ADHD – THE BASICS: ADD and ADHD are psychiatric disorders characterized by inattentiveness or hyperactivity and compulsiveness, which hinder a child's academic or social performance. Because there is no objective clinical test to confirm ADD or ADHD, the diagnosis is based on a set of subjective symptoms. If children exhibit any six of nine characteristics in either category, they are labeled ADD or ADHD. In an effort to help children who are struggling at school because of their short attention spans, many parents, teachers, and doctors make the assumption that these children have ADD and start them on medications. Unfortunately, they are often treating the symptoms and not the real cause. High distractibility and difficulty remaining on task is not the sole domain of ADD.
When classroom teachers are confronted with children who ''will not listen,'' ''cannot sit still,'' ''does not finish classroom assignments,'' and ''creates problems for other children,'' hearing loss is not the first problem the teacher considers. Maybe it should be.
Research studies show that one out of three children have enough hearing loss to make learning difficult. Children in every school (public and private) are at risk for this silent epidemic.
Five million school-aged children, or 11.3% of all school children in the U.S.A. exhibit some degree of hearing impairment. This startling finding was reported by Fred Bess Ph.D., from the Department of Hearing and Speech Sciences, at Vanderbilt University Medical Center, in a recent issue of The Hearing Journal. Dr. Bess noted that many children have ''unrecognized'' hearing loss. The largest undetected hearing loss in children affects those considered to have ''minimal sensorineural hearing loss'' (MSHL). Dr. Bess found that the prevalence of MSHL in schools is 5.4%, or more than one of every twenty children.
Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect three to five percent of school-age children. ADHD core symptoms include; developmentally inappropriate levels of attention, concentration, activity, distractibility, and impulsivity. Children with ADHD usually have functional impairment across multiple settings including home, school, and peer relationships. ADHD has been shown to have long-term adverse effects on academic performance, vocational success and social-emotional development, according to the National Institute of Health and the office of Special Education Programs.
The diagnosis of ADD/ADHD is often based on doctor, parent, and/or teacher observations of the child's behaviors.
Could these two problems (ADHD and MSHL) overlap, or perhaps be easily confused based on observations of children's behaviors?
Recently, an assistive listening device manufacturer compared the behavioral characteristics of children with ADD/ADHD, to children with mild hearing loss. They discovered extraordinary similarities among the two groups.
Both groups have academic difficulty and both give inappropriate responses to questions. Neither group completes assignments, they both exhibit trouble sustaining attention during oral presentations, and for both, following directions is problematic. Impulsiveness and acting out are common to both groups, as is a poor self concept. Both groups of children exhibited low self esteem, fewer social interactions with their peers, and greater stress. Members of both groups were more likely to drop out of school. Both groups tended to repeat grades imposing a significant financial burden on the schools, and of course, their families.
Could this mean that some children diagnosed with ADHD/ADD could actually have mild or minimal hearing loss?
The Portrait Health Centers, a multi-specialty evaluation center specializing in attention Deficit Hyperactivity Disorder (ADHD) and learning disabilities announced today the availability o f a new internet resource to assist families who face the continuous challenges of ADHD. Portrait Health Centers, who became the first in the medical market to adapt the oncology Nurse Navigator model for attention deficit and learning disorders, is now providing on-line Nurse Navigator services to patients and families who do not live near a Portrait Health Center.
Dr. Jack Maggiore, Chief Healthcare Officer of Portrait Health states, "As the title implies, the Nurse Navigator is the guide who literally
takes your hand to lead you through the initial evaluation and serves as your advocate when our team of specialists design personalized
assessment and treatment recommendations. We encourage every parent who cares for a child who is diagnosed with ADHD or is
showing ADHD behaviors to visit a Portrait Health Center for an evaluation by a Nurse Navigator." Dr. Maggiore further explains,
"Since there is no single test for ADHD, the Nurse Navigator must first rule out other conditions for which there are clinical tests. The
Nurse Navigator does this through a series of questions which leads to the development of an investigative protocol unique to the child
- 500% increase in ADHD
- Epidemic is driven by misdiagnosis
- 2.7 million children on a stimulant medication
- 1.1 million or 40% of all ADHD children are on these drugs unnecessarily
- 800,000 are misdiagnosed simply due to immaturity
From the late 1980s to the early 2000s, the rate of diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) soared 500 percent. Today 5 to 10 percent of all U.S. children between the ages of 6 and 18 have been diagnosed with ADHD.
A recent study by University of Notre Dame economist William Evans and colleagues at the University of Minnesota and North Carolina State University suggests that, at least in part, the epidemic may be driven by misdiagnosis. The economists reach that conclusion based on statistical analyses of data on ADHD diagnosis, medication treatment and the age of those diagnosed relative to peers enrolled in school. The study will be published in an upcoming issue of the Journal of Health Economics.
Prenatal exposure to bisphenol A (BPA) — found in many consumer products (e.g., certain food and beverage containers) — is associated with neurobehavioral problems in girls at age 3 years, according to a prospective study in Pediatrics.
The study included some 240 mother-infant pairs from the Cincinnati area. Urine BPA concentrations were measured in the mothers during pregnancy and in the children during the first 3 years of life. Children's behavior and executive function were assessed at age 3 years with parental surveys.
