25th May 2005
robinfarley,
I thought the info below an RN friend of mine sent me might help. I wish you every success in helping your daughter.
addprogrammer
Diagnosing Difficulties
About 30 percent of young people with ADHD aren't diagnosed until middle school or later, says Quinn. These students are very bright, she says. "The more intelligent you are, the better you cope--until stressors in the environment outpace your ability to cope. Maybe your disorder becomes a problem in high school when you have only lecture classes, or in college when you have to do everything for yourself and go to class, too."
By the time someone with undiagnosed ADHD gets to middle school or high school, the main complaint is classroom underachievement rather than hyperactivity or distractibility, Quinn says. Some people shorten the name to ADD when it affects older people. "But you shouldn't assume that everyone who is underachieving has ADHD."
And, not everyone with attention difficulty has ADHD.
For example, when Linda Smith (not her real name) was 16, she had extreme difficulty concentrating. ADHD was suspected. Thorough examination, however, revealed the culprits were anxiety, depression and a sleep disorder, which are improving under a treatment plan that includes medicines and counseling.
Narrowing a diagnosis to ADHD requires more than a single visit to the doctor. Substantial detective work by the doctor involves talking not only to the patient, but also to the parents and to nurses and teachers at the patient's various schools.
"I ask to see all report cards from kindergarten on," Quinn says. "Teachers usually comment, `He would do so much better if he could only pay attention.' One mother said of her son in high school, `One day in first grade, he came home without shoes. He didn't know where he put them.' kids with this disorder lose their jackets, shoes. So he had symptoms early on."
There is no biological test for ADHD. Doctors base their diagnosis on guidelines set by the American Psychiatric Association. (See "Diagnostic Guidelines.")
Deciding to Use Stimulants
Stimulant treatment begins as a "trial," so you and your parents should tell the doctor regularly about improvements, such as handling school tasks better, and any side effects. The most common side effects are nervousness, sleep difficulty, and appetite loss. Less common are skin rash, nausea, dizziness, headache, weight loss, and blood pressure changes. Immediately report such serious effects as confusion, breathing difficulty, sweating, vomiting, and muscle twitches, which may signal too high a dose.
With this information and further examination, the doctor can determine the most effective dose that causes no, or only tolerable, side effects.
Patients who need stimulant medicine only for paying attention may not need it at all during weekends and summer vacations. If their difficult subjects are in the morning, a morning dose may be enough most days. Other patients need stimulant medicine much more often.
Stimulants are not for everyone with ADHD. For example, they shouldn't be used in someone with marked agitation, a twitching known as a tic, or the eye disorder glaucoma.
And like all medicine, stimulants pose risks. Whether to use stimulants is a case-by-case decision based on how the benefit stacks up against the risk.
In January 1996, FDA announced that in studies of rodents given methylphenidate, the drug produced a "weak signal" for the potential to cause liver cancer. The cancer occurred in male mice but not in female mice or rats. At FDA's request, Ciba-Geigy informed doctors and, along with other methylphenidate manufacturers, added the findings to their drugs' labeling.
Accompanying health problems like depression may require other medicines or psychotherapy.
"Individual therapy for ADHD may not be helpful," Sharp says. "Probably the most beneficial treatment for ADHD involves the entire family system, and behavior management is usually a large part of this treatment."
Some people have linked ADHD to sugar and food or color additives. "Research in this area has raised questions and contributes to understanding," says Catherine Bailey, an FDA science policy analyst. "But the idea that individual food substances cause ADHD is unproven. Still, if people want to avoid substances they perceive as problems, they should be sure to read food labels."
Moving Forward
Scientists don't know exactly what causes ADHD, but it tends to affect several in a family. When an identical twin has ADHD, the other usually does, too. Sharp had recruited twins for research to help clarify this.
While more males than females have ADHD, the gender gap is narrowing. Males taking medicine for the disorder outnumbered females 10 to 1 in 1985 but only 5 to 1 in 1995, the authors of the 1996 Pediatrics article stated.
Probably the hardest part of having ADHD is accepting the diagnosis, Quinn says. She stresses the importance of looking at everything else that's good in your life.
"The disorder is part of who you are and, yes, you have to control it," she says. "But it doesn't define you. It's okay to have attention disorder, so long as you know what to do about it."
RELATED ARTICLE: Diagnostic Guidelines
According to the American Psychiatric Association, a diagnosis of ADHD must meet the following guidelines:
* The patient must often have: either six of these inattention symptoms:
* does not pay close attention to details or makes careless mistakes
* has difficulty sustaining attention in activities
* does not seem to listen when spoken to directly
* does not follow through on instructions and fails to finish duties
* has difficulty organizing tasks and activities
* avoids, dislikes, or is reluctant to do tasks requiring sustained mental effort
* loses things necessary for tasks or activities
* is easily distracted
* is forgetful in daily activities or six of these hyperactivity or impulsiveness symptoms:
* fidgets with hands or feet or squirms in seat
* leaves seat in classroom or other times when remaining seated is expected
* inappropriately runs about or climbs excessively or, in older patients, feels restless
* has difficulty playing or taking part in leisure activities quietly
* is "on the go" or acts as if "driven by a motor"
* talks excessively
* blurts out answers before questions have been completed
* has difficulty awaiting turn
* interrupts or intrudes on others, such as butting into conversations or games.
* Symptoms must continue six months and be more frequent and severe than normal.
* Evidence must show significant damage to social, academic or work functioning.
* Some damage must occur in at least two settings, such as home and school.
* Some damaging symptoms must have occurred before age 7, even with a later diagnosis.
* The symptoms must not be due to another disorder.
