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41 | 2018-04-19 03:03:28 | Attention Deficit Hyperactivity Disorder | Attention Deficit Hyperactivity Disorder Page Content Article BodyAttention deficit hyperactivity disorder (ADHD) is a developmental disorder that affects the behavior, attention, and learning of children. If it is unrecognized, these children can face excessive criticism, failure, and disappointment, while their parents struggle with what to do. ADHD youngsters are easily distracted and have trouble concentrating. They may be impulsive and seem to act without thinking, touching objects that are off limits or running into the street to chase a ball without apparent regard for their own safety. In calm moments, they might know better. They may not cope well with frustration and can have dramatic mood swings. At school they may be fidgety and brimming with energy, finding it difficult to sit still, jumping out of their seat constantly, as if unable to control their perpetual motion. They often have difficulty with sequencing and organizational skills. Others who cannot concentrate may sit quietly, daydreaming and appearing "spaced out." Because of their behavior they may be rejected by other children and disliked by teachers; in the process, their report cards may be disappointing and their self-esteem may suffer, despite the fact that they are often as bright as their peers. Over the years a variety of labels—minimal brain dysfunction, hyperkinetic/impulsive disorder, hyperkinesis, hyperactivity, and attention deficit disorder with or without hyperactivity—have been used to describe children with some or all of these behavioral problems. Now, most experts are using the term attention deficit hyperactivity disorder as a diagnosis for children whose behavior tends to be characteristically impulsive, inattentive, or a combination of both. Since all children have these traits some of the time, the diagnosis usually requires that the symptoms be present for at least six months by age seven, be evident in various situations, and be more intense than usually seen in other children of the same age and gender. More than 6 percent of school-age children have ADHD. Boys outnumber girls. Researchers are examining multiple causes of the disorder, including heredity, brain chemistry, and social factors. Some researchers believe that children with ADHD have abnormally low levels and imbalances of certain neurotransmitters, the chemicals that convey messages between brain cells. Recent studies suggest that various parts of the brain may be functioning differently than in the majority of children. Many ADHD children also have reading disabilities and other specific learning problems, which further interfere with their success at school. (Most children who have specific learning problems do not have ADHD.) Children with difficulties with language and memory have problems with schoolwork that are compounded when ADHD characteristics like distractibility and impulsiveness are present. A child with ADHD can affect his family in many ways. Normal family routines may be hard to maintain because the child's behavior has been so disorganized and unpredictable, often for a number of years. Parents may not be able to comfortably plan outings or other family events, not knowing what their child's behavior or activity level is likely to be. Children with ADHD frequently become "overexcited" and out of control in stimulating environments. They may also exhibit angry and resistant behavior toward their parents or have low self-esteem. This may be the result of the child's exasperation at failing to meet their parents' expectations or to manage day-to-day tasks due to ADHD symptoms. School performance also suffers, and teachers complain to parents, who also must struggle with their child's difficulties with peers—conflicts, inappropriate behavior, and having few friends. The condition may produce enormous stress for families, who often search for physicians and others able to provide the care they need. Last Updated 11/21/2015 Source Caring for Your School-Age Child: Ages 5 to 12 (Copyright © 2004 American Academy of Pediatrics) |
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42 | 2018-04-19 03:03:34 | Behavior Therapy for Children with ADHD | Behavior Therapy for Children with ADHD Page ContentMost experts recommend using both medication and behavior therapy to treat ADHD. This is known as a multimodal treatment approach. There are many forms of behavior therapy, but all have a common goal—to change the child's physical and social environments to help the child improve his behavior. Under this approach, parents, teachers, and other caregivers learn better ways to work with and relate to the child with ADHD. You will learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. Your child will learn better ways to control his behavior as a result. You will learn how to be more consistent. The table below shows specific behavior therapy techniques that can be effective with children with ADHD. Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child's life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions. How can I help my child control her behavior?As the child's primary caregivers, parents play a major role in behavior therapy. Parent training is available to help you learn more about ADHD and specific, positive ways to respond to ADHD-type behaviors. This will help your child improve. In many cases parenting classes with other parents will be sufficient, but with more challenging children, individual work with a counselor/coach may be needed. Taking care of yourself also will help your child. Being the parent of a child with ADHD can be tiring and trying. It can test the limits of even the best parents. Parent training and support groups made up of other families who are dealing with ADHD can be a great source of help. Learn stress-management techniques to help you respond calmly to your child. Seek counseling if you feel overwhelmed or hopeless. Ask your pediatrician to help you find parent training, counseling, and support groups in your community. Additional resources are listed at the end of this article. Tips for helping your child control his behavior:Keep your child on a daily schedule. Try to keep the time that your child wakes up, eats, bathes, leaves for school, and goes to sleep the same each day.Cut down on distractions. Loud music, computer games, and TV can be overstimulating to your child. Make it a rule to keep the TV or music off during mealtime and while your child is doing homework. Don't place a TV in your child's bedroom. Whenever possible, avoid taking your child to places that may be too stimulating, such as busy shopping malls.Organize your house. If your child has specific and logical places to keep his schoolwork, toys, and clothes, he is less likely to lose them. Save a spot near the front door for his school backpack so he can grab it on the way out the door.Reward positive behavior. Offer kind words, hugs, or small prizes for reaching goals in a timely manner or good behavior. Praise and reward your child's efforts to pay attention.Set small, reachable goals. Aim for slow progress rather than instant results. Be sure that your child understands that he can take small steps toward learning to control himself.Help your child stay "on task." Use charts and checklists to track progress with homework or chores. Keep instructions brief. Offer frequent, friendly reminders.Limit choices. Help your child learn to make good decisions by giving him only 2 or 3 options at a time.Find activities at which your child can succeed. All children need to experience success to feel good about themselves.Use calm discipline. Use consequences such as time-out, removing the child from the situation, or distraction. Sometimes it is best to simply ignore the behavior. Physical punishment, such as spanking or slapping, is not helpful. Discuss your child's behavior with him when both of you are calm.Develop a good communication system with your child's teacher so that you can coordinate your efforts and monitor your child's progress.Additional Information on HealthyChildren.org:Understanding ADHD: Information for ParentsCommon ADHD Medications & Treatments for ChildrenHow Schools Can Help Children with ADHDCommon Coexisting Conditions in Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/9/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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43 | 2018-04-19 03:03:40 | Causes of ADHD: What We Know Today | Causes of ADHD: What We Know Today Page ContentAttention-deficit/hyperactivity disorder (ADHD) is one of the most studied conditions of childhood, but ADHD may be caused by a number of things. Research to date has shown: ADHD is a neurobiologic condition whose symptoms are also dependent on the child's environment.A lower level of activity in the parts of the brain that control attention and activity level may be associated with ADHD.ADHD frequently runs in families. Sometimes ADHD is diagnosed in a parent at the same time it is diagnosed in the child.In very rare cases, toxins in the environment may lead to ADHD. For instance, lead in the body can affect child development and behavior. Lead may be found in many places, including homes built before 1978 when lead was added to paint.Significant head injuries may cause ADHD in some cases.Prematurity increases the risk of developing ADHD.Prenatal exposures, such as alcohol or nicotine from smoking, increase the risk of developing ADHD.There is little evidence that ADHD is caused by: Eating too much sugarFood additivesAllergiesImmunizationsWhy do so many children have ADHD?The number of children getting treatment for ADHD has risen. It is not clear whether more children have ADHD or more children are receiving a diagnosis of ADHD. Also, more children with ADHD are getting treatment for a longer period. ADHD is now one of the most common and most studied conditions of childhood. Because of more awareness and better ways of diagnosing and treating this disorder, more children are being helped. It may also be the case that school performance has become more important because of the higher technical demand of many jobs, and ADHD frequently interferes with school functioning. Additional Information on HealthyChildren.org:Inheriting Mental DisordersUnderstanding ADHD: Information for ParentsTreatment & Target Outcomes for Children with ADHDCommon ADHD Medications & Treatments for ChildrenAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/9/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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44 | 2018-04-19 03:03:47 | College Support Services and Accommodations for Adolescents with ADHD | College Support Services and Accommodations for Adolescents with ADHD Page Content Article BodyBefore he can choose an appropriate college, your teenager will need to consider—ideally with you and his guidance counselor, teachers, pediatrician, and/or psychologist—which services or accommodations he may need in his new life as an undergraduate. Services and accommodations for college students with ADHD may include Special orientation programs to introduce students to the institution’s academic structure and available services Specialized academic advisors or counselors to help students