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Guide to ADHD

ADHD, or Attention Deficit Hyperactivity Disorder (formerly known as ADD) is a neurological condition that causes children to lose focus and behave in ways that, if untreated, may make it difficult for them to successfully participate in school, social and family life. Children with ADHD can be inattentive, hyperactive or impulsive, and many have a combination of these behaviors. Other learning disabilities or mental conditions can also accompany ADHD.

Although it's the nation's most common childhood mental disorder -- 8 percent of all U.S. kids, which translates to about 5 million, have been diagnosed -- ADHD can be surprisingly hard to spot because it affects individual children so differently. ADHD kids can be rowdy troublemakers who get into fights and fail at school, excessively chatty straight-A know-it-alls who constantly interrupt their teachers, or "space cadets" who stare out the window unaware that rest of the class has left for lunch. While all young children can be impulsive, hyperactive or inattentive at times, for children with ADHD these behaviors are so frequent and severe that they interfere with normal activities, often leaving them confused, frustrated, or angry.

According to the Centers for Disease Control and Prevention, boys are more likely to be diagnosed with ADHD than girls (9.5 percent of all boys, versus 5.9 percent of girls) but experts are unsure if that means more boys actually have the condition, or if they're just more likely to have the type of ADHD that results in disruptive behavior. Kids who act out, especially in school, are more likely to be noticed and referred for diagnosis than those who drift off into their own world.

The good news is that a great deal of research has been done on ADHD (which has been a recognized mental condition since the 1960s) and there are a number of strategies, including medication, behavioral modification and school accommodations, that can help children manage their condition and lead successful, happy lives.

SYMPTOMS

Most children are evaluated for ADHD shortly after they enter grade school because their inability to focus, follow directions and control behavior becomes a real barrier to success in that structured setting.

ADHD has three subtypes; predominately hyperactive-impulsive, predominately inattentive, and combined hyperactive-impulsive and inattentive. That means your child may have all of the symptoms in one category, or several from each.

The symptoms listed below come from the American Psychiatric Association's Diagnostic and Statistical Manual IV, (DSM IV) and are the criteria a doctor would use to diagnose your child. However, because living, breathing kids are more than a collection of lists in a diagnostic manual, we'll also provide some examples of how these behaviors can play out in real life.

For the behaviors listed below to be truly considered signs of ADHD, they must last for six months, be more severe than in other children the same age -- i.e., they're causing significant problems at school, home and/or in social settings -- and some symptoms should have been present before your child turned 7.

ADHD/Inattentive Type

This is the child that gets labeled as lazy, spacey, ditzy or incompetent. His teacher may groan in frustration at how he daydreams and tunes out during class. She may come home with her sweater buttoned wrong, inside out or forgotten altogether. He may leave his glove at Little League -- every single practice. Parents may have to deal with the terror of waiting at the bus stop for a child who doesn't show up because he got on the wrong school bus and didn't notice till it drove away. A child may lose friends because she forgets she was invited for a play date or walks right past playmates without seeing them because her mind is elsewhere.

A child must have had 6 of the following 9 symptoms for more than six months to be diagnosed with ADHD/inattentive type:

    Does not pay close attention to details, makes careless mistakes
    Often has trouble keeping attention on tasks
    Often does not seem to listen when spoken to directly
    Often does not follow through on instructions and fails to finish work or chores (because of failure to understand, not defiance)
    Often has trouble organizing activities
    Often avoids or dislikes things that take a lot of mental effort for a long period of time
    Often loses things needed for tasks and activities
    Is often easily distracted
    Is often forgetful in daily activities

ADHD Hyperactive/Impulsive Type

Only about 5% of kids who have ADHD are classified as this type, which is typically diagnosed at preschool age. Most of those diagnosed will later go on to develop the inattentive or combined type.

People think of hyperactive and impulsive kids as wild, obnoxious, bratty problem children or, worst of all, just plain bad. She may grab toys and refuse to share long after others have gotten the concept. A hyperactive child will keep playing tag while his classmates line up. He may frighten or intimidate other children by pushing or yelling, or he could be the loveable, but virtually untamable class clown. Hyperactive kids are often daredevils, prone to taking flying leaps off the couch. Parents of hyperactive and impulsive kids dread calls from school or a neighbor asking them to come get their misbehaving child, and they're driven to exhaustion by kids that never nap, sit still or stop talking.

