ADHD: Strategies focus on learning new skills

By Richard Haber, MD
“I think little Johnny needs to be on medication.” It’s words like these that many parents hear after attending their first parent teacher meeting of the season. ADHD is a real disorder, stemming from a lack of neurotransmitters in those areas of the frontal lobe that help us focus on the task at hand. Attention difficulties are also often co-morbid with mood disorders and anxiety, as well as learning disabilities.
Because staying focused is a fundamental requisite for school aged children, this is when the signs of ADHD usually manifest. In fact, symptoms have been present from a very early age in most kids.
Diagnosis is generally not made before age 7, to allow for behavioral maturation and exclude extraneous influences. Symptoms must be present in ≥?2 settings, such as both school and home, and lead to impaired functioning. Pervasive developmental disorder, autism, anxiety, depression, bipolar disorder, or other psychiatric or medical diagnoses need to first be ruled out. See Tables 1 and 2 for other DSM-IV diagnostic criteria.
Treatment should be multimodal and not focused on medication alone. Parent support groups are often useful for coping strategies. Individual behavioral or family therapy may be necessary. To assure the best possible academic outcome, cooperation and communication with the child’s teacher is essential.
Additional tutoring in subjects where the youngster may be experiencing difficulty can enhance the whole treatment plan. Last, and equally important, stimulant medications have been proven to be both effective and safe, as they ameliorate the symptoms so that the other strategies can be applied more successfully.
Table 1. Criteria for diagnosis of inattention

Table 1. Criteria for diagnosis of inattention

Six or more of the following must be present for at least 6 months and lead to academic impairment:
  • fails to pay close attention to details or makes careless mistakes
  • difficulty sustaining attention in tasks or play
  • often doesn’t listen when spoken to directly
  • fails to follow through on instructions and homework
  • disorganized
  • avoids or dislikes tasks requiring sustained attention
  • often forgets things or loses items necessary for a project
  • easily distracted by extraneous stimuli
  • forgetful in daily activities
Table 2. Criteria for diagnosis of hyperactivity/impulsivity

Table 2. Criteria for diagnosis of hyperactivity/impulsivity

Six or more of the following for at least 6 months and impinging on the child’s life:

  • often fidgets or squirms
  • stands in classroom when sitting is expected
  • runs about inappropriately
  • difficulty in engaging in quiet play activities
  • as if “driven by a motor” or “on the go”
  • talks excessively
  • blurts out answers before question is completed
  • difficulty awaiting turn
  • often interrupts or intrudes into games