identify the classes, professors, class load, and even the major best suited to their interests and needs Priority scheduling to allow students to sign up for the most appropriate classes at the most appropriate times of day Reduced course loads, which prevents students with ADHD from becoming overwhelmed (A reduced course load may mean that the student will have to make up credits during summer school or a fifth year.) A private dormitory room for students who may find the presence of a roommate too distracting or disruptive Math laboratories, writing workshops, computer laboratories, and reading courses to supplement and improve basic academic skills Specialized tutoring for students with ADHD—emphasizing organizational and planning skills and effective study techniques, as well as help with specific coursework and examination preparation A “personal coach” to check in with the student each day, reviewing his schedule for the day and the work she expects to accomplish Classroom technology, such as laptop computers, tape recorders, videos, and other recording aids, to facilitate students’ ability to retain and review the information in classroom lectures Academic aides, including in-class note-takers and homework editors Special testing arrangements, such as untimed examinations or testing in a separate, quiet room Advocates to help communicate a student’s diagnosis and needs to professors when appropriate and to help him obtain needed services Support groups or contact with other students with ADHD who can provide companionship, emotional support, and information Career guidance and mentoring for students with ADHD Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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45 | 2018-04-19 03:03:52 | Common ADHD Medications & Treatments for Children | Common ADHD Medications & Treatments for Children Page ContentFor most children, stimulant medications are a safe and effective way to relieve ADHD symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior. Stimulants may be used alone or combined with behavior therapy. Studies show that about 80% of children with ADHD who are treated with stimulants improve a great deal once the right medication and dose are determined. Two forms of stimulants are available: immediate-release (short-acting) and extended-release (intermediate-acting and long-acting). Immediate-release medications usually are taken every 4 hours, when needed. They are the cheapest of the medications. Extended-release medications usually are taken once in the morning. Children who use extended-release forms of stimulants can avoid taking medication at school or after school. It is important not to chew or crush extended-release capsules or tablets. However, extended-release capsules that are made up of beads can be opened and sprinkled onto food for children who have difficulties swallowing tablets or capsules. Non-stimulants can be tried when stimulant medications don't work or cause bothersome side effects. Which medication is best for my child?It may take some time to find the best medication, dosage, and schedule for your child. Your child may need to try different types of stimulants or other medication. Some children respond to one type of stimulant but not another. The amount of medication (dosage) that your child needs also may need to be adjusted. The dosage is not based solely on his weight. Your pediatrician will vary the dosage over time to get the best results and control possible side effects. The medication schedule also may be adjusted depending on the target outcome. For example, if the goal is to get relief from symptoms mostly at school, your child may take the medication only on school days. It is important for your child to have regular medical checkups to monitor how well the medication is working and check for possible side effects. What side effects can stimulants cause?Side effects occur sometimes. These tend to happen early in treatment and are usually mild and short-lived, but in rare cases they can be prolonged or more severe. The most common side effects include: Decreased appetite/weight lossSleep problemsSocial withdrawalSome less common side effects include: Rebound effect (increased activity or a bad mood as the medication wears off)Transient muscle movements or sounds called ticsMinor growth delayVery rare side effects include Significant increase in blood pressure or heart rateBizarre behaviorsThe same sleep problems do not exist for atomoxetine, but initially it may make your child sleepy or upset her stomach. There have been very rare cases of atomoxetine needing to be stopped because it was causing liver damage. Rarely atomoxetine increased thoughts of suicide. Guanfacine can cause drowsiness, fatigue, or a decrease in blood pressure. More than half of children who have tic disorders, such as Tourette syndrome, also have ADHD. Tourette syndrome is an inherited condition associated with frequent tics and unusual vocal sounds. The effect of stimulants on tics is not predictable, although most studies indicate that stimulants are safe for children with ADHD and tic disorders in most cases. It is also possible to use atomoxetine or guanfacine for children with ADHD and Tourette syndrome. Most side effects can be relieved by: Changing the medication dosageAdjusting the schedule of medicationUsing a different stimulant or trying a non-stimulant Close contact with your pediatrician is required until you find the best medication and dose for your child. After that, periodic monitoring by your doctor is important to maintain the best effects. To monitor the effects of the medication, your pediatrician will probably have you