A child must have 6 of the following 9 symptoms for more than six months to be diagnosed with ADHD/hyperactive-impulsive type:

    Often fidgets with hands and feet or squirms in seat
    Often gets up from seat
    Often excessively runs about our climbs when not appropriate
    Often has trouble playing or doing leisure activities quietly
    Is on the go as if driven by a motor
    Often talks excessively
    Often blurts out answers before questions have been finished
    Often has trouble waiting his turn
    Often interrupts or intrudes on others

ADHD Combined Hyperactive-impulsive and Inattentive Type

This is the most common type of ADHD, with symptoms of both the inattentive and hyperactive-impulsive types. Remember, not all children with ADHD display all the symptoms.

CAUSES

Research has not determined what exactly causes ADHD, but scientists believe it could be in imbalance in neurotransmitters, the chemicals that regulate how the brain processes and regulates responses to stimuli. Also, a landmark 1996 study conducted at the National Institutes for Mental Health (NIMH) also found that two portions of the brain thought to regulate attention are smaller in children with ADHD. Since then, brain imaging technology has advanced and many other studies have shown disparities between the brains of children with and without ADHD, including one 2007 study that showed that the brains of children with ADHD mature in the same pattern as those of other children, but up to three years later. Scientists are still working to discover just what these differences mean.

Why does one child's brain have trouble regulating attention and activity levels, while another's doesn't? There doesn't seem to be one overwhelming reason, but there are a number of factors that can make a child more likely to develop ADHD.

Heredity
Like many mental conditions, along with other traits ranging from diabetes to alcoholism to red hair, ADHD seems to run in families. However, since the disorder (called minimal brain dysfunction or hyperactivity in previous decades) may have gone undiagnosed, parents will have to look for clues on their family tree. School failures, delinquency, multiple divorces, employment problems and addictions can all be signs that family members may have had undiagnosed and untreated ADHD.

Smoking, drinking and drug use during pregnancy
Several studies link each of these damaging behaviors with children later developing ADHD. Smoking and drinking are linked to prematurity, another factor in ADHD, but researchers are discovering other links. For example, a 2009 British study found that smoking disrupted the thyroid function of both mother and fetus, which they theorized could lead to chemical imbalances in the infant brain. Smoking can also reduce oxygen flow to the embryo's brain.

Prematurity
Infants born prematurely are more likely to develop ADHD as children. In 2006, Danish researchers found babies born between 34 and 36 weeks were 70 percent more likely to develop the condition later. The "why" of prematurity and ADHD is still a mystery, but theories include lack of oxygen and damage to the brain.

Lead
Preschoolers exposed to high levels of lead are more likely to develop ADHD. The brain develops at a breakneck pace during a child's first three years, and lead is thought to disrupt enzymes needed to build the "roadways" of synapses and neurons that process information.

Nutritional Triggers
The idea that sugar makes kids hyper is probably a myth. Medical evidence has found no strong link between sweets and ADHD. However, recent research has indicated that some other food additives, like artificial colors and preservatives, as well as pthalates (chemicals found in some plastics) may contribute to hyperactivity.

PREVENTION

You can't do much to prevent ADHD -- more and more research links it to genetics. But you can minimize unnecessary risk factors.

  • Don't drink, smoke or do drugs while pregnant or trying to conceive (like we even need to tell you!) Follow your doctor's instructions for reducing the chance of preterm labor and delivery, especially if you have special health conditions that put you at risk. Eat healthy, take your vitamins, get your (approved) exercise, and minimize stress.

  • Once your baby is born, be wary of environmental risks, like lead paint in older homes (keep in mind it wasn't banned by the US government until 1978). Keep up with the advisories on lead in imported toys and other baby items. Avoid bottles, microwave containers and other items using pthalates.

  • Make sure your baby/toddler/young child eats a healthy diet and keeps a regular schedule with plenty of sleep and exercise. While these strategies won't prevent ADHD, a chaotic home or life and unhealthy lifestyle will make an already hyper and/or distracted child worse.