Each 10-fold increase in gestational BPA concentration was associated with poorer scores for anxiety, hyperactivity, depression, emotional control, and inhibition among 3-year-old girls (but not boys). Childhood BPA concentrations were not related to neurobehavioral outcomes.
The researchers say that although the clinical relevance of their results "is unclear at this point ... clinicians can advise concerned patients to reduce their [BPA] exposure ... by avoiding canned and packaged foods, [thermal] receipts, and polycarbonate bottles with the recycling symbol 7."
Confirm Your Child’s Diagnosis and ADHD Medication Effectiveness at Portrait Health Centers With Continuous Performance Testing
What is “Continuous Performance Testing” (CPT)?
Specialized computer testing programs are now available to assess attention, concentration, and impulsivity. Research strongly supports the diagnostic ability of these programs that use sight and sound to check how a child responds to a variety of challenges. Following each 30-minute test, a preliminary score is generated, determining the presence and severity of inattentiveness and impulsivity. Researchers now say that, without CPT, ADHD-treatment is not up-to-date. There are a few different CPT programs, and Portrait Health Centers uses the program with the most research behind it.
Why use CPT?
When ADHD-like symptoms are present, the use of CPT is a quick, non-invasive, effective, and reliable way to establish a
“baseline”. CPT can then be used to test medications for effectiveness. Since there is no “practice effect,” and patients can do CPT several times, the impact of different dosages and medications can be measured. This means that you no longer need to wonder if a prescribed drug is appropriate and effective. Upon completion of a CPT test, results are immediately analyzed and a complete interpretation and graphical report is provided to you and explained through a personal consultation. With your consent, CPT reports are shared with the prescribing physician.
When the Treatment Path is Idenitifed
The side effects of ADHD medications are well documented, but can be effectively managed by working with the team of specialists at The Portrait Health Centers. Studies have shown that patients treated for ADHD benefit most from a combination of therapies, including nutritional and psychological counseling. Also, throughout the course of treatment, CPT can be periodically administered to monitor your child’s progress to provide you and your doctor with reassurance,
or as necessary, to identify the need for adjustments in therapies. Since dosages are likely to change your child grows, this kind of continual assessment is critical.
In its new guidelines for diagnosing and treating ADHD, the American Academy of Pediatrics recommends that parents of preschoolers with behavioral issues get their kids evaluated. Could you spot the signs of ADHD in your young child?
For the first time in 10 years, the American Academy of Pediatrics (AAP) has revised its recommendations for the diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in children. Among the biggest changes is the inclusion of preschoolers
(4 to 5 year-olds) and adolescents (13- to 18-year-olds); previously, the guidelines focused only on kids between the ages of 6 and 12.
According to the U.S. Centers for Disease Control and Prevention, ADHD affects some 5.4 million children in the United States — more than half of whom are 11 or younger. Of those, as many as two-thirds exhibited symptoms at or before age 4, according to a study in the Journal of Developmental & Behavioral Pediatrics.
Diagnosing ADHD in children that young is complex and somewhat controversial. After all, most 4- and 5-year-olds are fidgety or have energy to burn — but how many of them actually need to be treated for it? The new AAP recommendations clear up some of that confusion for pediatricians and other health professionals, but parents of preschoolers should be aware of the signs and recommendations, too. Here’s what you need to know:
New guidelines will address ADHD in preschoolers, and ADHD that accompanies other medical conditions.
Primary care physicians should begin evaluating children for attention deficit/hyperactivity disorder at age four and continue through age 18, according to a new clinical guideline from the American Academy of Pediatrics.
An accumulation of evidence in recent years has enabled diagnosis and management of ADHD in a broader pediatric population. Earlier versions of the guidelines covered children ages 6 to 12.
“There was enough evidence that we could feel comfortable about the criteria being appropriate for preschoolers and that the process for making the diagnosis was similar enough to what primary care physicians were doing with the elementary school-age children that it would be appropriate to recommend their diagnosing to four years of age,” said Mark Wolraich, MD, of the University of Oklahoma in Oklahoma City, and chair of the writing committee for the updated guideline.
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Because ADHD frequently persists into adolescence, and continues to undermine teens' academic and social functioning, most adolescents continue to need treatment. However, as issues of self-direction and autonomy become more important for teens, resistance to treatment for ADHD - medication or otherwise - frequently intensifies and many adolescents stop treatment prematurely. This is a challenge that many parents struggle with.
It is thus important to understand the factors - particularly adolescents' perspectives on treatment - that affect the receipt of ADHD treatment during this critical developmental period. Examining this issue was the focus of a study published recently in the Journal of Adolescent Health [Bussing et al (2011). Receiving treatment for Attention-Deficit Hyperactivity Disorder: Do the perspectives of adolescents matter. Journal of Adolescent Health, 49, 7-14.]
Participants were 168 adolescents - about 50% female - and their parents recruited through a public school system in the US. These adolescents screened positive for ADHD in elementary school and were contacted 6 years later for a follow-up assessment. At follow-up, over 60% continued to meet full diagnostic criteria for ADHD and many others still had elevated levels of ADHD symptoms. The researchers were interested in how many adolescents had received ADHD treatment in the past year and the parent and child characteristics that predicted the receipt of treatment.