Early Intervention Key in Treatment of ADHD

"Imagine the 'terrible 2's' that will not end. Imagine trying to do that for many years and that's what it is like to live with a child with ADHD," says Dr. Deborah Pearson, associate professor of psychiatry and behavioral sciences at The University of Texas-Houston Medical School and a clinician and researcher at the UT-H Mental Sciences Institute.

Attention deficit/hyperactivity disorder - described in the 1960s as hyperkinetic reaction in childhood and now referred to as ADHD - affects an estimated 3-5 percent of school-age children. According to Dr. Pearson, only some of the children who have ADHD ever get formally diagnosed. She cites a lack of information about ADHD to parents and teachers as one of the reasons why more kids aren't getting the help they need. Financial barriers to diagnosis also exist, she says, both at home and in schools.

Some children diagnosed with ADHD exhibit both hyperactivity and inattentiveness, others are primarily hyperactive, while a third group of children present with predominant symptoms of inattentiveness. While ADHD is more commonly diagnosed in boys than girls, Dr. Pearson believes many girls have the third type of ADHD but are going unnoticed in the classroom. "Many of us in the field feel that many girls are overlooked because they are daydreaming quietly and are not running around their first grade classroom getting into trouble and getting noticed," she says.

Diagnosing someone with ADHD is a comprehensive process. At the UT-Houston Mental Sciences Institute, a full psychological profile is conducted on the child, including a history of the entire family and documentation of the child's behavior in school, at home and at the clinic. One key component is the onset of symptoms, which must have occurred before the age of 7 to be considered ADHD.

Forty percent of children diagnosed with ADHD also have a learning disability, says Dr. Pearson. "These children are vulnerable to depression and low self-esteem," she says. "If you're known as the class dummy in a world that prizes academic prowess, then you don't feel really good about yourself."

Children with ADHD are also at higher risk for developing conduct problems. In addition, they may have a difficult time maintaining relationships with others their own age. "One of the giveaways is that little Johnny's playmates are often younger than he is and he can't sustain a peer-peer relationship," she says.

When Dr. Pearson teaches medical students about ADHD, she uses the analogy of standing on one foot. "You could do it for 30 seconds, but not for the whole day. It's like that for a child with ADHD. They can pay attention for a few minutes, but ask them to sit quietly and pay attention for a whole school day and it's absolutely impossible."

There is no known cure for ADHD. But early intervention with treatment by a trained professional can reduce the chances of a lifetime of failures in school and job performance as well as marital and other social problems for many people.

ADHD may be treated with medication, the most common of which are psycho-stimulants like Ritalin. "A vast pool of research suggests that Ritalin is very safe and very effective in about 3/4 of children who take it," Dr. Pearson says. "In the other 1/4, it is less effective."

She notes that Ritalin is beneficial because it treats both the hyperactivity and the inattentiveness, while some anti-depressant medications also used to treat ADHD control the hyperactivity symptoms but are less effective in treating the cognitive problems. However, the anti-depressants do address the issues of depression that may be coupled with ADHD.

ADHD may also be treated with behavioral intervention. However, Dr. Pearson cautions that this method needs to be carried out both at home and in school, which requires parents and teachers to work in tandem in order to maintain a seamless system.

Dr. Pearson is collaborating with Dr. Kathryn Kotrla on a neuroimaging study to monitor pre- and post-medication effects on the brain functioning of children with ADHD. The study is looking for children 7-11 years of age who have ADHD. Another study is just getting under way and will focus on medication treatment for children with conduct disorders, many of whom may also have ADHD. This study will study children 7-14 years of age.

For more information about these studies, call 713-500-2580.

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©2006 Texas Medical Center

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