DIAGNOSIS

If you feel your child may have ADHD, your first call should be to your pediatrician. Some pediatricians feel comfortable diagnosing and prescribing treatment for ADHD, others may refer you to a specialist, like a developmental pediatrician who specializes in the condition, a neurologist or a psychologist.

Since there is no blood or imaging test to diagnose ADHD, your pediatrician or the specialist will review your child's medical records and conduct a thorough physical examination to rule out other causes for your child's problems, like:

  • Poor vision
    It's hard to pay attention when you can't see the book, computer or blackboard.
  • Poor hearing
    Hearing loss can make a child appear as if she's not listening. Even children whose hearing is tested regularly can develop middle ear infections and subsequent hearing problems.
  • Hyperthyroidism
    If your child's thyroid is producing too much hormone, he could appear nervous or develop a "spacey" stare -- symptoms that mimic ADHD.
  • Emotional trauma or response to change
    Life events such as divorce, a recent move or a death in the family can alter a child's behavior and cause him to lose interest in school or become aggressive.
  • Situational problems
    A chaotic classroom, a disorganized home life or chronic lack of sleep can cause children to lose focus or act out.
  • Other learning disabilities or mental conditions
    Anxiety, depression, dyslexia and other problems can cause symptoms similar to ADHD, or can co-exist with ADHD.

AT THE DOCTOR

Finding a Specialist

Your pediatrician may refer you to a specialist to diagnose and/or treat ADHD if she does not diagnose or treat ADHD (or she may refer you for diagnosis, but manage treatment once the diagnosis is made). Developmental pediatricians, psychiatrists, psychologists, neurologists, social workers and other medical professionals can, if properly licensed, diagnose ADHD. However, only medical professionals can prescribe medication.

If your child has co-existing conditions, like learning disabilities or other mental disorders, that may influence the kind of professional you choose. You also may want to get a referral from your insurance company to ensure diagnosis and treatment are covered. Universities and large hospitals often have ADHD centers and can provide names of specialists. And of course word-of-mouth is always an excellent way to find help.

You can also go to CHADD.org (Children and Adults with ADD) and access CHADD's professional directory. CHADD doesn't endorse or recommend any professionals, but does provide a list sorted by region. Local chapters in your area may also be able to help.

At the Doctor's Visit

Once your doctor eliminates other explanations for your child's behavior, your doctor or a specialist will evaluate your child for ADHD. Come to your appointment prepared.

  • Bring a written list of your child's issues, when they started and why they're causing problems. Otherwise, it's too easy to "go blank" when a doctor asks questions.

  • Bring all relevant school, medical and daycare records.

  • Be prepared to be asked brutally honest questions and give brutally honest answers about your family lifestyle, diet and any recent changes or events that could affect your child's behavior. Does your child routinely stay up past bedtime? Has the family been experiencing any big changes? Honesty is the best way to get your child the help he needs.

  • Both parents should come if at all possible. If you're a single parent or only one parent can come, consider bringing a friend or relative.

  • Have one person take notes; it's an emotional process and you'll want to remember everything the doctor says.

At your appointment, your doctor will probably:

  • Interview you and your child
  • Ask a series of questions to see if your child's behavior meets the symptom criteria of the DSM-IV (see symptoms)
  • Review school records
  • Have you complete rating scales, ie, Does your child have trouble sitting still? Yes, no, somewhat

Your doctor may also want to gather information from teachers, childcare providers and others who have observed your child in his daily life before making a diagnosis.

If your child has demonstrated a significant number of symptoms over a long period of time, and that behavior is wreaking havoc on his life in and outside the home, your doctor will most likely diagnose ADHD.

TREATMENT

There is no "cure" for ADHD, but your doctor will suggest a number of treatment strategies that can help control your child's symptoms and make it easier for him to lead a normal, happy, successful life. Common treatment strategies include a combination of medication, behavioral therapy, parent training and school accommodations. Although controversy has continued to shadow ADHD treatments, most research shows that a combination of medication and behavioral therapy is most effective for most children.

Treatment can begin immediately, but while some children see nearly instant improvements, others must try a number of medications, dosages and therapies before getting optimum results.

