What you need to know about ADHD

Tuesday, August 07, 2012

GoLocalWorcester Health Team

GoLocalWorcester spoke with Dr. JoAnn Carson, MD, specialist in development and behavioral pediatrics at UMass Memorial’s Children’s Medical Center and professor at the University of Massachusetts School of Medicine, who evaluates young children with developmental delays and behavioral problems, about Attention Deficit Hyperactivity Disorder (ADHD).

What is ADHD? Is it hereditary?

ADHD is a behavioral disorder with multiple possible causes, including genetic, central nervous system insults (such as fetal exposures to alcohol and nicotine, or lead) and psychosocial factors. There is frequently, but not always, a history in the family of ADHD.

How early can it be diagnosed?

Diagnosis can be made as early as 4 years of age. In adolescents and adults, symptoms of inattention and distractibility are likely not ADHD if these symptoms were no present prior to puberty (or around age 12).

Diagnosis of ADHD is made when a history from both parents and teachers indicates a significant level of inattentive and/or hyperactive/impulsive symptoms, developing prior to age 12 that negatively affect at least one area of function (i.e., academic, peer relationships, behavior).

Does ADHD appear in conjunction with other conditions?

It is important at all ages to ensure that the inattentive or hyperactive symptoms are not primarily due to another medical problem (e.g., obstructive sleep apnea), a learning disability, or another mental health problem (e.g., depression, anxiety, Autism Spectrum Disorder). Sometimes, these disorders account for the symptoms entirely. Frequently, however, these other disorders come hand in hand with ADHD.

Does early diagnosis improve outcomes? What has been the best treatment?

In October of 2011, the American Academy of Pediatrics published newly revised guidelines regarding ADHD diagnosis and management. One of the changes is expanding the age range for diagnosis to include 4 and 5 year olds. It is difficult to accurately diagnose ADHD in preschoolers due to the fact that the symptoms of ADHD may be developmentally normal for this age group.

Nonetheless, children of this age whose inattentive, hyperactive and impulsive symptoms are interfering with peer relationship and behavior at home or at school may benefit from ADHD management. Treatment in preschoolers, the AAP advises, entails behavioral interventions (mainly behavior management training for parents) prior to consideration of medication management. In contrast, there is good evidence that ADHD medication is an important component of ADHD treatment, and should be recommended in conjunction with behavioral interventions and classroom modifications. Early multimodal treatment can prevent some of the related outcomes associated with ADHD, e.g., school failure, declining self-esteem, depression, school drop-out and substance abuse.

Can it be outgrown?

Most individuals with ADHD diagnosed in childhood have persistent symptoms into their adult years. Individuals can learn to compensate for their ADHD symptoms, for example, by making lists, thus limiting the functional impact of their symptoms.

Dr. Carson graduated in 1977 from Yale College (Bachelors of Science), in 1981 from Columbia University College of Physicians and Surgeons (M.D. degree), and trained at Jacobi Medical Center in the Bronx. I was an attending physician at Jacobi for several years prior to moving to the University of Connecticut in 1991. In 2001, she completed a fellowship in General Academic Pediatrics, specializing in Developmental-Behavioral Pediatrics, and a Masters of Public Health at University of Connecticut School of Medicine in 2001. In 2009, she joined the faculty at University of Massachusetts School of Medicine, where she evaluates young children with developmental delays and behavioral problems at UMMHC.

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