Diagnosis and treatment of ADHD

Diagnosis and treatment of ADHD is a concern for between 5 and 10% of children in the U.S. today.   However, this number maybe artificially inflated according to a study released in early 2008 by a research group at UCLA.  According to these researchers at least half of the children diagnosed with ADHD in their study showed the cognitive deficits that are associated with the condition. (1)

Until this point many scientists and doctors recognized the discrepancies between the number of children diagnosed with this condition based on the area of the country in which they lived.  The differences appeared to be related to the cultural differences in the area and not related to a difference in diagnosis or physical disability related to geography.

Now, more evidence appears to point to misdiagnosis across the U.S. and not just in pockets of communities.   Part of the discrepancy may also lie in the common method used for diagnosing the disorder.  Evaluation tools are used by the physician, parents, teachers and other adults who are in consistent contact with the child such as music teachers or coaches.  The results of all of the tools are compared and compiled to determine if the child has a problem with ADHD.

ADHD is actually an extreme amount of behavior on a normal continuum that varies in the population just like height, weight or IQ can vary from person to person.  The prevalence of the diagnosis can therefore be defined where the health professionals tend to “draw the line”, based on the severity of the symptoms, overall impairments and cultural norms.

Treatment of ADHD also varies from country to country.  In the U.S. the treatment protocols often include medications and behavioral therapy to help the child or adult more successfully manage their symptoms and more fully participate with peer groups or at work.

However, researchers in the same study released at UCLA found that individuals with ADHD in Finland have the same ‘look’ of the disorder as those individuals in the U.S..  This meant that the prevalence of diagnosis, symptoms, psychiatric comorbidity and cognitive deficits looked the same.  The difference lies in the treatment of the condition because in Finland the patients aren’t treated with stimulant medication the way that they are in the U.S.

Other studies also support that individuals treated only with medication have a lower success rate, as evaluated by a repeat of the tool and interviews with parents and teachers, than those who are also treated with behavioral therapy or counseling.  The additional ‘talk’ therapy helps children, parents and families to develop coping strategies for the behaviors and learn new techniques for parenting and interactions with peers and teachers.

ADHD can be a global condition that affects every aspect of a child’s life but with early diagnosis and intervention, support and therapy children and adults can learn to improve their interactions with peers, increase their productivity at work and school and improve their ability to interact in their family.

(1) UCLA Newsroom: Study Raises Questions about Diagnosis, Medical Treatment of ADHD
http://newsroom.ucla.edu/portal/ucla/new-thinking-revealed-about-adhd-43193.aspx

RESOURCES

NeuroReport: Reduced White Matter Integrity in Attention-Deficit Hyperactivity Disorder
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819371/

PsychCentral: Mindfulness Skills Useful in Addressing ADHD
http://psychcentral.com/lib/2010/mindfulness-skills-useful-in-addressing-adhd/all/1/

National Institute of Mental Health: Attention Deficit Hyperactivity Disorder
http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml

US Department of Health and Human Services: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder
http://consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110html.htm

Centers for Disease Control and Prevention: Attnetion Deficit Hyperactivity Disorder
http://www.cdc.gov/ncbddd/adhd/

HelpGuide: ADD/ADHD Tests and Diagnosis
http://www.helpguide.org/mental/adhd_add_diagnosis.htm

American Academy of Pediatrics: AAP Expands Ages for Diagnosis and Treatment of ADHD in Children
http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Expands-Ages-for-Diagnosis-and-Treatment-of-ADHD-in-Children.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token

American Family Physician: Adult ADHD: Evaluation and Treatment in Family Medicine
http://www.aafp.org/afp/2000/1101/p2077.html

Pediatrics: ADHD: Clinical Practice Guidelines for the Diagnosis, Evaluation and Treatment of Attention Deficit/Hyperactivity Disorder in Children and Adolescents
http://pediatrics.aappublications.org/content/128/5/1007.full