walk you through the process that we go through in our practice of evaluating children when they come in. The parent may bring the child in with a question of ADHD or with behavioral problems. In the first part of the evaluation, the child and parents would meet with me; I would gather a lot of history from them, certainly asking questions very specific to ADHD signs and other conditions. I would ask if the symptoms were present before age 7, do they occur at home, school, day care. The observations of the child during their appointment also provides information about their behavior, how they respond to questions, did they interrupt, could they follow the content of the session.
The second portion of the evaluation we use different ADHD screening forms to gather information from other sources parents, teachers, other family members, and day care about the child’s behavior.
The parents would be asked to return the screening forms to our office. The last part of the evaluation is to return to an appointment with Dr. Rose Ehret, a Child and Adolescent Psychiatrist that I work with who continues with the evaluation. At this point, the diagnosis, treatment options and medication use will be reviewed. They will discuss option of medication, how they work, choices, and risks involved.
[Judy] Once a diagnosis is established, what are the treatment options for the child and family?
[guest] The treatment must be individualized for each child and their family. The optimal treatment for ADHD is based on a classic study of 570 children carried out in the Multimodal Treatment Study from 1999. The findings recommend the combination of education about ADHD, therapy and medication.
[Judy] When it comes to ADHD, there is some conflicting information out there. There are reports about medications not being safe for kids – there have also been stories that question whether medications are over-prescribed. Can you help us sort these issues out?
[guest] I would advise parents to speak with their Primary Care Physician or provider who prescribe for your child.
In May 2006, the FDA reversed an earlier call about serious side effects with psycho stimulant medication. These medicines are very effective in children who are properly diagnosed with ADHD. Studies indicate that 70-80% has a good response to medications and as usual with any medication follow up is very important.
[Judy] What risks are there if parents make a decision to not treat a child who is diagnosed with ADHD?
[guest] First, safety issues are of concern because of the impulsivity. You do not want a child running across a busy road or leaving the house if they need to be supervised, poor judgment, substance abuse, school failure, drop, depression, anxiety and low self-esteem.
[Judy] In your work with children who have ADHD and their families, how do you decide what therapy is most helpful?
[guest] A treatment plan would be individually tailored to meet the needs of the child and family. Therapy might focus on the work of developing copying strategies to address problem areas, educating the child and family about ADHD is very much a part of this and helping the child to feel better about themselves. It is also very important to work closely with the school the child attends.
[Judy] What are some of the improvements one could expect from treatment?
[guest] Safer behavior, improved relationships with family, school and peers. Improved academic work, improved self-image and becoming more independent, being able to do more things on their own
[Judy] Take us through some of the tips that parents can use to help their children?
[guest] I want to summarize some tips and I think they are good for all children, but when it comes to ADHD, it is critical to be very consistent with them. Keep a regular schedule; Prepare for any change in routine; Reduce distractions; Organize things in your home; Guide your child to stay on task. Give one instruction at a time; Provide for breaks; Exercise; Stay calm when correcting behaviors; Limit choices
[Judy] Before we run out of time, I want to share some web-based resources recommended by Maureen.
You’ll find a summary of today’s interview on the Central Vermont Medical Center’s web page … that address is: www.centraltoyourwellbeing.org
You can also see a few other web-sites listed on your screen.
www.chadd.org www.aap.org www.aacap.org
These sites are recommended for reliable information about Attention-Deficit Hyperactivity Disorder.
Maureen, I want to thank you for being with us – and helping us separate some of the fact from fiction regarding ADHD.
If you have questions or comments, you can contact Maureen at Family Practice Associates, part of the Central Vermont Medical Center in Berlin. The phone number is 802-479-0014 … that’s 479-0014.
[Judy] That’s our program for today. Thanks for joining us … I’m Judy Simpson … I’ll see you again next time on Across the Fence.
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