[blparent] diagnosing Attention deficit

Thu May 13 15:08:36 UTC 2010

Hi,

I totally agree with this assessment.  Some kids really do need to be 
medicated and that's fine.  But in alot of cases kids are medicated 
unnecessarily just because parents and or schools want a quick fix instead 
of trying to figure out what the real problem is.  the original question was 
about keeping track of toddlers in busy crowds, and it has already been 
answered.

Tammy
----- Original Message ----- 
From: "Jo Elizabeth Pinto" <jopinto at pcdesk.net>
To: "NFBnet Blind Parents Mailing List" <blparent at nfbnet.org>
Sent: Thursday, May 13, 2010 12:05 AM
Subject: Re: [blparent] diagnosing Attention deficit

> 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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