MEDICATION

Seventy to 80 percent of children with ADHD respond to treatment with stimulants, so this is often the first line of defense. Doctors sometimes prescribe nonstimulants for the approximately 20 to 30 percent of children with ADHD who don't respond to stimulant treatment.

Stimulants

There are over a dozen stimulant medications on the market, but here are the most common.

  • Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin, Focalin): The most widely-used drug therapy for ADHD and still the most common.
  • Dextroamphetamine-amphetamine (Adderall)
  • Dextroamphetamine (Dexedrine)
  • Lisdexamfetamine dimesylate (Vyvanse)

It seems strange that giving stimulants to an already hyper child could help, but researchers believe they may help adjust the levels of neurotransmitters in the brains of ADHD children. Stimulants can be prescribed in short-acting and long-acting forms, so your child may take medication as often as three times a day or perhaps only once a day. Medications come in pill, liquid, capsule and patch forms.

Most children experience some side effects, the most common being insomnia, decreased appetite, or weight loss. Occasionally, kids will experience irritability or a "rebound" effect when the medication wears off. Very rare side effects can include facial tics, which most often disappear with a lower dose or change in medication, and a reduced growth rate. Kids should be screened for any pre-existing heart conditions before starting stimulants.

 

Nonstimulant medication

There are two nonstimulants specifically for ADHD treatment in children.

  • Atomoxetine (Strattera): Strattera increases the levels of the neurotransmitter/hormone norepinephrine to the brain. Researchers think this chemical plays a key role in focus and attention. This drug may also reduce anxiety. Strattera can cause some rare but very serious side effects, including jaundice and other liver problems, and suicidal thinking.

  • Guanfacine (Intuniv): This newer form of Tenex, a drug for high blood pressure, was approved for ADHD treatment in fall 2009. Again, doctors are not really certain why it works, but it may help control behavior by affecting the prefrontal cortex, the area of the brain that serves as a check on our impulses. The most common side effects of Intuniv are tiredness and sleepiness. Other side effects may include low blood pressure and low heart rate, dizziness, fainting episodes and nausea.

THERAPY

Therapy can be important in treating ADHD, either alone or with medication. Many parents object to giving their children drugs before first trying other strategies. Others start with therapy and then progress to therapy plus medication, often when school becomes more complex and challenging. A good doctor will work with you to find the treatment strategy best suited for your family and your child. (Get help starting your search.)

Counseling

Individual and family sessions with a psychiatrist, psychologist or other counselor specializing in ADHD can help children and families deal with the anger and frustration it can cause and create a more positive environment for working on coping strategies.

Behavioral Modification

Medication can help a child focus, but behavioral techniques will give him (and you!) concrete methods to help change his behavior, often through charts that provide visual reminders and offer rewards for positive actions, like remembering books or standing quietly in line. (For some sample free charts for every age group, go to the Association for Comprehensive Neurotherapy) [[link: http://www.latitudes.org/behavioral_charts.html]] Children, parents and teachers or caregivers can learn behavioral therapy techniques from psychiatrists, psychologists, or other counselors (sometimes called coaches) who specialize in ADHD.

Parent training

Kids with ADHD don't always respond typically to common parenting techniques. If you ask them to set the table, and they don't do it, they may need a warning or two before you lower the boom. Parent training provides ADHD-specific strategies for discipline as well as teaching organization and problem-solving skills.

Some tips on parenting children with ADHD include:

Reinforce natural consequences of actions

Most children will learn from their mistakes, but ADHD children may not make the connection between actions and consequences the way parents expect. Most kids who, for example, swing from a second story banister and break an arm will know not to do it again. An ADHD child may come home from the ER, climb back up on the banister, cast and all, and break his other arm. ADHD children who push, shove and annoy other children can be puzzled when they don't have friends. Even if it seems obvious, parents should stress (in a positive and loving way) the cause and effect relationship between a child's behavior and results.

Use positive discipline

While with non-ADHD children parents often can simply correct misbehaviors, with ADHD kids it is better to focus on teaching and reinforcing good behavior rather than waiting for mistakes. For instance, don't just give a time out for pushing on the playground, give your child praise or a sticker for playing appropriately.

