For millions of families, back to school means shopping for new clothes and supplies, backpacks and lunch bags. For others the big question is which pill will go into the backpack.
Experts estimate that nearly 9 percent of American youngsters have attention deficit hyperactivity disorder (ADHD). These children are easily distracted, often fidget or squirm, may talk excessively or interrupt others and may have trouble focusing or waiting their turn.
There is no simple test for attention deficit disorder (ADD) or ADHD. No blood test or questionnaire is adequate to make the diagnosis. Experienced therapists make this diagnosis on the basis of the clinical history and a thorough interview.
Few school health issues are more controversial. Some people believe that ADHD is vastly over-diagnosed. Large classes or poor teaching could lead some kids to act up out of boredom.
Teachers, however, must deal with youngsters with poor impulse control who may disrupt an entire class and interfere with everyone’s ability to learn. Children with ADHD often struggle with social relationships as much as with lessons and homework.
Parents frequently feel conflicted. One reader wrote: “I think my son has ADD. His teachers say he has trouble staying focused and staying on task.
“I hate the idea of giving him powerful medications. He's a sweet-tempered kid and they don’t have any discipline problems with him, but he is failing his grade. At the urging of the school, I have put him on Adderall.
“I hate it. It’s been just one week, but he’s come home moody and often times in tears. What can I do?”
Some children do well on stimulant medicines like Adderall or Ritalin. They are able to focus in school and achieve goals that would otherwise be out of their reach. But others suffer side effects such as loss of appetite, stomachaches, mood swings, insomnia, weight loss, nervousness and tics.
Parents may also be confused and concerned about whether children need an electrocardiogram (ECG) before taking such medicines. Last spring the American Heart Association suggested that might be advisable, causing many parents to wonder if the drugs could cause heart problems.
There have been cases of heart rhythm disturbances and even sudden death associated with stimulants. Nevertheless, the American Academy of Pediatrics recently declared that healthy children don’t need routine heart screening or ECGs before taking these drugs.
Medications are not the whole story on treating ADHD. According to expert Edward Hallowell, MD, author of Delivered from Distraction, medicines can be helpful but need to be supported by behavioral approaches, sound nutrition, adequate sleep and exercise.
When Dr. Hallowell spoke on our radio show, he also described the use of dietary supplements such as fish oil, grape seed extract and pine bark extract. The best approach to ADD and ADHD involves teamwork. Parents, physicians, teachers and children need to work together to meet the challenges posed by this complex condition.