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Attention Deficit Hyperactivity Disorder


Andrew Ferguson, M.D.

Approximately three to five percent of the children in the United States have Attention Deficit Hyperactivity Disorder or ADHD. More boys than girls have ADHD for reasons that are poorly understood. ADHD behaviors usually begin in childhood but can persist through adolescence into adult life. Children with ADHD cannot sit still, plan ahead, finish tasks or even be aware of their environment. The behavior is situational, for the child may excel in one environment, but do poorly in another, demonstrating disorganized or even frenzied behaviors.

The diagnosis of ADHD is not straightforward and it is sometimes even misdiagnosed. A routine laboratory test or X-ray study cannot discover the disease. Doctors look for and characterize specific behavioral patterns which help make the diagnosis. ADHD can be categorized into three general behaviors: inattention, hyperactivity, and impulsivity. Children with or without ADHD exhibit these behaviors in some combination. However, in ADHD, the behavior patterns are persistent and ultimately impair the child’s development.

Other medical conditions can mimic ADHD and must be carefully considered before making a diagnosis. A complete neurological and developmental evaluation of the child is imperative. For example, attention lapses may be a sign of a type of seizure disorder rather than ADHD. Children with anxiety and/or depression may have disruptive behavior and underachievement that may be mistaken for ADHD. Learning disorders must be considered in the evaluation because they can coexist with ADHD, thus complicating treatment.

The cause of ADHD is not well understood. Some parents may look in the past and try to correlate the cause of the disorder to early child life and development. New thinking about the disorder theorizes that ADHD is a biochemical imbalance of the brain, and not exclusively linked to upbringing. Researchers have used blood flow studies of the brain, known as PET scans, to show decreased blood flow in areas of the brain responsible for attention in children with ADHD. Although these studies are in their infancy, they have sparked a new line of thinking about the causes of ADHD that may lead to new treatments.

Stimulants are commonly used to treat ADHD. These drugs act on the ADHD brain in a paradoxical way to increase the ability to work, focus and learn. Under close medical supervision, and with the correct dose, these drugs are usually safe for children and work well. Doctors need to thoroughly evaluate each case, make an accurate diagnosis, and discuss the risks and benefits of drug therapy with the patient and parents before prescribing.

The use of stimulants in children has ignited controversy in the public eye. However, when used properly and under proper supervision, the medicine can make it easier for a child with ADHD to succeed at school. This may lead to an increased level of self-esteem and reduce the incidence of emotional problems later in life. Drug therapy is only one component to the treatment of ADHD. Strict time management techniques, cognitive therapy and social skills training are essential as well. Teaching parents coping skills can be beneficial in helping manage their child’s behavior. Schools have become more aware of ADHD as a disease and the special needs these children have.

The future hopefully will hold a better understanding of the cause of ADHD, which may help doctors better diagnose the disease and reduce the incidence of misdiagnosis. It may also shed light on new modalities of drug and behavioral treatment.

Andrew Ferguson, M.D., is board-certified in family practice and practices in association with Patrick Shanahan, M.D., in Chestertown. He earned his medical degree from the University of Maryland.