Be clear and consistent

This is a good idea with all children, but essential for those with ADHD, who can't intuit what parents want if it isn't spelled out clearly for them. Don't say "Play nice!" Instead tell your child "Do not hit or push. If you do, we'll have to leave the park." Don't say "Behave for Grandma" but instead "Only walking is allowed in Grandma's house" or "Last time at Grandma's you drew on the walls. She was sad and you had a timeout. Here is your paper. It is the only thing you are allowed to draw on."

Support groups

Peer support can give families coping with ADHD encouragement, advice and information. Children and Adults with ADD (CHADD) lists local affiliates, many of which offer support groups, on its website, chadd.org.

ALTERNATIVE AND COMPLEMENTARY MEDICINE

Type "natural cures for ADHD" into your browser and discover just how many people are willing to take your money -- and possibly harm your child!

Currently, medical evidence does not support the idea of alternative therapies for ADHD, although there is some promising research into certain diets and neurofeedback, a form of biofeedback where children look at visual images of their brainwaves and learn to control them -- therefore controlling the ADHD behaviors that produce them.

A 2001 study on 56 boys with ADHD showed symptom improvement in the 19 boys who received Interactive Metronome Training, a computerized simulation of the simple piano metronome. This promising study launched a whole industry of metronome training, when really what is needed is more research.

No legit scientific evidence backs up online favorites like megadoses of vitamins or herbal remedies for ADHD, and these supplements are so poorly regulated that you can never be sure what you are buying or giving your child.

If you do wish to explore complementary therapies (those done in conjunction with, rather than as an alternative to, conventional medicine), try those that are first of all harmless, and second can benefit health in some way, even if they're not proven for ADHD. Examples include yoga or eliminating food additives in your child's diet. But always consult your doctor first.

Also, remember that complementary medicine doesn't necessarily mean taking a pill or eating special foods. Activities like exercise, soothing music at meal or bedtime, and a schedule that ensures your child gets adequate sleep can all be considered "therapy" for ADHD.

SCHOOL STRATEGIES

Public school districts are required by federal law to offer reasonable accommodations for kids with ADHD under section 504 of the Federal Rehabilitation Act of 1973, a civil rights act. Your child's teacher can put you in touch with the appropriate special education administrators in your school district.

Children may also qualify for school services under the Individuals with Disabilities Education Act. Your school district's special education team will know which law applies to your child. Children who qualify for services under IDEA (IDEA can sometimes provide more extensive accommodations than a 504 plan) will receive an Individualized Education Plan or IEP that will spell out just how the school will accommodate your child and what their goals for his education are. The plan will be reviewed and needed changes made each year. For more information, go to http://idea.ed.gov. Even preschoolers can sometimes qualify if they are identified through Child Find, the government early intervention program, although ADHD is most often diagnosed in school-age children.

Parents may be hesitant to have a 504 plan or IEP for their child for fear of stigmatizing them. (This is probably a leftover from the days when "special ed" was segregated from the rest of the school and often a dumping ground for anyone teachers couldn't deal with.) But a 504 or IEP is really just a way to make sure the school is working together as a team to help your child achieve maximum success in school. It also offers parents legal protection and remedies if the school does not make needed accommodations. Teachers and administrators are not going to share this information with students. And remember, ADHD is such a common disorder that it's likely numerous children at your child's school will have the most common accommodations, like extra time on tests.

Parents who choose religious or other private schools will have to organize accommodations outside this official process (unless they are referred to private schools because the local school system cannot accommodate their child). These schools may not offer the same level of support for ADHD children. However, they may have smaller class sizes and other advantages for children with ADHD. Parents will have to evaluate the differences and the cost, and make the decision.

You can also encourage your child's teacher or principal to attend a seminar or workshop on ADHD, where they can learn more about behavior modification and other strategies to help their classroom run more smoothly for all students.

CHILD'S POINT OF VIEW

Children with ADHD can be angry, frustrated and depressed, especially before they're diagnosed and treated. Think about it -- kids love to please. Imagine trying, day after day, and failing miserably, and wondering what is wrong with you and why you are different. Kids reports feelings of sadness, anger and frustration:

  • "It's like he's in a three ring circus trying to juggle five things -- and he can't juggle," says Carla Nickerson, of Largo, FL of her son, Jacob Aylen, 11. Jacob and his step brother both have ADHD.

