ADHD

A MedShadow interview with Dr. Amanda Baten, Clinical and Nutritional Psychologist, who specializes in diagnosing and treating ADHD / video transcription

 

Attention Deficit Hyperactivity Disorder(ADHD) and Attention Deficit Disorder (ADD) diagnoses are so common that parents will often casually refer to an active child as ADHD or in a moment of distraction a person might joke, “Sorry, an ADD moment.” In reality, ADHD is very difficult to diagnose. ADHD often is a co-diagnosis with learning or social disabilities. It is difficult to determine if mild allergies, psychological issues or other factors result in ADHD/ADD-like behavior. A full diagnostic evaluation to determine ADHD/ADD will also test for learning disorders. Doctors spend hours with a patient, often over the course of several appointments,  for a full neuropsychoeducational evaluation – which is needed for most school accommodations (like extended time to take classroom tests) and for standardized test accommodations for college entrance exams.

ADHD/ADD cannot be diagnosed before the age of 7. This confuses many parents, because one of the criteria for a diagnosis is that the symptoms appear earlier than age 7. However, a neuropsychological assessment (the appropriate way to diagnose ADHD) uses IQ as part of the assessment. The IQ is unstable before age 7 and can change with intervention and learning.

From Amanda Baten, Ph.D. (interviewed in video above): “My training in neuropsychology emphasized that IQ, which is measured and used as part of the assessment of evaluating this disorder, is not stable prior to the age of 7 and can change with interventions and learning. Therefore, even though we may see symptoms before the age of 7 AND that having those symptoms before the age of 7 are part of the criteria for meeting the diagnosis, we don’t make a hard diagnosis until the age of 7. That’s because part of the criteria (IQ) can change, and we don’t want these kids stigmatized or misdiagnosed and have to have that diagnosis permanently on their school records.”

ADHD/ADD is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty concentrating contrasting with periods of high concentration on particular subjects, impulse control issues, and hyperactivity (over-activity). All children (all humans) display these attributes at times, the difficulty is in determining when the behavior crosses the line into a diagnosable condition. Only a doctor can make the diagnosis — not a teacher, not your neighbor with four children, not you.

Several decades ago it was assumed that children outgrew ADHD/ADD. Now the medical community is aware that many diagnosed with ADHD have the symptoms into adulthood, potentially through their life. For this reason it’s important to consider environmental factors (food allergies, caffeine, visual distractions), behavioral modification therapy and the other tools of living with ADHD/ADD. (View MedShadow’s interview with Dr. Amanda Baten (above) for more info.)

Training parents to deal effectively with child disruptive behavior and improve parenting skills is more effective in most cases than is medicine. Medicines treat only the symptoms of ADHD, they are not a cure and they do not teach tools to handle daily challenges. The later effects of childhood and teen exposure to the stimulant medicines commonly used to treat the symptoms of ADHD/ADD are not known. Many people do need the medicine, but if you or your child can manage the symptoms without medication there will be no risk of an unexpected, adverse outcome in years or decades to come.

A new study from Johns Hopkins (reported in The Atlantic) found that 160 out of 180 kids on ADHD medicine still exhibited ADHD symptoms 6 years later. The parents, when interviewed, claimed the ADHD had been chronic through the 6 years. There were unanswered questions raised by the study: were the children each prescribed the right medicine for him/her? did they take the medicine correctly? Were they diagnosed too young? These children were diagnosed at 4 1/2 years old – to young for a full neuropsychoeducational evaluation. So maybe ADHD medicines don’t really manage ADHD. Or maybe some of these kids never had it. Or maybe something else. ADHD is complicated and approaches to management must change if they are ineffective. No point in continuing to give a child a stimulant drug when it’s not working.

Many teens who take stimulants for ADHD/ADD like the immediate benefit of increased concentration. Used correctly, stimulants are a good tool. Because they help anyone concentrate, there are students who do not have ADHD who will use these stimulants to study or to perform better on a test. This is drug abuse – the stimulants normally prescribed for ADHD are Schedule II drugs, they are controlled substances because they have a high potential for abuse and dependance. All parents need to be aware of these temptations and risks for their children.

Treatment: Because there are few physical side effects of non-drug treatment, MedShadow Foundation carries very little information about it. That is not to imply it isn’t worthy of consideration. In fact, every child and adult with ADHD should have the benefit of non-drug treatment before trying drugs. And all children, and adults, with ADHD should continue to use non-drug treatments and training for ADHD even if also using prescription drugs.

Non-drug treatments include many options including and not limited to: behavioral training for the parents of diagnosed children, Cognitive-behavioral therapy for diagnosed children and adults with ADHD, nutritional analysis, altering the environment of work/study space, and consideration of medical issues with similar symptoms such as sleep deprivation (see Misdiagnosis following).

Misdiagnosis: The causes of ADHD are not known. There are many hypotheses and quite a few guesses. But as far as we can tell at MedShadow Foundation, no one is certain if it is genetic, learned, acquired or other. What we are seeing is that the symptoms of ADHD are highly similar to other conditions and – very importantly – may respond to treatments for entirely different ailments. See the opinion piece by Vatsal G. Thakkar on the link between sleep deprivation and ADD/ADHD. It’s very convincing.

Immediate Side Effects of stimulant medicines (common ones are Ritalin, Concerta, Dexedrine or Adderall) often, but not always include: Trouble sleeping, nausea, lack of appetite, weight loss, headaches, dry mouth, dizziness, irritability, or mood changes. Most of these medicines lose efficacy over time, so anyone on these medications should see their doctor on a regular schedule. Each medicine has it’s own unique characteristics, so consult with your health care provider.

Long-Term Side Effects: There are many concerns about the possible long-term effects of stimulants. We at MedShadow can find little information about the long-term effects of drugs used to treat the symptoms of ADHD. We searched the internet and linked to those articles and web sites we found most useful and credible on our page: ADHD Long-term Effects. Ask your health care provider and your pharmacist for more information. If you know of an article that should be included and is not, please contact us.

The risks and benefits of any drug –both short term and long term risks — should be discussed with your health care provider and carefully considered. Remember that you have options — among them are behavioral therapy, combined drug and behavioral therapy, parenting classes, watchful waiting.

Please know that we at MedShadow are concerned consumers and parents, not medical professionals. You should never substitute our comments for your opinion and consulting with your doctor/health care provider.

 Suzanne B. Robotti

 

Last updated: November 16, 2014