ASK A USCF BENIOFF OAKLAND CHILDREN’S HOSPITAL OAKLAND/WALNUT CREEK EXPERT: ADHD
Q: ADHD is a medical condition that affects 5 to 10 percent of all children. What are the types of ADHD and are there differences in girls and boys?
A: There are actually three main types of ADHD. The inattentive type of ADHD was formerly known as Attention Deficit Disorder, or ADD. Symptoms include making careless mistakes, failing to follow through with tasks, difficulty with organization, losing things easily and being readily distracted and forgetful. The hyperactive and impulsive type includes symptoms like fidgeting, squirming, running around, climbing on things, talking too much, interrupting, or moving quickly from one activity to another. The combined type of ADHD includes both inattentive and hyperactive symptoms. Boys are three times more likely than girls to have the disorder. Girls may demonstrate more of the inattentive symptoms and therefore a diagnosis can be missed because it’s not as obvious as in boys.
Q: If you think your child has ADHD, when is the appropriate time to seek help?
A: Between the ages of 5 and 7, symptoms may begin to cause impairment at school or in relationships. Hyperactive or impulsive behaviors can be perceived as disruptive. Or a child may act like the class clown. The child may get into trouble with a teacher or have difficulty interacting with other children. When a child can’t manage impulses well, other children may not want play with them. It takes much more effort for children with ADHD to control their behaviors than children without ADHD. It is critical to acknowledge that these behaviors are the result of the disorder and not willful misbehavior on the child’s part.
Q: How can ADHD affect a child’s performance at school?
A: Another symptom of ADHD is that a child might fail to make expected academic gains at school. By 4th grade, ages 9-10, school becomes more complex and abstract. Attaining academic goals may become a challenge. A child might have more trouble finishing class work or homework. He or she might not feel “smart” and this may lead to decreased self-esteem. A child may also interrupt other children and annoy them. The child can begin to feel that no one likes them and that they can’t do things right, leading to anxiety or depression. It is critical to prevent this from happening.
Q: Should ADHD symptoms be treated with medication or with behavioral approaches?
A: It comes down to the child. For the most part, the core symptoms of ADHD are usually best treated with a medication. The most effective type of medication is a stimulant medication. These medications are typically 75 to 90 percent effective at treating the core symptoms of ADHD, but leave the body’s system at the end of the day. Because ADHD is neuro-biologically based condition, no amount of psychotherapy can change core executive functioning challenges. However, learning some behavioral techniques and skills can help manage some of the symptoms and families can also use these techniques. For example, don’t give three-step instructions – break ideas down into single steps. Have a checklist at the front door and before leaving the house, have your child can make sure that daily items like a backpack, homework, lunch and jacket are going too. Learning key behavioral interventions is important because not every child is going to take a medication every day, and they are good skills to have moving forward into adolescence and adulthood. Some children with ADHD will function better with medication alone, but many children with ADHD will benefit from a combination of medication and behavioral interventions.
Q: Is ADHD a life-long condition?
A: Up to two-thirds of people with ADHD outgrow the symptoms – particularly the hyperactive and impulsive symptoms – but sometimes the disorder persists into adulthood and may require indefinite treatment. Although both children and adults suffer from the disorder, ADHD at age 5 can look very different from ADHD at age 15 or 45. ADHD is a common disorder that many children live and thrive with, but it is important as a parent to remain patient and supportive.
Dr. Petra Steinbuchel; Director of Child & Adolescent Psychiatry and Medical Director, Mental Health & Child Development, UCSF Benioff Children’s Hospital Oakland