Q. Is ADHD on the increase? If so, why?
A. No one knows for sure whether the prevalence of ADHD per se has risen, but it is very clear that the number of children identified with the disorder who obtain treatment has risen over the past decade. Some of this increased identification and increased treatment seeking is due in part to greater media interest, heightened consumer awareness, and the availability of effective treatments. A similar pattern is now being observed in other countries. Whether the frequency of the disorder itself has risen remains unknown, and needs to be studied.
Q. Can ADHD be seen in brain scans of children with the disorder?
A. Not directly, no. But neuroimaging research has shown that the brains of children with ADHD differ fairly consistently from those of children without the disorder in that several brain regions and structures (pre-frontal cortex, striatum, basal ganglia, and cerebellum) tend to be smaller. Overall brain size is generally 5% smaller in affected children than children without ADHD.
While this average difference is observed consistently, it is too small to be useful in making the diagnosis of ADHD in a particular individual. In addition, there appears to be a link between a person’s ability to pay continued attention and measures that reflect brain activity. In people with ADHD, the brain areas that control attention appear to be less active, suggesting that a lower level of activity in some parts of the brain may be related to difficulties sustaining attention.
Q. Can a preschool child be diagnosed with ADHD?
A. The diagnosis of ADHD in the preschool child is possible, but can be difficult and should be made cautiously by experts well trained in childhood neurobehavioral disorders. Developmental problems, especially language delays, and adjustment problems can sometimes imitate ADHD. Treatment should focus on placement in a structured preschool with parent training and support. Stimulants can reduce oppositional behavior and improve mother-child interactions, but they are usually reserved for severe cases or when a child is unresponsive to environmental or behavioral interventions.
Q. What is the impact of ADHD on children and their families?
A. Life can be hard for children with ADHD. They’re the ones who are so often in trouble at school, can’t finish a game, and have trouble making friends. They may spend agonizing hours each night struggling to keep their mind on their homework, then forget to bring it to school. It is not easy coping with these frustrations day after day for children or their families. Family conflict can increase. In addition, problems with peers and friendships are often present in children with ADHD. In adolescence, these children are at increased risk for motor vehicle accidents, tobacco use, early pregnancy, and lower educational attainment. When a child receives a diagnosis of ADHD, parents need to think carefully about treatment choices. And when they pursue treatment for their children, families face high out-of-pocket expenses because treatment for ADHD and other mental illnesses is often not covered by insurance policies. School programs to help children with problems often connected to ADHD (social skills and behavior training) are not available in many schools. In addition, not all children with ADHD qualify for special education services. All of this leads to children who do not receive proper and adequate treatment. To overcome these barriers, parents may want to look for school-based programs that have a team approach involving parents, teachers, school psychologists, other mental health specialists, and physicians.
Q. Aren’t there nutritional treatments for ADHD?
A. No. Many parents have exhausted nutritional approaches, such as eliminating sugar from the diet, before they seek medical attention. However, there are no well-established nutritional interventions that have been consistently demonstrated to be efficacious for assisting the great majority of children with ADHD. A small body of research has suggested that some children may benefit from these interventions, but delaying the implementation of well-established, effective interventions while engaged in the search for unknown, generally unproven allergens, is likely to be harmful for many children.