 Oct. 18, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
What do Dennis Rodman, Ansel Adams, Mariette Hartley and Sir Anthony Hopkins have in common? They are all famous people, of course, but in addition they were all diagnosed with attention-deficit/hyperactivity disorder as children.
Their accomplishments in life support the belief that children diagnosed with ADHD have unique gifts as well as the learning and behavioral problems familiar to most family physicians.
Supporting the strengths in ADHD kids and helping them overcome their weaknesses were the subjects of a lecture called "Pills and Skills" given yesterday by Clare Jones, Ph.D., a diagnostic specialist and educational consultant with Developmental Learning Associates in Scottsdale, Ariz.
"When you look at the ADHD patients you have in your practice, I hope you will think of the wonderful possibilities ahead for people with attention disorders and the great hope we have for their success in life," Jones said.
The strengths experts have identified in ADHD children include strong verbal abilities, thinking in terms of the big picture, creativity and strong long-term memory abilities. Their weaknesses include impulsiveness, poor organizational skills and poor short-term memory abilities.
Diagnosing ADHD
More than two million children in the United States have been diagnosed with ADHD. "Seventy percent of children with ADHD have a mom or dad diagnosed with ADHD," Jones said, and so a family history is a key risk factor to consider in diagnosing this disorder. Adopted children have the highest rates of ADHD among all children.
Other diagnostic factors include developmental signs, such as memory problems that affect visual-motor skills. ADHD kids also have difficulty interacting with others. They are more impulsive than other children, and they may not look at the person to whom they are talking.
Comorbidities are common in ADHD children, Jones said. About 33 percent have learning disorders, 50 percent have disruptive behavior disorder, 25 percent have anxiety and 10 percent to 30 percent have mood disorders. From 27 percent to 75 percent also have tic disorders.
Involve parents and teachers
Family physicians need to involve parents and teachers in the diagnosis and management of ADHD, Jones said. There are parent and school checklists available to help identify ADHD behavior. A battery of psycho-educational tests is also available to help physicians determine the strengths and weaknesses of these children.
Recent research suggests that an alteration in a dopamine-receptor gene, DRD4, contributes to ADHD in some children. Functional magnetic resonance imaging has shown that ADHD children have smaller right brain sections.
Jones said that stimulants remain the first choice of medications prescribed to treat ADHD. Ninety percent of those who respond to these medications show short-term benefits. Sustained-release medications provide beneficial long-term effects. Next January, a new non-stimulant medication approved by the FDA will come on the market.
Beyond medications, however, ADHD children also require behavioral interventions in school, such as providing them with structure and routine, redirecting their attention when they become inattentive and giving them additional time to accomplish written work.
ADHD children may also need a mentor, coach or tutor in middle school and training in social skills. At home, they require a structured and organized environment and an understanding family, Jones said.
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Copyright © 2002 by
American Academy of Family Physicians.