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AD/HD: Treating young people

Kim Meier

Reprinted from "Treatments for young people" issue of Visions Journal, 2006, 3 (1), p. 9-10

Just over 3% - or about 30,900—of BC’s children and youth have been diagnosed with attention-deficit/hyperactivity disorder (AD/HD). This makes AD/HD the second most commonly diagnosed mental disorder among youth, second only to anxiety disorders.

It was previously believed that a signifi cantly higher number of boys are affected by AD/HD than girls. In recent years, however, it has become clear that the rate of AD/HD among girls is much closer to that of boys than was reported in the past. A 2006 Australian study offers some insight into why girls may be underdiagnosed: while problems with school and grades are common factors in boys who are receiving treatment for AD/ HD, the most common factor for girls is the presence of depression—not a symptom typically associated with AD/HD.

According to the Diagnostic and Statistical Manual for Mental Disorders, diagnosis of ADI HD revolves around three types of symptoms: inattention, hyperactivity and impulsivity. Some of these symptoms must have been present before age seven.

Children affected by AD/HD often have trouble listening when people are speaking directly to them. They fi nd it hard to follow instructions or stay organized. Easily distracted and forgetful, kids with AD/HD are often fi dgety and restless. Unable to pay attention to detail, they may make careless mistakes in their homework assignments. They may also have trouble controlling impulses—causing them to interrupt others or blurt things out at inappropriate times. In order for an AD/HD diagnosis, symptoms must affect a child’s ability to function in more than one setting—for example, both at home and at school.

AD/HD is typically treated with medication, behavioural therapy or a combination of both. Medications have shown to be the best treatment strategy for AD/HD, though when used in combination with behavioural techniques, kids may be able to take lower doses.

Behaviour therapy works to change the way a child or teen acts and reacts. By looking at the situations that can make a child’s symptoms worse, behavioural treatments teach new skills to child ren, their parents and even teachers and friends.

Each behaviour therapy plan is tailored to a child’s unique needs. A typical plan involves techniques such as reinforcing positive behaviours, time outs and point reward systems. In addition, adults learn to create environments for children to help avoid situations that may set off symptoms—like quiet rooms free of distraction for studying.

Typically, AD/HD is treated with a type of medication known as a psychostimulant. Stimulants affect the body by improving communication between cells in the nervous system. In essence, they allow a person to feel more alert and more able to focus their attention. Stimulants commonly prescribed for the treatment of AD/ HD include Adderall, Concerta, Dexedrine and Ritalin. About three-quarters of children who take stimulants fi nd them effective.

Generally, stimulants are effective for about three to six hours after a dose is taken. Children and teens will often need to take medication at school after the effects of the fi rst dose wears off. Newer, longerlasting medications allow kids to avoid midday doses—this helps to keep children from feeling self-conscious at school or in public places.

Although there are negative side effects to taking prescription drugs—loss of appetite, headaches, stomach aches and troubles sleeping, for example— many fi nd the benefi ts of medication greatly outweigh the costs. Children with AD/HD who use stimulants often fi nd it easier to concentrate. An improved attention span allows kids to follow directions, complete homework assignments and perform better in school. When more focused and less impulsive, children and teens fi nd it easier to relate to their peers and get along with family members. Despite the benefi ts of medication, researchers say that nearly half of children with AD/HD who would benefi t from prescription medication are not being treated.

Unable to stay focused, children affected by the disorder, who do not receive treatment of some kind, can fall severely behind in school. Problems with concentration and impulsivity can continue into adulthood, following the adult with AD/ HD through life, affecting employment and relationships. Children with untreated AD/HD are also at risk for criminal behaviour.7 Youth can even go on to develop co-occurring disorders, including depression or substance use disorder. Appropriate treatment can reduce the risk of developing a substance use disorder by 50%.

It’s important to identify and treat a child with AD/HD. With the proper support and treatment, kids affected by the disorder go on to live healthy, normal lives.

 
About the Author

Kim is an undergraduate student in cognitive science at Simon Fraser University. She is currently on a co-op term at Canadian Mental Health Association, BC Division

Footnotes
  1. Waddell, C. & Shepherd, C. (2002). Prevalence of mental disorders in children and youth (a research update prepared for the Ministry of Children and Family Development). Vancouver, BC: University of British Columbia. www. childmentalhealth.ubc.ca/ documents/publications/ MHECCU_Prevalence_ Oct02.pdf

  2. Graetz, B.W., Sawyer, M.G., Baghurst, P. et al. (2006). Gender comparisons of service use among youth with attention-defi cit/ hyperactivity disorder. Journal of Emotional and Behavioral Disorders, 14(1), 2-11.

  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author

  4. Brown, R.T., Amler, R.W., Freeman, W.S. et al. (2005). Treatment of attention-defi cit/hyperactivity disorder: Overview of the evidence. Pediatrics, 115(6), e749-e757

  5. National Resource Center on AD/HD. (2004). What we know: Managing medication for children and adolescents with AD/HD (information sheet 3). Landover, MD: Children and Adults with AttentionDefi cit/Hyperactivity Disorder. www.help4adhd.org/en/ treatment/medical/WWK3

  6. Reich, W., Huang, H. & Todd, R.D. (2006). ADHD medication use in a population-based sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 45(7), 801-807

  7. National Resource Center on AD/HD. (n.d.). Diagnosis & Treatment. www.help4adhd.org/en/ treatment

  8. Biederman, J. & Faraone, S.V. (2005). Attention-defi cit hyperactivity disorder. Lancet, 366(9481), 237-248

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