FP Report -- 1999 Post-Assembly Edition
Help children and adults overcome attention disorders
Attention-deficit/hyperactivity disorder can be difficult to diagnose, yet proper intervention and treatment can have a profound impact on the lives of patients with attention disorders.
During an Assembly case study session on children and adults with attention disorders Sept. 16 in Orlando, Fla., two experts in the field presented overwhelming evidence that even patients with severe AD/HD can be helped.
"Diagnosis at an early age is critical, because the earlier you can intervene the better chance the patient has to develop skills to cope and find success in life," said Clare Jones, Ph.D., a nationally known expert on AD/HD and the author of four books on the subject. "It's important for the patient and family to develop a positive attitude. The message is, 'You can help this unique child survive and thrive.'"
Jones and James Nahlik, M.D., associate clinical professor of community and family medicine at St. Louis University Medical School, discussed six case studies of patients ranging in age from 5 years to adult. AD/HD is a lifespan disorder, Dr. Nahlik said.
"The symptoms may change over a patient's life, but children do not outgrow AD/HD," he said. "You can diagnose AD/HD at any time during a patient's life."
Jones noted that mild attention disorders are the most difficult to diagnose, because patients often develop their own coping skills.
"Many patients with mild AD/HD never realize they have the disorder because they have been able to deal with it effectively on their own," she said. "Thus the patients you are most likely to see in your practice will have moderate to severe AD/HD and definitely need your help."
Behavior modification, psychotherapy, family therapy and support groups can be indicated for AD/HD children and their families, Nahlik said. Family therapy is important, he noted, because some 70 percent of children with attention disorders have one or both parents with the same disorder.
He went on to discuss some of the commonly prescribed medications for AD/HD, including psychostimulants such as the commonly prescribed Ritalin® and Cylert®.
"Psychostimulants are beneficial in 70 to 80 percent of patients with AD/HD, but parents often ask us, 'Why stimulate the hyperactive child?'" Nahlik said. "The explanation is that these medications specifically stimulate the part of the brain involved with attention."
Although medications are beneficial, both speakers recommended a "skills, not pills" approach to treatment.
"Medication can be helpful as part of the process of helping a patient learn to focus and stay on task," Jones said. "Just writing a prescription isn't enough -- you have to empower your patients to help themselves."
FP Report is published by the AAFP News Department. Copyright © 1999 by American Academy of Family Physicians.
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