and your child's teacher(s) fill out behavior rating scales, observe changes in your child's target goals, notice any side effects, and monitor your child's height, weight, pulse, and blood pressure. Stimulants, atomoxetine, and guanfacine may not be an option for children who are taking certain other medications or who have some medical conditions, such as congenital heart disease. Are children getting high on stimulant medications?When taken as directed by a doctor, there is no evidence that children are getting high on stimulant drugs such as methylphenidate and amphetamine. At therapeutic doses, these drugs also do not sedate or tranquilize children and do not increase the risk of addiction. Stimulants are classified as Schedule II drugs by the US Drug Enforcement Administration because there is abuse potential of this class of medication. If your child is on medication, it is always best to supervise the use of the medication closely. Atomoxetine and guanfacine are not Schedule II drugs because they don't have abuse potential, even in adults. Are stimulant medications gateway drugs leading to illegal drug or alcohol abuse?People with ADHD are naturally impulsive and tend to take risks. But patients with ADHD who are taking stimulants are not at a greater risk and actually may be at a lower risk of using other drugs. Children and teenagers who have ADHD and also have coexisting conditions may be at higher risk for drug and alcohol abuse, regardless of the medication used. See ADHD and Substance Abuse: The Link Parents Need to Know for more information.Unproven treatments:You may have heard media reports or seen advertisements for "miracle cures" for ADHD. Carefully research any such claims. Consider whether the source of the information is valid. At this time, there is no scientifically proven cure for this condition. The following methods need more scientific evidence to prove that they work: Megavitamins and mineral supplementsAnti–motion-sickness medication (to treat the inner ear)Treatment for candida yeast infectionEEG biofeedback (training to increase brain-wave activity)Applied kinesiology (realigning bones in the skull)Reducing sugar consumptionOptometric vision training (asserts that faulty eye movement and sensitivities cause the behavior problems)Additional Information on HealthyChildren.org:Understanding ADHD: Information for ParentsADHD and Substance Abuse: The Link Parents Need to KnowTreatment & Target Outcomes for Children with ADHDBehavior Therapy for Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD All About ADHD Medication (Understood.org) Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/10/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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46 | 2018-04-19 03:03:55 | Common Coexisting Conditions in Children with ADHD | Common Coexisting Conditions in Children with ADHD Page ContentAs part of the diagnosis, your pediatrician will look for other conditions that show the same types of symptoms as attention-deficit/hyperactivity disorder (ADHD). Your child may simply have a different condition or ADHD and another condition. Most children with a diagnosis of ADHD have at least one coexisting condition. Common coexisting conditions of ADHD: Learning disabilities—Learning disabilities are conditions that make it difficult for a child to master specific skills such as reading or math. ADHD is not a learning disability. However, ADHD can make it hard for a child to do well in school. Diagnosing learning disabilities requires evaluations, such as IQ and academic achievement tests, and it requires educational interventions.Oppositional defiant disorder or conduct disorder—Up to 35% of children with ADHD also have oppositional defiant disorder or conduct disorder. Children with oppositional defiant disorder tend to lose their temper easily and annoy people on purpose, and they are defiant and hostile toward authority figures. Children with conduct disorder break rules, destroy property, get suspended or expelled from school, and violate the rights of other people. Children with coexisting conduct disorder are at much higher risk for getting into trouble with the law or having substance abuse problems than children who have only ADHD. Studies show that this type of coexisting condition is more common among children with the primarily hyperactive/impulsive and combination types of ADHD. Your pediatrician may recommend behavioral therapy for your child if she has this condition.Mood disorders/depression—About 18% of children with ADHD also have mood disorders such as depression or bipolar disorder (formerly called manic depression). There is frequently a family history of these types of disorders. Coexisting mood disorders may put children at higher risk for suicide, especially during the teenage years. These disorders are more common among children with inattentive and combined types of ADHD. Children with mood disorders or depression often require additional interventions or a different type of medication than those normally used to treat ADHD.Anxiety disorders—These affect about 25% of children with ADHD. Children with anxiety disorders have extreme feelings of fear, worry, or panic that make it difficult to function. These disorders can produce physical symptoms such as racing pulse, sweating, diarrhea, and nausea. Counseling and/or different medication may be needed to treat these coexisting conditions.Language disorders—Children with ADHD may have difficulty with how they use language. It is referred to as a pragmatic language disorder. It may not show up with standard tests of language. A speech and language clinician can detect it by