Clinical Corner – Understanding ADD/ADHD (by Dr. Matt)

I am a psychologist who has treated hundreds, if not thousands, of kids with ADHD (I will use the term ADHD to stand for both ADHD and ADD even though only 70% of those who suffer from ADD also show signs of hyperactivity).  This problem affects approximately 4% of school-aged children.

This disorder is characterized by difficulties with the executive functions of the frontal lobes, most notable in those abilities to control impulses.  Thus, one has intelligent, kind children acting in ways which seem to defy common sense, i.e. impulsively doing things that know will get them into trouble, responding inappropriately when attention is required because other stimulus has 'pulled' their attention away, misreading subtle cues in relationships, etc.  These children are overwhelmed by the 'now' and, thus, their abilities to use knowledge and reason in acting seems to lag behind their actions.  It is not uncommon for a child to say "I knew I was going to get caught, but I did it anyway".  This is because the environmental cues control behavior, instead of the internal cues and thoughts of the child.  These children know what they should do, but the environment overwhelms them and they act in accordance with it rather than in ways that show inhibition and self-control.

This is a very frustrating condition for families but even more so for youngsters who have it.  Imagine how confusing it is for kids to know they are bright but are falling farther and farther behind their peers in academic performance.  Likewise, imagine being in 4th–6th grades and not being able to pick up the subtle cues needed in relationship building.  Other kids notice this and the ADHD child compensates by doing more and more of the same thereby alienating them even more.  It is painful to watch abut even more painful to live.

The research in this area has consistently shown that kids with ADHD are very treatable with a combination of therapy and medication.  In fact, I am often able to let parents know that their child "only has ADHD" which is good news because we can treat it so well.  Let me tell you there is no greater joy for a child (or parents) than seeing his world change for the better.  Whether is be experiencing success in school, social relationships, or extra-curriculars; the world is no longer a scary place but a place full of opportunity.

Medication is often prescribed by the treating physician and there are a variety of medications to chose from, e.g. Ritalin, Cylert, Dexedrine, Wellbutrin, Strattera, etc.  The combination of therapy and medication should help children to become sharper and more attuned so that they can do more things in a more competent manner.  This makes kids feel much more powerful and in control of their environment rather than the other way around.

With respect to side effects of medication, research suggests the most commonly reported ones are a slight decrease in appetite and some difficulty falling to sleep in the initial week or two.  However, for every parent contemplating medication, we advise sitting down with the prescribing physician to talk about side effects and consequences.

Another important component of treatment is teaching the family (and the child if he/she is old enough) about ADHD.  In our practice, if your child is suspected of having ADHD we do a full hour of teaching work (complete with outline and reading materials) to help parents learn about this disorder.  Our goal is to have parents become 'mini-experts' so that they can converse intelligently with anyone about this disorder.  In this way parents can go to school, doctors' offices, etc. and be a part of the treatment team instead of just following rules given to them.  It also helps parents understand the treatment protocol and the shortcomings of certain "fad" therapies and untested treatments.

Lastly, to all those families dealing with this issue, there are therapies that work.  My heart goes out to you because it is a struggle that few will understand unless they have been through it themselves.  However, it is winnable and I suggest you keep on learning about it and working with each other to overcome it.