George A. Sprecace M.D.,
J.D., F.A.C.P. and Allergy Associates of New London,
ATTENTION DEFICIT / HYPERACTIVITY DISORDER (ADHD)
- Even More Information
The following are notes personally taken at a presentation on the subject
of ADHD by Dr. Wilens, pediatric psycho-pharmacologist from Massachusetts
General Hospital and Harvard Medical School. Once again, as noted
elsewhere in this section, the key to the proper treatment of children
with this spectrum of disorders is a proper multi-disciplinary diagnostic
There you have it, folks. Clear now? No? Good,
because then you're on the right track for seeking a multi-disciplinary
evaluation of your child - or even of yourself if you suspect something.
But remember...ignoring the situation or going into denial is an action
- and it may be a very wrong action.
The prevalence of ADHD in the United States and in the developed world
is about 8% of the population. The condition is highly genetically
"Regarding over-diagnosis, half are being diagnosed, and of those, one-quarter
are being treated."
In vitro use of alcohol and/or tobacco is definitely associated with an
increased likelihood of ADHD in the offspring so exposed.
Developmentally inappropriate hyperactivity and impulsivity are both important,
with one finding outweighing the other in any given case. At least
six of the symptoms and signs outlined in the ADHD section of DSM -
1V should be present. Duration should be at least 6 months for
the diagnosis to be considered.
The problems arise before the age of 7 years old, even as early as age
three years. By age 6-9 years, the condition may well be chronic
and less amenable to treatment.
The degree of impairment is often not marked.
The results of a missed diagnosis and no treatment include: low self-esteem;
increase in tendency for substance abuse; increased incidence of accidents
and injuries, especially motor vehicle accidents and especially while "multi-tasking"
Co-morbidities like anxiety and depression are common, even in pre-schoolers.
Regarding prognosis, hyper-activity tends to improve by ages 9-12.
In adults, inattentiveness tends to persist, and the condition often leads
to substance abuse.
Treatment includes medications and behavior modification. "Just medications
are effective also".
Medicatons include stimulants (eg. methylphenedate: ritalin or concerta),
tricyclic anti-depressants, and anti-hypertensives (eg. clonidine)
- or atomoxetine. Results with stimulants are dose-dependent.
Controversies regarding the use of stimuants. Growth suppression?
"No". Tics? "No". Substance abuse? "No".
Effects on vital signs? "No".