Attention Deficit Hyperactivity Disorder (ADHD) is the most common developmental issue in childhood, affecting approximately 8 percent of all children. While most people think of ADHD children as being hyperactive, there are actually three subtypes: the inattentive type without any hyperactivity or impulsivity, the hyperactive/impulsive type without attention problems, and the combined type with significant hyperactivity, impulsivity and inattention.
Many people think ADHD is a made-up diagnosis, but it is actually one of the most researched disorders in all of pediatrics, and has been proven to be not only genetic in origin, but also a biochemical disorder with relative deficiencies of several neurotransmitters causing the problems. Another common misconception is that this is a problem in the United States but really not found in other countries. In reality, studies in virtually every country in the world have shown similar levels of this condition.
Traditionally, ADHD has been thought of as a school problem. ADHD children certainly have problems in school. They struggle to stay focused and pay attention, often having difficulty finishing their work. They have difficulty remaining in their seat, often fidgeting, standing, moving around, tapping their fingers and making noises. In addition, they often talk when quiet is expected, blurt out answers without being called on and generally disrupt the class. They are often the class clown. It affects their grades despite the fact that this condition has nothing to do with intelligence. Homework becomes a nightmare for both the child and his or her parents as staying focused and completing it takes far longer than other children.
While ADHD definitely impacts all aspects of school, the problems are not limited to the academic world. These children are at significantly increased risk for many other problems.
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▪ They have four times as many serious injuries as children without ADHD.
▪ Their risk of substance abuse is three times that of non-ADHD children. They begin using tobacco twice as often as non-ADHD children and quit half as often.
▪ When they begin driving their risk of driver-caused accidents, including death, drunk driving, violations and license suspension, is dramatically higher.
▪ They have three times as many sexual partners, nine times more unwanted pregnancies and four times as many sexually transmitted diseases.
▪ They get arrested twice as often, are convicted three times as often and jailed 10 times as often as non-ADHD children.
▪ They have anxiety disorders at a rate of 33 percent and depression at 25 percent.
▪ One third of these children have learning disabilities.
▪ They struggle socially, often finding others rejecting them as being annoying.
You can easily see how ADHD can affect every aspect of life. But don’t worry. Research has shown that if ADHD is treated properly the risks of all of these things decrease to the same level as children without this condition. Proper treatment can actually prevent these significant risks.
Most children with ADHD benefit from a multimodal approach. This means tailoring their school environment to their specific needs and getting help from the school. Fortunately public schools are required by law to provide these accommodations. In addition, there are approaches that can greatly improve the behavioral issues that are part of ADHD. When anxiety or depression are part of the picture, working with a therapist can improve these conditions greatly. And medications can be a great benefit for the appropriate child. Your pediatrician can discuss this with you.
Still, the question lingers: Is ADHD over diagnosed and treated in the United States? There has been much research on this issue. We know that approximately 8 percent of children have ADHD. We also know that far less than 8 percent of children have been diagnosed or treated for ADHD. Thus, it is not being over-diagnosed or treated.
Diagnosis involves a significant evaluation process that can be done by your pediatrician or by a specialist such as a developmental and behavioral pediatrician or psychologist. Often this process is not followed and in that case a mistaken diagnosis is sometimes made.
ADHD is one of the most common disorders of childhood. It has serious outcomes for children affecting all aspects of their lives every day. But the good news is that it is one of the most researched disorders and has well proven treatments that can lead to normal lives. For more information about ADHD, visit cdc.gov/ncbddd/adhd/. Or, to have your child evaluated, call 305-243-9225.
Eugene Hershorin, M.D., is associate chair of the Department of Pediatrics and chief of the Division of General Pediatrics at UHealth – University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.