Friday 2 August 2013

ADHD in Children: FAQ Part 2

- How is it diagnosed in children?

The diagnosis of ADHD is made with careful clinical assessment by a trained specialist, usually a psychiatrist. A detailed history from the parents and teachers is taken to assess for ADHD symptoms and during the interviews, the child is observed for ADHD behaviour. Clinical scales may be used to determine the severity of ADHD and to assess improvement in subsequent follow-ups after treatment.

- In your opinion, do you think ADHD is over- or under-diagnosed in Singapore ? Why?

ADHD continues to be under-diagnosed in Singapore. Even though, parents and teachers are more likely to pick up the symptoms of ADHD and know that their kids have difficulties, many continue not to to bring their children to psychiatrists for formal diagnosis and  treatment. Parents are fearful that their children will be stigmatised and they have misconceptions about the illness and medication. They are unaware that without treatment, the consequences of ADHD is debilitating and affects the child negatively in the long term.  

- Why is it easy for ADHD (especially the milder cases) to go unnoticed? How common is it for parents/ teachers to think that the child is simply "naughty"? How to tell when the child's "naughtiness" could be ADHD?

Parents and teachers often think that children with milder forms of ADHD as being naughty and lazy. This is especially so when the symptoms are predominantly in the attention deficit domain. As these children do not display hyperactive behaviour and are often well behaved in school, adults may not realised that they are having problems concentrating in class and are not fulfilling their potential academically.

It is very common for ADHD symptoms to be misconstrued as "bad" or "naughty" behaviour by parents and teachers alike. Even after diagnosis, parents and teachers often require plenty of education and convincing before realising that the symptoms are not wilful or deliberate in nature. It is normal for kids to have naughty behaviour here and there. However, ADHD symptoms are pervasive, meaning that the child is constantly inattentive, hyperactive and impulsive in most situations. Unlike in naughty behaviour, these symptoms lead to long term difficulties academically in school and in other aspects of the child's life.

- How is ADHD treated? How safe is it for children to take medication for ADHD long-term?

ADHD can be treated with medications. Currently, two main types of medications are available, stimulants and norepinephrine uptake inhibitors. They help ADHD by  increasing the level of neurotransmitters (chemical messengers) in the brain called dopamine and norepinephrine. Behavioural modifications and therapy are also useful treatments and are always given alongside medications.

Latest studies showed that medications are safe and effective for long term ADHD treatment when taken under the supervision of a psychiatrist and earlier fear of untoward heart problems are unfounded. However when under treatment, the psychiatrist will continue to monitor for any possible side effects that may occur and will make the necessary adjustments when needed.

- How can parents of ADHD children cope and what can they do to help their child?

First and foremost, parents will need to be educated about that ADHD  is not unlike any other medical problems and ADHD children are not lazy, naughty or being wilful. As such, what parents need to do is not be punitive but to approach the symptoms with patience and compassion and to assist the child with managing his or her symptoms. Parents should consult their child's psychiatrist in learning about the specific approaches they can adopt. These will usually include setting up firm and consistent boundaries and routines for the child, rewarding and encouraging positive behaviour and meting out the appropriate consequences for bad behaviour. Adjustment to communication styles are important. Parents need to catch their child's attention before speaking to them rather than just yelling at them. Use as little words as possible as the ADHD child has poor attentional span and will not be able to follow long instructions.