Question: — My son is in early teen years. He has a brilliant mind and can do different things if he focuses his mind on it. But he cannot focus on anything. His report card from the school has not been particularly good lately. He wants to constantly play with his cellphone or computer games. What should I do? — Sarah, of Fort Wayne, Indiana
Sarah, your child may have attention deficit hyperactivity disorder. Attention deficit/hyperactivity disorder is characterized by hyperactivity and impulsivity. Some people call it ADD, but ADHD is the correct name for it.
ADHD is a treatable neurobehavioral disorder found in kids, teens and adults. Up to 70% of childhood cases with symptoms lead to impairment in functioning persisting into adulthood.
ADHD is a treatable medical disorder. The exact cause of ADHD is unknown, but researchers believe it may be caused in part by an imbalance in chemical messengers that affect the brain.
It is estimated that nearly 17 million Americans are affected by ADHD. Need some context? The state population of New York is just over 19 million. Approximately 4.4% or 10.5 million adults are estimated to have ADHD.
There are three main types of ADHD: predominantly inattentive, predominantly hyperactive/impulsive and combined type.
Anyone can have moments of being inattentive, impulsive or hyperactive. Adults with ADHD, however, experience these symptoms repeatedly and in a way that is severe enough to have an impact at home, school or work, or even in social situations.
Treatment for people with ADHD can be by medicines, behavior therapy or psychotherapy, or both. Medications approved by the Food and Drug Administration are brain stimulants (amphetamines and methylphenidate) and nonstimulants (atomoxetine and extended-release clonidine and guanfacine). Your doctor can decide which one will be better for your son.
There are guidelines from the American Academy of pediatrics recommending different interventions for different age groups of patients.
For preschool children 4-5 years or older, the first line treatment is parental training in behavior management. They also recommend behavioral classroom interventions. The second line treatment may be medicines.
For children 6-11 years old, FDA-approved medications are recommended. But parental training in behavior management, behavioral classroom interventions or educational interventions are also needed.
Children 12-17 years old are recommended first-line treatment with FDA approved medicines along with training or behavior interventions along with educational interventions.
Symptoms may be any of the following:
• Your child may start homework or chores but quickly loses focus or gets easily sidetracked.
• You may hear from teachers that your child has difficulty paying attention to lessons. Perhaps your child cannot appropriately follow instructions or stay organized in their schoolwork.
• It could be that when you speak directly to your child, you notice that his/her mind seems to be elsewhere, even in the absence of obvious distractions.
• Does your child constantly lose school materials — or if older, misplace glasses, keys, wallet or cellphone?
• Did you notice your child cannot sit still in the chair? Does it seem like your child is unable to be still for an extended period? Maybe your child cannot seem to play quietly or participate in social activities.
• Some children with ADHD may talk excessively. Your child might blurt out answers to questions and has difficulty taking turns. This can be as obvious as completing other people’s sentences or not being able to wait in line.
Treatment for adult ADHD is like treatment for childhood ADHD. Adult ADHD treatment includes medications, psychological counseling (psychotherapy) and treatment for any mental health conditions that occur along with ADHD.
In adult the ADHD symptoms may include: Impulsiveness, disorganization and problems prioritizing. They may have poor time management skills or problems focusing on a task.
People with ADHD may be poor planners, have low frustration tolerance and have frequent mood swings or hot temper. Sometimes they may have problems following through and completing the task. Trouble coping with stress may be another feature.
ADHD should be properly treated otherwise it may lead to poor school or work performance, unemployment and consequent financial problems.
Not only that, but they also may get into trouble with the law or start suffering from alcohol or substance misuse. This may lead to unstable relationships, poor physical and mental health and poor self-image.
Medication is often the treatment of choice, as it currently is most effective. However, medication has only short-term effects, treatment adherence is often low and most importantly, some medication has serious side effects. Therefore, there is a need for other interventions for youngsters with ADHD. Mindfulness training is emerging as a potentially effective training for children and adolescents with ADHD as an add-on tool of treatment.
Recently, the British Medical Council published an article about use of meditation in treatment of ADHD as a supportive measure. There are many methods of meditation. Mindfulness is one of the techniques of meditation. If practiced 10-15 minutes daily they can improve the focus, concentration and reduce the stress. Mindfulness for children with ADHD and mindful parenting being increasingly used. There are people who are trained in mindful meditation and teach it. The hypothesis is that compared to care-as-usual only, the addition of the mindfulness training will improve self-control of youth with ADHD. Research done at Harvard Medical School showed six months regular practice of 10 minutes of meditation may increase the number of cells in the brain.
A good resource for support is the Attention Deficit Disorder Association.
If any of the symptoms listed above continually disrupt your child’s or your life, I would suggest talking to your school authorities and talking to a doctor who treats ADHD. It can be managed. Your son has a good future.
Suman Kumar Mishr MD, Fellow of American College of Endocrinology, Cridersville