  • "In kindergarten he cried a lot and was very sad and felt he couldn't do things to the expectations of teachers and parents," says Penny Williams, of Asheville, NC, mother of Emma, 10 and Luke, 7. Luke was diagnosed with ADHD two years ago.

  • Jeanne Bailey's daughter, now 16, of Alexandria, VA began to have problems keeping up in school age nine and worked hard to compensate in school. Under that pressure, she became explosively angry with family members at home.

Because children don't know they have a medical condition, they may not share their feelings with parents until after they start treatment and realize the difference in their ability to keep up with peers and control their behavior. Once they realize they are not "bad" or "stubborn" or "spacey," they can feel relief.

"When I take my medication, I hear everything," is how her stepson describes it to stepmother Carla Nickerson. When Jacob Aylen's medication wears off, he tells his mother, "I'm so confused, I need to take my pill so I can 'come back.'"

Getting ADHD diagnosed and treated early can make a positive difference in a child's attitude and personality, says Karran Harper Royal, of New Orleans, the parent of two sons with ADHD, Khristopher, now 23, and Kendrick, 14. Kendrick was diagnosed more quickly than his brother because Harper Royal knew about ADHD the second time around. "Kendrick did not go through years of getting kicked out of the classroom and it makes a difference in his whole disposition. He doesn't have that built-up anger and rage."

Some kids may be embarrassed about having ADHD. Parents, doctors and counselors each play an important role in making children feel confident and comfortable with the fact they have a medical condition that needs treatment, just like asthma or diabetes. For children who find reporting to the school nurse for meds embarrassing, long-acting medications that can be given at home and last the whole school day can help.

MOM'S EXPERIENCE

Parents of ADHD kids often experience some of the same feelings as their children -- frustration, anger, sorrow and a sense of failure.

  • When Khristopher was little, Karran Harper Royal had never heard of ADHD. All she knew is that she was the mother of the "bad" child in kindergarten. She even quit her job to work in the classroom to try and control Khris. "It was always 'Mrs. Royal, Khris did this, Khris did that!' He was always being put out of the classroom," she remembers. She was humiliated -- and worried. Her brothers had behaved just like Khris, and ended up as dropouts. One even went to prison. When a teacher told her about ADHD and she had her son evaluated, she was relieved -- he had a condition that could be treated. (Khris is now a successful musician who attended the prestigious Berklee College of Music in Boston.)

  • One of the most difficult decisions, parents say, is whether or not to put their children on medication. Because ADHD is a mental condition and there are no specific tests, like MRIs or blood tests, to diagnose it, some critics insist it doesn't exist, despite the fact that the same thing is true of other conditions, like depression and schizophrenia. Acquaintances and family members not educated about ADHD can be dismissive and even cruel.

  • "Society is so judgmental," says Carla Nickerson. "People say 'how do you know it's truly a syndrome or disease?' Even I thought it was crazy!" She notes that no one criticizes her in the same way for giving Jacob, who also has diabetes, insulin.

  • "It took me about three or four days of grieving before I agreed to do the medication," says Penny Williams. "Like the general public, I had this [mistaken] idea that I was going to medicate my child to get him to comply."

Once ADHD is diagnosed and kids are started on a course of treatment, parents say things get smoother -- but only with hard work. Parents have to rethink their discipline and organizational techniques, keep up with medication schedules, watch for troubling side effects, and advocate with schools so their children get accommodations and the best education possible. Many describe it as a full time job.

"I had to stay involved every step of the way," says Harper Royal of raising two sons with ADHD. But the payoff, she says, has been huge.. "I don't have to worry about my son going to jail or being a drug user." (statistics say children with untreated ADHD are more likely to do drugs or get into trouble with the law.) "He's made good choices."

AGE-BY-AGE GUIDE

Infant

There is no legitimate way to diagnose an infant with ADHD, but the American Academy of Child and Adolescent Psychiatry says that all of the following can be signs of a tendency to develop ADHD later.