I thought the info below an RN friend of mine sent me might help. I wish you every success in helping your daughter.
addprogrammer
Diagnosing Difficulties
About 30 percent of young people with ADHD aren't diagnosed until middle school or later, says Quinn. These students are very bright, she says. "The more intelligent you are, the better you cope--until stressors in the environment outpace your ability to cope. Maybe your disorder becomes a problem in high school when you have only lecture classes, or in college when you have to do everything for yourself and go to class, too."
By the time someone with undiagnosed ADHD gets to middle school or high school, the main complaint is classroom underachievement rather than hyperactivity or distractibility, Quinn says. Some people shorten the name to ADD when it affects older people. "But you shouldn't assume that everyone who is underachieving has ADHD."
And, not everyone with attention difficulty has ADHD.
For example, when Linda Smith (not her real name) was 16, she had extreme difficulty concentrating. ADHD was suspected. Thorough examination, however, revealed the culprits were anxiety, depression and a sleep disorder, which are improving under a treatment plan that includes medicines and counseling.
Narrowing a diagnosis to ADHD requires more than a single visit to the doctor. Substantial detective work by the doctor involves talking not only to the patient, but also to the parents and to nurses and teachers at the patient's various schools.
"I ask to see all report cards from kindergarten on," Quinn says. "Teachers usually comment, `He would do so much better if he could only pay attention.' One mother said of her son in high school, `One day in first grade, he came home without shoes. He didn't know where he put them.' kids with this disorder lose their jackets, shoes. So he had symptoms early on."
There is no biological test for ADHD. Doctors base their diagnosis on guidelines set by the American Psychiatric Association. (See "Diagnostic Guidelines.")
Deciding to Use Stimulants
Stimulant treatment begins as a "trial," so you and your parents should tell the doctor regularly about improvements, such as handling school tasks better, and any side effects. The most common side effects are nervousness, sleep difficulty, and appetite loss. Less common are skin rash, nausea, dizziness, headache, weight loss, and blood pressure changes. Immediately report such serious effects as confusion, breathing difficulty, sweating, vomiting, and muscle twitches, which may signal too high a dose.
With this information and further examination, the doctor can determine the most effective dose that causes no, or only tolerable, side effects.
Patients who need stimulant medicine only for paying attention may not need it at all during weekends and summer vacations. If their difficult subjects are in the morning, a morning dose may be enough most days. Other patients need stimulant medicine much more often.
Stimulants are not for everyone with ADHD. For example, they shouldn't be used in someone with marked agitation, a twitching known as a tic, or the eye disorder glaucoma.
And like all medicine, stimulants pose risks. Whether to use stimulants is a case-by-case decision based on how the benefit stacks up against the risk.
In January 1996, FDA announced that in studies of rodents given methylphenidate, the drug produced a "weak signal" for the potential to cause liver cancer. The cancer occurred in male mice but not in female mice or rats. At FDA's request, Ciba-Geigy informed doctors and, along with other methylphenidate manufacturers, added the findings to their drugs' labeling.
Accompanying health problems like depression may require other medicines or psychotherapy.
"Individual therapy for ADHD may not be helpful," Sharp says. "Probably the most beneficial treatment for ADHD involves the entire family system, and behavior management is usually a large part of this treatment."
Some people have linked ADHD to sugar and food or color additives. "Research in this area has raised questions and contributes to understanding," says Catherine Bailey, an FDA science policy analyst. "But the idea that individual food substances cause ADHD is unproven. Still, if people want to avoid substances they perceive as problems, they should be sure to read food labels."
Moving Forward
Scientists don't know exactly what causes ADHD, but it tends to affect several in a family. When an identical twin has ADHD, the other usually does, too. Sharp had recruited twins for research to help clarify this.
While more males than females have ADHD, the gender gap is narrowing. Males taking medicine for the disorder outnumbered females 10 to 1 in 1985 but only 5 to 1 in 1995, the authors of the 1996 Pediatrics article stated.
Probably the hardest part of having ADHD is accepting the diagnosis, Quinn says. She stresses the importance of looking at everything else that's good in your life.
"The disorder is part of who you are and, yes, you have to control it," she says. "But it doesn't define you. It's okay to have attention disorder, so long as you know what to do about it."
RELATED ARTICLE: Diagnostic Guidelines
According to the American Psychiatric Association, a diagnosis of ADHD must meet the following guidelines:
* The patient must often have: either six of these inattention symptoms:
* does not pay close attention to details or makes careless mistakes
* has difficulty sustaining attention in activities
* does not seem to listen when spoken to directly
* does not follow through on instructions and fails to finish duties
* has difficulty organizing tasks and activities
* avoids, dislikes, or is reluctant to do tasks requiring sustained mental effort
* loses things necessary for tasks or activities
* is easily distracted
* is forgetful in daily activities or six of these hyperactivity or impulsiveness symptoms:
* fidgets with hands or feet or squirms in seat
* leaves seat in classroom or other times when remaining seated is expected
* inappropriately runs about or climbs excessively or, in older patients, feels restless
* has difficulty playing or taking part in leisure activities quietly
* is "on the go" or acts as if "driven by a motor"
* talks excessively
* blurts out answers before questions have been completed
* has difficulty awaiting turn
* interrupts or intrudes on others, such as butting into conversations or games.
* Symptoms must continue six months and be more frequent and severe than normal.
* Evidence must show significant damage to social, academic or work functioning.
* Some damage must occur in at least two settings, such as home and school.
* Some damaging symptoms must have occurred before age 7, even with a later diagnosis.
* The symptoms must not be due to another disorder.