A New ADHD Guide for Parents

Kids get hyper. Running around screaming is almost an inalienable right of childhood. But when hyperactivity and a short attention span hinder a child from learning and socializing, the cause probably goes beyond simple excitement, simple sugars or lack of sleep. It might be a neurobehavioral condition — and it could be attention deficit hyperactivity disorder (ADHD). If and when that diagnosis is finally made, however, how do you decide which treatment is best?

A new medication guide offers a starting point for parents, educators and child mental health specialists: created by the American Academy of Child and Adolescent Psychiatry (AACAP) and the American Psychiatric Association (APA), the guide explains the ins-and-outs of treating a child with ADHD, from drug choices and side effects to behavioral treatments and what to do in the case of a coexisting condition, such as bipolar disorder. Two years ago the AACAP and APA created a similar guide for depression, which is available on the same website and has since gotten more than one million hits.

Research suggests that at least one child in a classroom of 30 will have ADHD. The Centers for Disease Control and Prevention estimate that ADHD has been diagnosed in 4.4 million children between the ages of 4 and 17, so-called "school-aged children," in the U.S., and that only about half of those children are currently receiving treatment. And nearly two-thirds of children with the disorder also have coexisting conditions, such as anxiety disorder, bipolar disorder or learning and language disabilities. "Primary care providers are so often overwhelmed with shortage of time that they can't provide adequate education," says Dr. Reed Sulik, a child psychiatrist at Minnesota's St. Cloud Hospital. "There's no way that this amount of information can be provided in a clinical setting. Parents need to master an understanding of their children's illness."

The AACAP and APA see the new ADHD guide, in part, as a solution to the problem that Sulik points out: the lack of information resources and mental health professionals devoted to child psychiatry. "[Many reports] have demonstrated a real paucity of child-adolescent psychiatrists and child psychologists and social workers, who are trained specifically to work with children...given the enormous need in our country for services," says Anders. He calls the issue a "workforce crisis" and suggests that the medical community ought to do more — medical-school loan forgiveness plans and more openings at hospitals, for instance — to attract professionals to children and adolescent psychiatry. In the meantime, several states, including Minnesota and Vermont, have established programs to enhance collaboration between primary care providers and child and adolescent mental health professionals. In Massachusetts, for example, about 90% of doctors who treat children can call a pediatric psychiatrist through the state's Child Psychiatry Access Project and get immediate assistance with a child patient. And a face-to-face follow-up evaluation with the mental health specialist can occur within days.

At home, however, parents should seek more and better information on their own, and the comprehensive new ADHD guide is a good place to begin, says Dr. Benedetto Vitiello, a psychiatrist and chief of the National Institute of Mental Health's child and adolescent treatment and preventive interventions research branch — provided that the child has undergone a thorough evaluation for ADHD. He says that a proper diagnosis must be the starting point. The ideal treatment should combine medication with behavioral and psychosocial therapies and, says Vitiello, should be carefully and continually monitored. "It's not possible to put a child on cruise control and to go with the same dose and the same medication for months and years without physiologically revisiting what's going on, adjusting the dose and rediscussing the issue," says Vitiello. "ADHD is not one of those things to say 'Aha, you have it. Take this medication,' and that's it. There should be an interaction with the clinician, every two months or so to revisit the situation to see what the needs of the child are."