Atrium Health Navicent Primary Care Monroe
ADHD Evaluation & Management
Evaluation and Management of Attention Deficit/Hyperactivity Disorder
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common chronic behavioral diagnoses of children and adolescents in the United States. Symptoms of ADHD are developmentally incorrect levels of inattentiveness, impulsivity, and abnormally excessive movement. Children afflicted with ADHD often suffer from poor academic performance, coexisting psychiatric and developmental conditions, and a high level of stress for the child and their family. Although it can be costly, the successful evaluation and management of ADHD are imperative to improving the quality of life for the struggling child.
Blood tests and imaging studies of the brain cannot help in the diagnosis of ADHD. There is no single test as a diagnostic. Like other psychiatric and many medical conditions, ADHD is a clinical diagnosis based on a manifestation of symptoms and impairments. Usually, family physicians are asked to evaluate a child experiencing poor school performance, difficult peer relationships, and/or defiance toward parents.
The evaluation begins with direct questioning or pre-visit questionnaire covering the child's academic performance, behavior at home, school, and other social situations, success with friendships, and their moods. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) set the criteria to diagnose ADHD based on academic performance and ADHD behaviors witnessed at home and in school.
Giving the child a complete physical is an important step in the diagnosis. Visual and auditory impairments, as well as other physical conditions, can mimic the symptoms of ADHD.
An accurate diagnosis requires screening for coexisting psychiatric conditions such as oppositional defiant disorder, conduct disorder, depression, and anxiety. The family physician will pose questions to identify coexisting conditions. A positive result will require evaluation by a professional clinician.
Twenty to 30 percent of children with ADHD also suffer from learning disabilities. Cognitive testing to identify learning disabilities, as well as academic strengths, should be included. Using this information, educational steps should be taken to help the child experience success in school.
The child's developmental history must also be examined. Developmental delays may suggest an underlying condition. The family's approach to discipline and their difficulties correcting the child are also important factors. Family dysfunction and tensions can create behaviors similar to ADHD symptoms.
Treatment for ADHD traditionally involves medication to improve attention and decrease excessive physical activity. This course does not assist the child's ability to function in educational or social situations. To improve the child's discipline and coping abilities, parents and teachers must be involved in behavioral interventions to improve academic and social development. Behavioral interventions that use positive rewards can encourage appropriate behaviors while reducing the unwanted actions. Interventions are most effective when they focus on a few specific of behaviors and offer structured rewards and consequences, which are applied consistently at home and in school.
Children with ADHD should be encouraged to participate in sports or other social recreation. Through these activities, they can develop self-esteem in addition to positive relationships with peers and adults.
Educational interventions are designed to increase the child's academic success by developing their strengths, providing support for their special needs, and reconciling any knowledge and skill shortfalls. It is important to know schools have a legal obligation to determine whether a child is eligible for special educational services. They are required to offer tutoring or classroom adaptations.
Although stimulants remain the pharmaceutical agents of choice for the management of ADHD, other suitable medications are available. Achievement of the greatest benefit may require slowly increasing the initial dosage to an appropriate level as well as staggering doses throughout the day. The best treatment plan is tailored to meet the needs of the child and family.
The evaluation and management of ADHD will be an ongoing part of the involved family's life. Follow-up visits should occur as often as needed and include medication management as well as reviews of the ADHD rating scales.