[blparent] diagnosing Attention deficit

Thu May 13 04:05:13 UTC 2010

An interesting read.  However, I stick to my original premise, which is that 
Shannon asked about how to keep track of a wandering toddler in a crowd. 
She said that her son was a social, active little boy.  She didn't mention 
any kind of aggressive or impulsive problems, such as are described in this 
study.  Someone else on the list brought up ADHD in a context where it 
didn't fit at all.  The possibility of ADHD gets thrown around way too 
easily these days.

Jo Elizabeth

--------------------------------------------------
From: "Veronica Smith" <madison_tewe at spinn.net>
Sent: Wednesday, May 12, 2010 9:56 PM
To: "'NFBnet Blind Parents Mailing List'" <blparent at nfbnet.org>
Subject: [blparent] diagnosing Attention deficit

> Preschool-Age ADHD Children: Too Young for a Diagnosis?
> Is a diagnosis or treatment possible for ADHD children under 5? A new 
> study
> sheds
> light on attention deficit in preschoolers.
> by
> Arlene Schusteff
> A new study, the Preschool ADHD Treatment Study, or PATS, provides 
> insights
> about
> diagnosing and treating very young children with ADHD.
> ADDitude magazine
> Friends didn't want their kids to be around our son.
> Mary K., mom to Brandon, a preschooler with severe ADD
> The Preschool ADHD Treatment Study (PATS): What You Need to Know
> Background
> Sponsored by the National Institute of Mental Health, and conducted by a
> consortium
> of researchers at six sites, PATS is the first long-term, comprehensive
> study of
> treating preschoolers with ADHD. The study included more than 300 three- 
> to
> five-year-olds
> with severe ADHD (hyperactive/impulsive, inattentive, or combined type).
> Most exhibited
> a history of early school expulsion and extreme peer rejection.
> Stage 1: Parent Training
> Ten-week parent training course in behavior modification techniques, such 
> as
> offering
> consistent praise, ignoring negative behavior, and using time-outs.
> Result:
> More than a third of the children (114) were treated successfully with
> behavior
> modification and did not proceed to the medication stage of the study.
> Stage 2: Medication
> Children with extreme ADHD symptoms who did not improve with behavior
> therapy (189)
> participated in a double-blind study comparing low doses of 
> methylphenidate
> (Ritalin)
> with a placebo.
> Result:
> Methylphenidate treatment resulted in significant reduction in ADHD
> symptoms, as
> measured by standard rating forms and observations at home and at school.
> Notable findings
> .  Lower doses of medication were required
> to reduce ADHD symptoms in preschoolers, compared to elementary school
> children.
> .  Eleven percent ultimately stopped treatment
> , despite improvements in ADHD symptoms, due to moderate to severe side
> effects,
> such as appetite reduction, insomnia, and anxiety. Preschoolers appear to 
> be
> more
> prone to
> side effects
> than elementary schoolers.
> .  Medication appeared to slow preschooler growth rates.
> Children in the study grew half an inch less and weighed three pounds less
> than
> expected. A five-year follow-up study is looking at long-term growth rate
> changes.
> Look for preliminary results in 2009.
> Bottom line
> Preschoolers with severe ADHD experience marked reduction in symptoms when
> treated
> with behavior modification only (one third of those in the study) or a
> combination
> of behavior modification and low doses of methylphenidate (two thirds of
> those in
> the study). Although medication was found to be generally effective and
> safe, close
> monitoring for side effects is recommended.
> For more information on the Preschool ADHD Treatment Study:
> Journal of the American Academy of Child and Adolescent Psychiatry
> , November 2006. (
> jaacap.com
> ), National Institute of Mental Health, (
> nimh.nih.org
> ).
> Treating ADHD Children
> Mary K., of Hillside, New Jersey, suspected that her son, Brandon, should 
> be
> diagnosed
> with attention deficit disorder (ADD ADHD). At home, life was difficult --
> as it
> is for many families with
> ADHD children
> . "Brandon drew on the walls and didn't listen to anything we said. He 
> threw
> pictures
> or silverware across the room when he was frustrated, which was all the
> time. We
> lived and died by Brandon's moods. If he was in a good mood, everyone in 
> the
> house
> was in a good mood, and vice versa. I had a three-year-old running my
> household,"
> says Mary.
> At first, Mary and her husband ascribed Brandon's high activity level to
> 'boys being boys'
> . But when the preschool he attended asked the three-year-old to leave
> because of
> concerns about his
> aggressive and impulsive behaviors
> , she began to suspect an ADHD diagnosis was needed.
> An elementary school disorder?
> After Brandon was asked to leave a second preschool - he'd chased a girl
> around the
> playground with a plastic knife, saying he would "cut her up" - Mary 
> booked
> an appointment
> with her son's pediatrician to ask about diagnosing the preschooler with
> attention
> deficit disorder. Her doctor's response, however, was that Brandon was 
> much
> too young
> for an ADHD diagnosis. And this response is one that parents of children
> with ADHD
> across the country in similar circumstances can expect to encounter. Why?
> Attention deficit disorder has traditionally been viewed as a disorder of
> elementary
> school children. While there are hundreds of scientific studies generating 
> a
> wealth
