Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: ADHD - New Ideas and New Questions

Category: Child Care


The American Academy of Pediatrics has co-sponsored a project in the San Diego public school system called PARD, which stand for Project for Attention Related Disorders. In this project, teachers, doctors and parents are all working together to best help the five to ten percent of students in the San Diego area who are felt to have attention deficit hyperactivity disorder. ADHD is the most common neurobehavioral disorder occurring in childhood and results from a persistent disfunction in the central nervous system. It is not related to sex or intelligence level or cultural environment. It is as common in middle and upper class children as lower class children but poor children have less opportunities for access to care by pediatricians, neurologists and learning specialists.

One of the common findings in ADHD kids is inappropriate social responses. These children tend to talk out of turn, get out of their seats without permission and frequently get into trouble disturbing their class. This frequently leads to academic and social failure, a damaged self esteem, secondary depression and acting-out behaviors. Acting-out behaviors include such things as accidents or a tendency toward substance abuse and other illegal activities as the child becomes older and continues to feel two steps behind and struggling. The American Academy of Pediatrics and experts throughout the country on ADHD feel that such negative outcomes are not inevitable. They strongly recommend a close working relationship between educational and mental health professionals to help ADHD children succeed academically and socially.

The PARD project in San Diego is about a year and a half old and is designed to identify and coordinate the health, social and educational services for children in the San Diego Unified School District who have ADHD symptoms.

ADHD is not just a medical problem and cannot be solved by placing a patient on Ritalin or some other medicine. It is essential that all aspects of the child's life including educational, family and self esteem issues be addressed. By doing this you can help these kids experience true success in their life.

Because Attention Deficit Disorder is frequently only seen in a classroom with lots of distractions with large numbers of kids and not seen in a pediatricians office, one on one, it is vital that teachers observe the children closely and work with the parents and pediatrician to properly diagnose and follow children with ADHD. Early intervention and identification is vital because a few lost years can damage a child's self esteem almost irreparably.

For young students, school is their world and if they are feeling down six to eight hours a day because of struggles in school related to their attention and behavior problems, it throws their whole life off. Most experts feel that ADHD kids need to be handled in regular classrooms and a system worked out with a team approach rather than isolating them in special education classes away from their peers.

One concern of many people is that ADHD is being over-diagnosed and, in some cases it probably is. The symptoms of attention deficit disorder (such as poor attention, distractibility, acting out, fidgetiness and erratic performance such as an A one day and an F the next) are all found in normal children. To truly diagnose ADHD, the child needs to manifest most of these symptoms over a period of time. Again this is why it is critical for a teacher who is with a child on a day to day basis over time to help describe and identify the problem. All of these symptoms can be brought on by several other conditions including simple family and home problems or emotional stress from any cause, so proper diagnosis is important.

There are at least two groups of ADHD kids, the first group is the third of all ADHD kids with extreme physical hyperactivity and the second group is the two thirds who don't seem to have too much physical hyperactivity. These two groups may actually have different conditions. Ongoing research is making the whole ADHD scene more and more complex. ADHD is some times associated with other learning disabilities. Ideally any child with ADHD should undergo a careful educational assessment to uncover any other specific minor learning problems they may have and try to adjust to these through modified learning techniques as much as possible. Good teachers know that every child learns slightly differently. Ideally each ADHD child would be in a classroom with a small number of students and a teacher with the patience of Job who could find the magic formula of learning that would work best for that child. Realistically, we just have to use the resources available and continue working together to do the best job we can for every single child. We need a strong partnership between teachers, parents, pediatricians and other learning specialists all of whom need to commit to a working partnership for the betterment of these children.