Clinical information/ testing reports History taking including  psychiatric interview is important to reach valuable diagnostic conclusion however following points may be worth mentioning.

If the child appears to have inattentive/hyperactive symptoms, it could be due to ADHD.

2- Disorganization/forgetting and losing things can be part of ADHD.

3- Kids having ADHD symptoms, show some deficits in social skills due to the fact that they miss out the information and quos given by others and can “miss the boat” while other kids without ADHD get that quickly, hence influence their interaction. By correcting these Symptoms and social skills training, this problem can be helped.

4-Learning can be affected by co morbid condition like learning issues plus inattention symptoms. On the other hand inattention can be worsened by learning issues so both can impact each other.

5- Self esteem issues can arise due to the fact that child feels insufficient or incapable of keeping up with academic and social areas and may lead to depressive feelings and prefer to be alone and solo player.

6- In some kids due to these problems behavior issues arise especially oppositional behavior.

Treatment strategies:

Of course first try the behavior modification plan but using medication can be helpful, if needed. It needs further discussion and labs test and EKG if plan is to start the medications.

Behavior modification Plans:

A- Improving the communication by:

a- Ask the child to stop what he/she is doing, and

b- Make eye contact.

c- Then tell him/ her instructions.

d- Ask him/her to repeat what is being said.

e- If he/she follows through the command, give him/her reasonable proportional reward immediately upon completion of the task.

B- Improving the behavior by:

a- Set a goal and educate fully what will be the reward upon successful completion of task and should be given the reward immediately as agreed.

b- Suggestion for rewards can be few. For example short term reward to be given immediately. Long term reward like earning over period of time, You can design plan like, If she/he does homework on time for 3 days everyday she will collect a star and 3 stars value of something which he/she likes and is reasonable ( Avoid Candy, Junk food, and aggressive video games etc as rewards).

C- Improving self esteem and learning by:

a- Praise him/her for any good behavior, (no false praises).

b- Minor achievements should be highlighted and encourage him/her to do more like that.

c- Let him/her have friends who are more friendly and tolerant then who are not.

d- Limit the use of screen electronic gadgets like computer, video games and etc.

e- Have him/her read short stories in free time and then asks her to tell the story followed by positive encouragement and rewards.

f- Short assignments followed upon by the retrieval of information and positive encouragement after successful task.

Above strategies are usually help full with or without medication depending upon the severity of illness.

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood (biological) disorders and can continue through adolescence and adulthood if left untreated (NIMH). Symptoms include difficulty staying on task and paying attention, difficulty controlling behavior (disruptive behavior,) and hyperactivity (over-activity) may lead to frequent minor injuries and falls.

As the Child grows there is need to successfully complete each (age specific) developmental task (Social, Educational, ETC) from infancy to Childhood, to latency, to preadolescent, to Adolescent and early Adulthood and so on so forth. ADHD can be a big obstacle in the way of achieving this success.

ADHD Symptoms usually appear between 3 year old to 6 year old and can continue later if not treated. (More common in Boys than girls)

Inattention part of ADHD can compromise the learning process, maintaining good school grades, following directions, hence leading to frequent negative feedback from the parents, teachers, and in other social settings.

Hyperactivity part of ADHD can lead to moving too much, not able to sit where it is required, jumping from place to place, may have minor frequent injuries or falls, resulting negative feedback can lead to many psychological issues, ranging from low self esteem, lack of confidence, poor school performance, and anxiety and depression. (Symptoms’ of Children having ADHD may varies)

Impulsive part of ADHD can lead to impulsively acting out with out prior thinking, making mistakes and get embraced, or suffer injuries.

Good news is it is treatable and in good hands it has very positive treatment outcome.

Facts about ADHD

Approximately 3-7% of school-aged children have the disorder. Prevalence rates seem to vary by community, with some research indicating that larger cities may have rates as high as 10-15%.

General Symptoms

Failure to pay attention or  failure to retain learned information

Fidgeting or restless behavior

Excessive activity or talking

The appearance of being physically driven or compelled to constantly move

Inability to sit quietly, even when motivated to do so

(Seems like driven by a motor)

Engaging in activity without thinking before hand

Constantly interrupting others or changing the subject

Poor peers relationship

Difficulty sustaining focused attention

Distractibility, Forgetfulness or absentmindedness

Continual impatience

Low frustration tolerance

When focused attention is required, it is experienced as unpleasant

Frequent shifts from one activity to another

Careless or messy approach to assignments or tasks

Failure to complete activities

Difficulty organizing or prioritizing activities or possessions

Inattention during infancy can include

Symptoms of Inattention

Difficult to soothe

Less babbling speech the first year

Poor sucking or crying during feeding

Smiles less often

May not enjoy soft touch

Symptoms of Hyperactivity during
infancy can include

An aversion to being cuddled or held

Strained/negative mother /child relationship

More frequent crying

Symptoms of Impulsivity during infancy can include

Frequent crying and colic (painful bowel problems)