> of data for diagnosing and treating ADHD in school-age children, there are
> few equivalent
> studies about diagnosing and treating preschoolers with ADHD. The
> Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
> (DSM-IV)
> criteria used to diagnose ADHD include symptoms such as, "out of seat
> during school,"
> "does not follow through on instructions," "avoids tasks with sustained
> mental effort,"
> and "fidgety and restless while sitting"-describing behaviors that may be
> developmentally
> appropriate for some preschoolers.
> Diagnosing ADHD in preschoolers
> Is it possible, then, to diagnose children with attention deficit disorder
> when impulsivity,
> opposition, and extreme activity are normal preschool behaviors? Yes, but
> the tipping
> point in diagnosis is usually a matter of degree. "Children with ADHD are
> much more
> extreme than the average three-year-old," says Alan Rosenblatt, M.D., a
> specialist
> in neurodevelopmental pediatrics. "It's not just that a child with ADD 
> can't
> sit
> still. It's that he can't focus on any activity, even one that's
> pleasurable, for
> any length of time."
> Larry Silver, M.D., a psychiatrist at Georgetown University School of
> Medicine, says
> that an experienced teacher, one with a baseline of appropriate
> three-year-old behavior,
> can be a tremendous help. "You have to look at whether or not the 
> behaviors
> are consistent
> in more than one environment," he notes.
> But experts caution that, even with "red flags," early diagnosis of ADHD 
> can
> be difficult.
> "You have to delve deep into the root of certain behaviors," says Silver. 
> "A
> child
> might have separation anxiety, his fine motor skills or
> sensory problems
> could be making it hard for him to behave, or it could be evolving
> Pervasive Developmental
> Disorder," he says.
> Nonetheless, Laurence Greenhill, M.D., of Columbia University/New York 
> State
> Psychiatric
> Institute, points to two behavioral patterns that often predict ADHD
> diagnosis later
> in life. The first, preschool expulsion, is usually caused by aggressive
> behavior,
> refusal to participate in school activities, and failure to respect other
> children's
> property or boundaries. The second, peer rejection, is one that parents 
> can
> easily
> identify. Children with extreme behaviors are avoided by their classmates,
> shunned
> on the playground. Other children are "busy" whenever parents try to
> arrange playdates
> .
> In these extreme cases, parents should take their preschooler to
> a pediatrician or a child psychiatrist
> . Diagnosis of ADHD should involve a thorough medical and developmental
> history,
> observation of social and emotional circumstances at home, and feedback 
> from
> teachers
> and health professionals who have contact with the child. In many cases,
> neuropsychological
> testing may be needed to rule out
> conditions whose symptoms might overlap with ADHD
> , including anxiety disorder, language-processing disorders,
> oppositional-defiant
> disorders, and sensory integration problems.
> Treatment options
> If your preschool child is diagnosed with ADHD, what is the next step? 
> Both
> the
> American Psychological Association
> and the
> American Academy of Child and Adolescent Psychiatry
> advise that ADHD treatment in children proceed according to the severity 
> of
> the
> symptoms. For
> children who play well
> with others and who have healthy self-esteem, Carol Brady, Ph.D., a child
> psychologist
> in Houston, says that environmental changes can help. "A smaller 
> classroom,
> with
> less stimulation, and a strong routine often make a tremendous difference 
> in
> improving
> ADHD symptoms in preschoolers."
> In most cases, parent effectiveness training or
> behavior therapy
> is the next course of action (see sidebar, at left,
> The Preschool ADHD Treatment Study (PATS)
> ). There is increasing evidence that treating ADHD symptoms in 
> preschoolers
> can be
> extremely effective, even for children with a high degree of impairment. 
> But
> what
> if your child with ADHD doesn't respond to behavioral interventions? Is 
> ADHD
> medication
> the answer? Methylphenidate (brand names include Ritalin and Concerta) is
> the most
> commonly prescribed medication to treat children diagnosed with ADHD, but 
> it
> is not
> approved by the Food and Drug Administration for use in children younger
> than six.
> The Preschool ADHD Treatment Study, or PATS, conducted by the National
> Institute
> of Mental Health (NIMH), is the first long-term study designed to evaluate
> the effectiveness
> of treating preschoolers with ADHD with behavioral therapy, and then, in
> some cases,
> methylphenidate. In the first stage, the children (303 preschoolers with
> severe ADHD,
> between the ages of three and five) and their parents participated in a
> 10-week behavioral
> therapy course. For one third of the children, ADHD symptoms improved so
> dramatically
> with behavior therapy alone that they did not progress to the ADHD
> medication phase
> of the study.
> Preliminary data were released in late 2006. "PATS provides us with the 
> best
> information
> to date about treating very young children diagnosed with ADHD," says NIMH
> director
> Thomas R. Insel, M.D. "The results show that preschoolers may benefit from
> low doses
> of medication, when closely monitored."
> This article comes from the August/September issue of ADDitude.
> To read this issue of ADDitude in full,
> purchase the back issue
>
>
>
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