  • Colic
  • Poor sucking/frequent feedings
  • Irritability
  • Thumb sucking
  • Difficult to comfort/dislikes being held
  • Poor sleeper

Of course many babies exhibit these behaviors and do not go on to develop ADHD. They're of more concern if the baby has other risk factors, such as a family history of ADHD or prenatal exposure to drugs, alcohol or cigarettes.

Toddlers

Diagnosing toddlers with ADHD is extremely controversial since developmentally, most lack impulse control and have short attention spans. However, children that will later be diagnosed with ADHD can exhibit these traits to the point where they are actually dangerous -- hitting, taking toys, even dashing into the street -- on an ongoing basis. Children with ADHD may have frequent and violent temper tantrums, and be poor sleepers and picky eaters as toddlers. (But please remember, none of these signs guarantees your child will have ADHD!)

Some parents do seek diagnosis and treatment for very young children with severe behavioral issues. But because the brain is still rapidly developing at this point and few psychiatric medications are approved for very young children since side effects can be severe and troubling, doctors are most likely to recommend only parental training and behavior modification.

Grade-school Children

The vast majority of children are diagnosed with ADHD during the first few years of school when their inability to focus and lack of control make learning and social functioning difficult.

Children with ADHD may be rude, aggressive or inattentive in class. They are likely to forget assignments and lose materials. Many will fall behind because of ADHD behaviors or learning disabilities, which are common in children with ADHD. However, ADHD children can be extremely bright and may compensate, working feverishly to get good grades. Children with ADHD may have difficulty behaving appropriately on sports teams, at parties and on family outings. ADHD behaviors can cause family stress and strain parental relationships and marriages.

Once diagnosed with ADHD, children are most often treated with a combination of medication and therapy, however, some will only need one or the other. These therapies are effective in most children, but they're not magic -- many ADHD children will struggle more than their peers to succeed in school and social environments.

Early diagnosis and intervention is key to later success for ADHD children. Thanks to federal civil rights laws, public schools are required to provide accommodations or strategies and aids to enable children with ADHD to learn and compete with their non-ADHD classmates.

The Middle School Years

Many kids who have the inattentive type may be diagnosed for the first time around this age. Whether your middle schooler's been recently diagnosed or not, an increasingly difficult curriculum and adolescent hormones can wreak havoc in the lives of ADHD kids (not to mention their parents!) Parents, teachers and doctors need to be ready to readjust treatment strategies, including changing medications and doses, and developing new methods for organizing more complex schedules.

Middle schoolers should also begin to take more responsibility for their decisions and therapy. Some experts recommend that kids take a "holiday" from medication if they want and see how it affects their lives and their school performance. Otherwise it can become an area of conflict with parents.

Behavioral therapy should also focus on strategies that kids, rather than parents, can employ to remember homework and materials. Color coded charts will give way to notebook or computer organizers.

Beyond Middle School

All teens are impulsive, but since ADHD kids can be even more so, the dangers that lurk for all teens -- car accidents, drinking, drug abuse and irresponsible sex -- are magnified for them. Experts used to think children outgrew ADHD in their teen years, but now research indicates that about 60% of children with ADHD will have the condition as adults, although symptoms become less severe over time. That's why it is important for children to continue treatment and for parents to continue to advocate for their education. ADHD students may qualify for accommodations like extra time on standardized tests in high school and college.

Experts say teens who have learned how to schedule themselves and how to make appropriate decisions through therapy earlier in life will be less likely to struggle in school and with social relationships during the critical teen years. This will boost their self-esteem and lead to happier, healthier kids.

SUPPORT

There are many ADHD websites on the web, but surf carefully! Some are selling bogus "miracle cures." Others are focused on political agendas surrounding diagnosis and medication. The following will give you facts, support and links to other legitimate sources of information.

Children and Adults with ADD (CHADD)
Possibly the best comprehensive website on ADHD with fact sheets, connections to local groups, educational info and more.

National Resource Center on ADHD
This site is the clearinghouse for all the latest news on ADHD research.

ADDvance
The website of Patricia O.Quinn, MD and Kathleen Nadeau, PhD. You'll find lots of easy-to-digest information on ADHD, with an emphasis on girls and women.

ADHD Momma
Follow Penny Williams' great blog on being an ADHD parent.

The Centers for Disease Control and Prevention

The National Institutes of Mental Health

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