The new ADHD 2011 guidelines are good but the AAP also has a supplemental article with more information on the guidelines, Implementing the Key Action Statements: An Algorithm and Process of Care for the Evaluation, Treatment, and Monitoring of ADHD in Children and Adolescents available at:
Parents, teachers, and physicians who want to learn more about how to implement the ADHD guidelines can review this article. A number of important practical points are made in the article.
Untreated ADHD can cause severe problems in school success, in social development and friendships, and in family life. Therefore, the guidelines recommend that every child or adolescent with symptoms that could be ADHD be checked for the diagnosis. ADHD is common, and treatment can improve a child and his family’s life.
If a child has obvious impulsivity, hyperactivity, or inattention the parent will likely request evaluation for ADHD. But there are other symptoms that should suggest the possibility of ADHD and lead you to have your child checked.
Children with ADHD can have trouble planning their work and determining in what order to do the work (called executive function) and treatment may be very helpful (if the problem with executive function is due to ADHD and not something else).
Children with ADHD can have trouble making and keeping friends and trouble getting along with other children (perhaps because they are always distracted and don’t notice social cues). Treatment can help.
And children with ADHD often have trouble getting their school work done properly or sitting quietly in class. Again treatment can be very helpful.
And children with ADHD can cause problems at home in the family.
And so, parents and doctors should also consider evaluating children with any of the above problems for ADHD because, if the problem is due to ADHD, then medicine and/or behavior therapy may make all the difference in the world.
Other conditions can cause problems for the child’s academic, social, and family life. These include learning disorders, vision and hearing problems, stressful situations, depression, anxiety, and conduct disorder.
The school can arrange an evaluation for learning disorders. Other mental problems can be screened for with an instrument like the Strengths and Difficulties Questionnaire discussed in an earlier post. Depression can be screened for with the PHQ-9 for teens. Anxiety can be evaluated with the Screen for Child Related Anxiety Disorders (SCARED). Stressful life situations should be specifically looked for as they can be the cause of the symptoms and so won’t be helped by ADHD medicine .
ADHD diagnosis is supported by the parent, teacher, and physician clinical judgment and by a formal ADHD rating instrument like NICHQ Vanderbilt Assessment Scale (there is one for parents and one for teachers).
The problems thought to be caused by the ADHD need to be identified before treatment. If they don’t improve treatment should changed or stopped. Perhaps then a different treatment or second opinion would be indicated.
The problems that should be followed include academic performance, classroom behavior, friendship problems and family problems, ability to stay organized and on task, and relationships with teachers and other authority figures. At follow-up visits, each problem should be rated (better, worse, or same).
It is important to report any sleep problems your child may have because primary sleep apnea syndrome can present with impulsivity, hyperactivity, and inattention.
The article recommends that “All children being evaluated for ADHD should be systematically screened for symptoms of (ie,frequent snoring, observed breathing pauses; restless sleep, urge to move their legs at night; daytime sleepiness) and risk factors for (ie, adenotonsillar hypertrophy, asthma/allergies, obesity; family history of restless-leg syndrome/periodic limb-movement disorder, iron deficiency) primary sleep disorders.
Sleep screening tools recommended in the article include the BEARS sleep screening tool, the Pediatric Sleep Questionnaire (PSQ), and the Children’s Sleep Habits Questionnaire (CSHQ). Even mild sleep deprivation can worsen ADHD.
An outstanding article on sleep difficulties and ADHD is A Clinical Overview of Sleep and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (J Can Acad Child Adolesc Psychiatry 18:2 May 2009) available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687494/pdf/ccap-18-2-92.pdf
An excellent sleep questionnaire used by Comer Children’s Hospital of the University of Chicago is available at http://www.uchicagokidshospital.org/pdf/uch1001270.pdf
Upcoming post: How Parents Can Access an Online ADHD Toolkit