observing how a child uses language in her day-to-day activities.Additional Information on HealthyChildren.org:Understanding ADHD: Information for Parents Causes of ADHD: What We Know TodayTreatment & Target Outcomes for Children with ADHDHow Schools Can Help Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/9/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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47 | 2018-04-19 03:04:00 | Common Symptoms of Hyperactivity/Impulsivity | Common Symptoms of Hyperactivity/Impulsivity Page Content Article BodyEarly Childhood (preschool and early school years) Behavior within normal range: The child runs in circles, does not stop to rest, may bang into objects or people, and asks questions constantly. Behavior signaling a hyperactivity/impulsivity problem: The child frequently runs into people or knocks things down during play, gets injured frequently, and does not want to sit for stories or games. Behavior signaling the possible presence of ADHD, hyperactive-impulsive type: The child runs through the house, jumps and climbs excessively on furniture, will not sit still to eat or be read to, and is often into things. Middle Childhood (later primary grades through preteen years) Behavior within normal range: The child plays active games for long periods. The child may occasionally do things impulsively, particularly when excited. Behavior signaling a hyperactivity/impulsivity problem: The child may butt into other children’s games, interrupt frequently, and have problems completing chores. Behavior signaling the possible presence of ADHD, hyperactive-impulsive type: The child is often talking and interrupting, cannot sit still at mealtimes, is often fidgeting when watching television, makes noise that is disruptive, and grabs toys or other objects from others. Adolescence Behavior within normal range: The adolescent engages in active social activities (eg, dancing) for long periods, and may engage in risky behaviors with peers. Behavior signaling a hyperactivity/impulsivity problem: The adolescent engages in “fooling around” that begins to annoy others, and he fidgets in class or while watching television. Behavior signaling the possible presence of ADHD, hyperactive-impulsive type: The adolescent is restless and fidgety while doing any and all quiet activities, interrupts and “bugs” other people, and gets into trouble frequently. Hyperactive symptoms decrease or are replaced with a sense of restlessness. Last Updated 1/25/2016 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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48 | 2018-04-19 03:04:07 | Diagnosing ADHD in Children: Guidelines & Information for Parents | Diagnosing ADHD in Children: Guidelines & Information for Parents Page ContentYour pediatrician will determine whether your child has ADHD using standard guidelines developed by the American Academy of Pediatrics. These diagnosis guidelines are specifically for children 4 to 18 years of age. It is difficult to diagnose ADHD in children younger than 4 years. This is because younger children change very rapidly. It is also more difficult to diagnose ADHD once a child becomes a teenager. There is no single test for ADHD. The process requires several steps and involves gathering a lot of information from multiple sources. You, your child, your child's school, and other caregivers should be involved in assessing your child's behavior. Children with ADHD show signs of inattention, hyperactivity, and/or impulsivity in specific ways. See the behaviors listed in the table below. Your pediatrician will look at how your child's behavior compares to that of other children her own age, based on the information reported about your child by you, her teacher, and any other caregivers who spend time with your child, such as coaches or child care workers. The following guidelines are used to confirm a diagnosis of ADHD: Symptoms occur in 2 or more settings, such as home, school, and social situations, and cause some impairment.In a child 4 to 17 years of age, 6 or more symptoms must be identified.In a child 17 years and older, 5 or more symptoms must be identified.Symptoms significantly impair your child's ability to function in some of the activities of daily life, such as schoolwork, relationships with you and siblings, relationships with friends, or the ability to function in groups such as sports teams.Symptoms start before the child reaches 12 years of age. However, these may not be recognized as ADHD symptoms until a child is older.Symptoms have continued for more than 6 months.In addition to looking at your child's behavior, your pediatrician will do a physical and neurologic examination. A full medical history will be needed to put your child's behavior in context and screen for other conditions that may affect her behavior. Your pediatrician also will talk with your child about how your child acts and feels. Your pediatrician may refer your child to a pediatric subspecialist or mental health clinician if there are concerns in one of the following areas: Intellectual disability (formerly called mental retardation)Developmental disorder such as speech problems, motor problems, or a learning disabilityChronic illness being treated with a medication that may interfere with learningTrouble seeing and/or hearingHistory of abuseMajor anxiety or major depressionSevere aggressionPossible seizure disorderPossible sleep disorderHow can parents help with the diagnosis?As a parent, you will provide crucial information about your child's behavior and how it affects her life at home, in school, and in other social settings. Your pediatrician will want to know what symptoms