While school is officially back in session, for many families this presents challenges as they navigate learning, multitasking, and organizational skills. Attention deficit/hyperactive disorder is a prevalent diagnosis among school-aged children and teens. Data obtained from health surveys conducted in 2016 demonstrated 6.1 million children are being treated for ADHD, an increase of 2 million from 2003. Over time, this has led to an increase in adult-residual ADHD among college students and adults in the workforce.
WHAT IS ADHD
ADHD is one of the most common neurodevelopmental disorders of childhood and will often last into adulthood. It is characterized by difficulty paying attention, poor control of impulsive behaviors (acting without considering consequences) and being excessively active. This spectrum disorder comprises three subtypes: predominantly inattentive, predominantly hyperactive/impulsive, and combined presentation.
Individuals may find it hard to complete a task, especially if it requires multiple steps, sustained attention, or has many details. Conversation may be affected, especially in an environment with other distracting stimuli. Difficulty in completing and maintaining daily routines may also be observed.
Individuals may find it difficult to sit still for a long period (attending a lecture, sitting for a meal, or completing homework). Young children may run, jump, or climb at inappropriate times. Older children, adolescents, and adults may fidget or get restless during periods of waiting. Examples of impulsive behaviors include interrupting others, grabbing a desired object from another without asking, and difficulty waiting in line. Impulsivity may result in poor decisions; leading to accidents or injuries when consequences are not considered.
While the exact cause of ADHD is not fully understood, it is felt to be an interplay of genetics, birth history/trauma, environment, and sometimes traumatic brain injury related to sports or recreational activities. It is clear from family studies that the diagnosis of ADHD occurs more frequently in some families. However, it has also been demonstrated that ADHD increases among student athletes who have had a concussion, premature infants, and with exposure to neurotoxins both prenatal and postnatal. While likely not a cause of ADHD, environmental factors such as poor sleeping habits, excessive screen time, and increased sugar intake may exacerbate underlying symptoms. Another growing concern is the effect of artificial food dyes on behavior. In 2011, the FDA stated that synthetic food dyes had no adverse effects, however a growing number of studies suggested that red dye 40 and other synthetic food dye additives may increase symptoms in some children. While the effect appears small, certain individuals may react more strongly to these exposures. A trial of avoidance may be helpful if exposure is felt to be worsening ADHD symptoms.
Diagnosis is completed by a doctor or a mental health specialist. While there is no single test for ADHD, a combination of medical history and physical examination may be combined with Conner’s Index or Vanderbilt Assessment rating scales. It is important to rule out factors such as hearing and vision problems as well as specific learning disabilities, mental health challenges such as anxiety or depression, and sleep disorders. Additionally, blood tests to assess heavy metal toxicity or vitamin deficiencies may be evaluated.
While there is no cure, the goal is to reduce symptoms and increase functionality. Treatment may begin with improving sleep schedules, ensuring a healthy balanced diet, and evaluating the need to remove excess sugar or artificial food dyes. Establishing a healthy routine, especially concerning bedtime and the use of electronic devices, has demonstrated improvement in sleep and ADHD symptoms. Checklists, organizational folders, and electronic reminders may help complete detailed or multistep tasks in personal care, interpersonal relationships, and the workplace.
Cognitive behavioral therapy, a mental health therapy focused on strengthening wanted behaviors, such as increased focus, and eliminating unwanted behaviors, such as impulsivity, may be considered. In addition to a healthy, well-balanced diet, vitamin supplements such as vitamin D, magnesium, theanine, N-acetylcysteine (NAC), and natural caffeine extract (coffee or green tea) may also be helpful in symptom management of ADHD. Some supplements may not be appropriate for young children or certain patients with cardiac concerns. All supplements should be discussed with your physician prior to administration. For some patients, treatment with prescription medications is required. These medications work by increasing the “alertness” of the brain while decreasing hyperactivity and impulsivity. Non-stimulant medications allow the brain to react less impulsively and decrease “background noise” of thoughts or stimuli that might otherwise impede focus and attention.
Treatment includes screening and treating other underlying mental health concerns. Anxiety and depression occur very frequently in patients with ADHD. Substance abuse and self-treatment with stimulants may occur in patients not adequately treated for ADHD and associated mental health concerns.
If you feel you or your child may be experiencing symptoms of ADHD, the first step is a conversation with your physician or a mental health professional. Your child’s teacher or counselor may also provide input or screening. Additionally, many colleges have mental health services available to students. When it comes to ADHD, making the grade begins with a conversation – help is available!
Kendall Wagner, M.D. is a regular healthcare contributor to Do South® Magazine.
Chaffee Crossing Clinic
11300 Roberts Boulevard, Fort Smith, Arkansas