For ADHD kids, parent training should be initial intervention

ATTENTION DEFICIT/hyperactivity disorder (ADHD) is a common childhood illness, marked by hyperactivity, impulsivity and inattention. Hyperactive children seem to be in motion all the time.

In school, many ADHD children will squirm, fidget, move around in the classroom or continually talk. Impulsive children might act without thinking and only consider the consequences after they act. Inattentive children are often off-task, get distracted easily and need redirection and support to complete tasks.

At various times, any individual can be restless and distracted or have trouble finishing tasks. However, for a child to be diagnosed with ADHD, the symptoms must continue for six months and lead to problems in at least two areas of life, such as school, home, in the community or in social settings. The physician will consider other conditions that might produce similar symptoms, such as a family crisis, hearing problems, a learning disability, anxiety or depression. ADHD occurs in about 5% of school-age children, most often in boys, and frequently persists into young adulthood.

It seems counterintuitive: Why would physicians prescribe stimulant medications for children who are already overactive?

"These are children whose attention and concentration is poor," explains John T. Walkup, MD, the director of the Division of Child and Adolescent Psychiatry at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "Their ability to respond appropriately to relevant stimuli is delayed. Given this situation, stimulants enhance their ability to focus on a task."

Adverse events that are frequently reported with use of any stimulant include delayed sleep onset, headache, decreased appetite and weight loss, according to Mark Abramowicz, MD, editor-in-chief of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs.

"Stimulants should be used with great care in patients with a history of mania, psychosis, drug dependence or alcoholism," he says.

Dr. Walkup generally starts out with a short-term trial of medications, often over the weekend, or on a school holiday, so parents can see for themselves at home what effect the medication has on their child.

"During a short-term trial, the parents give the medication in the morning, and then they can observe the effects throughout the day," Dr. Walkup says. "When the diagnosis is correct and these medicines work, it can appear almost miraculous. You see a dramatic improvement in the youngster's confidence and productivity."

PARENT TRAINING FIRST STEP

Many different conditions present in children with roughly similar symptoms: over-activity, impulsivity, inattention, and underperformance. Those symptoms may be due to ADHD, or to pervasive developmental disorders, early abuse and neglect, learning disabilities, or early onset anxiety.

In addition, Dr. Walkup says, "children with ADHD are much more difficult to parent. Over time their parents can become less effective and feel unable to manage the child's behavior. Parent training helps stabilize the home situation, so it is easier to see which problems are related to ADHD and which may be due to ineffective parenting."