ADHD Essentials

Boost Your ADHD IQ: Latest Diagnosis and Treatment Guidelines

Impress your friends and family with your high “ADHD IQ,” by reading up on the most current diagnosis and treatment guidelines for kids and adults.

ADHD Diagnosis and Treatment Guidelines
ADHD Diagnosis and Treatment Guidelines

ADHD seems to be everywhere these days. In recent years, the number of diagnoses has skyrocketed. More than 6.4 million U.S. youth — one in nine children between the ages of 4 and 17 — have now, at some point in their lives, received a diagnosis of ADHD, according to a major national survey of parents. The disorder has recently become the second most frequent diagnosis of a chronic condition for children, after asthma.

We predict that, for the next few years, the numbers of both young and adult Americans diagnosed with ADHD will keep rising. One of the most important factors for this is the increased awareness and acceptance of the disorder. Moreover, an ADHD diagnosis provides a ticket for accommodations and special services in school, and can also garner payments from Medicaid and other health insurance programs. When conditions are explicitly linked to services and funding, their rates of diagnosis often rise beyond their actual prevalence. More fuel for the rise in rates comes from doctors who are diagnosing ever-younger children. Key professional groups, such as the American Academy of Pediatrics, now urge that diagnosis and treatment begin as early as age four. Here we aim to provide straight talk and sound guidelines for educators, policymakers, health professionals, parents, and the general public.

How much influence do parents have on their child’s ADHD?

Although ADHD always begins with biology (genes), a parent’s behavior can matter quite a bit. Skillful parenting makes a great difference in the lives of children with biological risk for ADHD. Researchers have found the gold standard to be “authoritative” parenting, which blends warmth with clear limits and strong guidance toward independence. A parent’s love can’t be overestimated when it comes to a child’s mental health.

A child with impulsive behavior is not easy to raise. What makes it harder is that, given the strong hereditary nature of ADHD, one or both of the child’s parents may be struggling with the same disorder or with similar symptoms. So the parent and child unintentionally violate each other’s personal boundaries and react emotionally.

It is important for parents of children with ADHD to make sure they acknowledge and treat any mental problems of their own that may be compromising their ability to help their offspring.

Who is most likely to diagnose ADHD correctly?

All licensed physicians and mental health professionals are technically qualified to diagnose ADHD. Currently the majority of U.S. children are diagnosed by their pediatricians, which we consider a discouraging state of affairs.

Although pediatricians are authorized to prescribe medication, few are expert in calculating optimal dosage levels and monitoring effectiveness — and even fewer are well informed about behavioral, school, and family-based interventions. Many pediatricians are aware of their limitations but end up conducting evaluations anyway, due to the serious national shortage of child and adolescent psychiatrists and developmental-behavioral pediatricians.

On the other hand, clinical child psychologists are a good option for diagnosis. They outnumber child and adolescent psychiatrists and developmental-behavioral pediatricians, and, if well trained, offer a wide range of psychosocial treatments.

Which is best: medication or behavior therapy?

Although medication for ADHD can reduce symptoms relatively quickly, people who have the disorder — especially those who are further impaired by anxiety, depression, conduct problems, or learning disorders — often need something more. Researchers have found that only the combination of well-delivered medication plus intensive behavior therapy provided essential benefits for children for school achievement, social skills, relief from comorbid conditions, and in the family’s shift toward a more authoritative parenting style.

Most children with ADHD can greatly benefit from behavior therapy, in addition to (or in some cases, instead of) medication. Many therapists believe that one of the best uses of medication is to help patients focus on behavior therapy, to offer the best chance of long-lasting benefits.

The hope among professionals is for synergy, with medication enhancing short-term concentration and impulse control, and behavior therapy working to improve long-lasting social and academic skills.

Should ADHD be considered a deficit of attention, or a lack of self-control?

It’s clear that many people with ADHD have a harder time than others do in controlling their impulses. That’s why some experts, chief among them the psychologist Russell Barkley, Ph.D., contend that the core problem with the disorder is less one of attention than of successful control of impulses. When people lack the ability to control or inhibit their responses, they never get a chance to deploy essential executive functions. Instead, they’re at the mercy of whatever responses were previously rewarded. Thus, people with the inattentive form of ADHD have a fundamentally different condition than do those whose main problem is impulsivity.

Yet another perspective comes from psychiatrist Nora Volkow, M.D., director of the National Institute on Drug Abuse. Volkow contends that ADHD boils down to a deficit of motivation, or, as she calls it, an “interest disorder.” She bases this on brain-scan findings, which reveal that at least some people with ADHD are under-aroused physiologically. This helps explain why they are chronically drawn to the neural boost of an immediate reward and less willing to do the long-term work to develop important skills.

The paradigm of a sleepy ADHD brain also sheds light on why so many people with the disorder are restless and fidgety, as constant activity may be a struggle to stay alert. Some experts use this model to explain why many people with ADHD tease and demand to get a rise out of others, as conflicts can be energizing. It takes time to understand the nature of the underlying problems linked to ADHD, which vary among people diagnosed with it and affect everyone differently in different environments and over a single day or year.

What are the long-term consequences of ADHD for females?

There’s no longer any question that women experience ADHD at much higher rates than were previously assumed. Beyond the sheer number of new diagnoses is the fact that prescriptions for ADHD medications are now rising faster for adult women than for any other segment of the population. Even though there are few long-term studies of girls with ADHD followed into adulthood, besides Hinshaw’s research, a sufficient number of girls with ADHD have been studied to yield a picture of the female version of the disorder.

> During childhood, girls meeting rigorous criteria for ADHD show serious behavioral, academic, and interpersonal problems, on a par with those of boys. Girls are less likely than boys to act out aggressively but more likely to suffer depression, anxiety, and related “internalizing” problems.

> Through adolescence, girls are as likely as boys to experience major life problems stemming from ADHD, including academic challenges and social awkwardness. Their risk for substance abuse may be lower.

> Hinshaw’s research has found an alarming problem in women diagnosed with ADHD. By early adulthood, a number of girls with ADHD engage in self-destructive behaviors, including cutting and burning themselves, as well as actual suicide attempts. This high risk has appeared chiefly in those sample members who were diagnosed with the combined form of ADHD (not the inattentive type alone) when they were girls, suggesting that impulsivity (and the social problems that come with it) plays a strong role here.

Although girls with the inattentive form of ADHD have comparatively less risk for self-destructive behavior, they struggle with significant academic problems and a high incidence of traffic accidents due to distraction.

Reprinted from ADHD: What Everyone Needs to Know, by STEPHEN P. HINSHAW, Ph.D., and KATHERINE ELLISON, with permission from Oxford University Press, Inc. Copyright 2016 Stephen P. Hinshaw and Katherine Ellison.

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