your child is showing, how long the symptoms have occurred, and how the behavior affects your child and your family. You may need to fill in checklists or rating scales about your child's behavior. In addition, sharing your family history can offer important clues about your child's condition. Keep safety in mind:If your child shows any symptoms of ADHD, it is very important that you pay close attention to safety. A child with ADHD may not always be aware of dangers and can get hurt easily. Be especially careful around:Traffic FirearmsSwimming poolsTools such as lawn mowersPoisonous chemicals, cleaning supplies, or medicinesHow will my child's school be involved?For an accurate diagnosis, your pediatrician will need to get information about your child directly from your child's classroom teacher or another school professional. Children at least 4 years and older spend many of their waking hours at preschool or school. Teachers provide valuable insights. Your child's teacher may write a report or discuss the following topics with your pediatrician: Your child's behavior in the classroomYour child's learning patternsHow long the symptoms have been a problemHow the symptoms are affecting your child's progress at schoolWays the classroom program is being adapted to help your childWhether other conditions may be affecting the symptomsIn addition, your pediatrician may want to see report cards, standardized tests, and samples of your child's schoolwork. How will others who care for my child be involved?Other caregivers may also provide important information about your child's behavior. Former teachers, religious and scout leaders, or coaches may have valuable input. If your child is homeschooled, it is especially important to assess his behavior in settings outside of the home. Your child may not behave the same way at home as he does in other settings. Direct information about the way your child acts in more than one setting is required. It is important to consider other possible causes of your child's symptoms in these settings. In some cases, other mental health care professionals may also need to be involved in gathering information for the diagnosis. Are there other tests for ADHD?You may have heard theories about other tests for ADHD. There are no other proven tests for ADHD at this time. Many theories have been presented, but studies have shown that the following tests have little value in diagnosing an individual child: Screening for high lead levels in the bloodScreening for thyroid problemsComputerized continuous performance testsBrain imaging studies such as CAT scans and MRIsElectroencephalogram (EEG) or brain-wave testWhile these tests are not helpful in diagnosing ADHD, your pediatrician may see other signs or symptoms in your child that warrant blood tests, brain imaging studies, or an EEG. Additional Information on HealthyChildren.org: Understanding ADHD: Information for Parents Causes of ADHD: What We Know Today Treatment & Target Outcomes for Children with ADHD Common ADHD Medications & Treatments for Children How Schools Can Help Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD How Is ADHD Diagnosed? Video (Understood.org) Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050 Attention Deficit Disorder Association or 856/439-9099 Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464 Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/9/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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49 | 2018-04-19 03:04:14 | Early Warning Signs of ADHD | Early Warning Signs of ADHD Page Content Article BodyMost experts agree that the tendency to develop ADHD is present from birth, yet ADHD behaviors are often not noticed until children enter elementary school. One reason for this delay is the fact that nearly all preschool-aged children frequently exhibit the core behaviors or symptoms of ADHD—inattention, impulsivity, and hyperactivity—as part of their normal development. As other children gradually begin to grow out of such behaviors, children with ADHD do not, and this difference becomes increasingly clear as the years pass. School settings can highlight a child’s problems relating to inattention, impulsivity, and hyperactivity because classroom activities demand an increased amount of focus, patience, and self-control. These types of demands are not as prevalent at home or in playgroups, so in those settings, the child may have had fewer problems. Usually by the time a child with ADHD reaches age 7 years, his parents have already become aware that their child’s inattentiveness, level of activity, or impulsiveness is greater than is typical. You may have noticed that your child finds it nearly impossible to focus on a workbook for even a very short period, even when you are there to assist him. Or you may still feel as worn out at the end of a day with your overly active 8-year-old as you did when he was 2. Your child may ask adults questions so often that you have begun to suspect it is not “normal.” Or, you may have noticed that he does not seem to be picking up the nuances of social interaction (respecting others’ personal space, letting other people have a turn to talk) that his playmates are beginning to adopt. Yet it is difficult for a parent to tell whether such behaviors are just part of the normal process of growing up (“Plenty of six-year-olds get bored with workbooks!”), whether they are more frequently problematic because of parenting difficulties (“Maybe I’ve been too inconsistent with setting limits.”), or whether this child’s temperament puts him far to one end of the spectrum (“He’s always been a handful.”), but not so far as to