Frequent infections, more allergies, etc

Inattention during Pre school years can include

¨     Strong will; unresponsive to discipline

¨     Some language difficulties

¨     Difficulties with structured play

¨     Toilet training problems

Symptoms of Hyperactivity during
Pre school years can include

¨     Higher activity levels than peers

¨     Problems noticeable in structured play

¨     Aggressive behavior

¨     Difficulty going to sleep

¨     Motor restlessness during sleep

¨     Strong will, “difficult to manage”

¨     Causing family disorganization and parents feeling overwhelmed

Symptoms of Impulsivity during Pre school years can include

¨      Extreme excitability

¨      Gross/fine motor difficulties (awkward, clumsy)

¨      Fearlessness, may endanger self or others

¨      Low frustration tolerance

¨      Peer problems begin

Inattention during elementary school years can include

¨     Failing to pay close attention to details or making careless mistakes while doing schoolwork or other activities

¨     Trouble keeping attention focused during play or tasks

¨     Appearing not to listen when spoken to

¨     Failing to follow instructions or finish tasks

¨     Avoiding tasks that require a high amount of mental effort and organization, such as school projects

¨     Frequently losing items required to facilitate tasks or activities, such as school supplies

¨     Excessive distractibility

¨     Forgetfulness

¨     Procrastination, inability to begin an activity

¨     Associated problems such as low self-esteem, depression, or anxiety

Symptoms of Hyperactivity during
elementary school years can include

¨     Diminished need for sleep

¨     Fidgeting with hands or feet, or squirming in seat

¨     Leaving seat often, even when inappropriate

¨     Running or climbing at inappropriate times

¨     Difficulty with quiet play

¨     Frequent feelings of restlessness

¨     Excessive speech

Symptoms of Impulsivity during elementary school years can include

¨     Social immaturity

¨     Frequent arguments with parents and peers

¨     Disregards socially-accepted behavioral expectations

¨     Requires more supervision than average

¨     Inconsistent with responsibilities and chores

¨     Continually striving to be the center of attention

¨     Answering a question before the speaker has finished

¨     Failing to await one’s turn

¨     Interrupting the activities of others at inappropriate times

¨     Poor peer relationships

Inattention during adolescence can include

¨     Frequently shifting from one uncompleted task to another

¨     Difficulty organizing activities

¨     Serious academic inconsistencies

¨     Ongoing underachievement

¨     Difficulties with household activities (cleaning, paying bills, etc.)

¨     Often viewed as lazy or disinterested

¨     Associated mood or behavior problems become more pronounced

Symptoms of Hyperactivity during
adolescence can include

¨     Increased hyperactivity

¨     Pronounced feelings of restlessness

¨     Low self-esteem

¨     Intense need to stay busy and/or to do several things at once.

¨     Discipline problems

¨     High-risk behavior

Symptoms of Impulsivity during Adolescence can include

Continued poor peers relationships

¨     Low self-esteem

¨     Discipline problems

¨     Continued frequent arguments

¨     Drug and alcohol abuse

¨     Risk-taking behavior

¨     Impulsive spending, leading to financial difficulties

Treatment options:

Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education or training, or a combination of treatments

Psychotherapy:

Behavioral therapy aims to help a child change his or her behavior in positive direction.

It involves practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events.

It teaches a child how to monitor his or her own behavior.

Praising or rewarding for acting in a desired way, such as controlling anger or thinking before acting.

Parents and teachers also can give positive or negative feedback depending upon the behavior.

In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Teaching children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing.

Learning to read facial expressions and the tone of voice of others, hence modify ones’ behavior.

Learning how to respond? Appropriate to certain situation.

Children with ADHD need guidance and understanding from their parents and teachers to reach their full potential in their life.

Medication:

Medication treatment if needed is safe and can be discussed with Child Psychiatrist.

Discuss the risk/benefits of taking the medications.

Know about the side effects and pre requisite to start the medications. (like ECG, Labs etc)

Usually medications used called (stimulant medications) Like, Ritalin, Concerta, Adderal, vyvance,Methylephenidate, Pristique  and Focalin to name a few.

In group of ADHD Children who can not tolerate (stimulant medications) can benefit from medications (non stimulant), Like Tenex, Strettera, Wellbutrin and Clonidine ETC.

Research Shows Combination treatment (psychotherapy and medications) is superior to individual treatment approach.

Medications does not cure ADHD but it treat the symptoms.

Reference

1. DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.Washington,DC: American Psychiatric Association.
2. Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S. Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. Journal of the American Academy of Child and Adolescent Psychiatry, 2002 Apr; 41(4):378-385.
3. Khan SA, Faraone SV. The genetics of attention-deficit/hyperactivity disorder: A literature review of 2005. Current Psychiatry Reports, 2006 Oct; 8:393-397.
4.      www.nimh.nih.gov.

Should you need additional information or would like to make an appointment with Dr. Tahir, ( Child and Adult Psychiatrist) E-Mail us at stahirmd@yahoo.com.