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Identification and Treatment of ADHD

At our Milwaukee, Kenosha and Brown Deer locations, the child and adolescent day treatment program provides a supplement to outpatient therapy and a transition from inpatient care. This half-day structured program allows patients to continue involvement with their family and school.

Attention Deficit Hyperactivity Disorder (ADHD) is a condition that is often first noticed during the preschool and early school years. The primary characteristics of ADHD are inattention, hyperactivity, and impulsivity.

Signs of Inattention:

  • Highly distractible
  • Difficulty staying with an activity until completion
  • Inattention to details and careless mistakes
  • Losing and forgetting things

Signs of Hyperactivity:

  • Always on the "go"
  • Fidgeting and restlessness
  • Difficulty sitting still
  • Easily bored

Signs of Impulsivity:

  • General lack of self-control
  • Difficulty waiting for turn/standing in line
  • Blurting out answers
  • "Acting before thinking"

According to the most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), there are three subtypes of ADHD that are based upon the above characteristics: ADHD - predominantly hyperactive-impulsive type; predominantly inattentive type, or combined type (both hyperactive--impulsive symptoms and symptoms of inattention). The symptoms must appear prior to age seven and must continue for at least six months. Because most children display the above characteristics during the introductory and pre-school years, it is important that a child who is suspected of having ADHD see a specialist to determine if the demonstrated behaviors are actually due to ADHD, or whether they are typical for the child’s age and development. Additionally, the behaviors must impair the child’s functioning in at least two areas, such as at home, in school, with peers, or in the community. So, a child who displays hyperactivity and impulsive behavior whose schoolwork, friendships, and relations at home are not impaired by these behaviors would not be diagnosed with ADHD.

In addition to the above, a child with ADHD will often display additional characteristics that may vary considerably in degree, such as disorganization, poor peer relations, aggressive behavior, trouble with authority figures, poor self-esteem, lack of motivation, sensation-seeking, poor fine motor coordination even though gross motor skills are intact, daydreaming, memory problems, obsessive thinking, and inconsistency.

Inconsistency is perhaps the hallmark of ADHD, as a child with ADHD will have good days and bad days. Some days the child may be able to focus on his work and control his impulsivity, but other days completely struggle. As a result, caregivers and teachers may believe that the problem behavior is purposeful and vindictive, when it is not. One of the foremost experts in ADHD research, Dr. Russell Barkley has stated, "The child with ADHD succeeds one time and we hold it against him for the rest of his life."

Treatment

Treatment for ADHD typically involves the combination of medication management, and behavioral treatment. Indeed, the results of the national Institute of Mental Health'’s Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder revealed that long-term combination treatments were generally superior to medication management, behavioral treatment, or routine community care only. A particular advantage of the combined treatment over medication management alone was that children could be successfully treated with lower doses of medication.

In summary, ADHD is a treatable condition that is not a "life sentence" for a child. However, it is important to obtain early and proper intervention. ADHD can often be difficult to distinguish from the spectrum of "normal" behavior as well as other conditions, such as anxiety, depression, parenting practices, abuse, adjustment difficulties, etc. Therefore it is important for a child suspected of having ADHD be evaluated by a qualified professional.