represent a disorder such as ADHD. This is why, for a child to be diagnosed with the disorder, the AAP advises pediatricians to gather information about the child’s behavior in at least one other major setting besides his home—including a review of any reports provided by teachers and school professionals. By comparing the child’s behavior across 2 or more settings, the pediatrician can begin to differentiate among such varied reasons for attentional problems as a “difficult” but normal temperament, ineffective parenting practices, inappropriate academic setting, and other challenges. She can also clarify whether the child’s behavior is preventing him from functioning adequately in more than one setting—another requirement for diagnosis. What Parents Notice When ADHD Behaviors Emerge It is sometimes hard to match the behavior we observe in our children with the formal terms used by pediatricians and other medical professionals. We rarely think of our children as having “hyperactive-impulsive problems.” Instead, we think, “Why can’t he ever settle down?” To confuse matters, the terms that doctors use for these behaviors have changed in recent years. The term “ADD” (attention deficit disorder) was once commonly used, and referred primarily to the form of ADHD with “inattentive only” symptoms. These children are not overly active, and their symptoms may even go unnoticed by many adults because their behavior is not disruptive. But more recently, the umbrella term “ADHD” is typically used when describing all types of ADHD. When reviewing the list that follows of typical remarks made about children with ADHD, ask yourself how many times per day or week you say or think the same things yourself. It is true that all parents make such comments now and then, but parents of children with ADHD continue to see the same behaviors on a daily basis, and for extended periods—long after other children have progressed. Parents of Children With Predominantly Inattentive-Type ADHD Say “He seems like he’s always daydreaming. He never answers when I talk to him. I wonder if he hears me.” “He loses everything. I’ve had to buy four new lunchboxes since school started.” “I’ll ask him to go up to his room and get dressed, and ten minutes later I find him playing with his toys with only his shirt on.” “He can’t remember what he learns because he misses instructions and explanations in school. Even though we work so hard on his schoolwork at night, by the next day he’s forgotten everything.” “One teacher called him her ‘space cadet,’ and another her ‘random student.’ ” Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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50 | 2018-04-19 03:04:21 | Educating Your Child's Siblings about ADHD | Educating Your Child's Siblings about ADHD Page Content Article BodyMy nine-year-old son was recently diagnosed with ADHD. He seems to be responding well to treatment and discussions of what ADHD is and how he can work to manage his problems. However, his older sister, who is thirteen, has responded to the news much more negatively. She resists going anywhere with the family where she might be seen by classmates in the company of her brother. At home, she calls him “weird” and yells at him to stay away from her and her friends. I understand that it can be difficult for an adolescent to deal with anything “different” about her family, but her behavior is rude and is damaging to my son’s self-esteem, hard as we are working to build it up. What can we do to persuade our daughter to be more supportive of her brother? It may help to look at a situation like this as more of an opportunity than a problem because it gives you an opening to work with your daughter on general issues relating to sensitivity to others, respect for family members’ rights and feelings, and acceptance of the challenges that each person must face, as well as issues directly related to ADHD. As you are already doing with your son, your daughter needs to be educated regarding what ADHD is and is not, which of your son’s behaviors are typical of children with ADHD and which are just part of normal sibling conflicts, and how her responses can help him achieve better self-control and improve general family functioning. If you have not already spoken directly with your daughter about these issues, be sure to do so—you might do some of this in the context of a “family meeting.” Your family may also benefit from one or more sessions with a family therapist or from a support group for families of children with ADHD that may help your daughter understand that the problems that she faces with her brother are common, and provide her with positive approaches for interacting with her brother. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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51 | 2018-04-19 03:04:27 | Employment and the Workplace for a Young Adult with ADHD | Employment and the Workplace for a Young Adult with ADHD Page Content Article BodyLife in the workplace can be formidable for a young adult with ADHD. Not only is he exposed to the same social and emotional pressures as his peers on college campuses, but he must also perform in a work environment that typically provides few or no supportive services and where no one may know he has ADHD. He may find it more stressful than he had expected to arrive at work exactly on time, manage paperwork or other detail-oriented work, attend frequent meetings, meet deadlines, and otherwise conform to what can often be a noisy, stressful and, in some cases, physically inactive environment. While teenagers with ADHD can often perform as well as their peers, adults with ADHD who are employed full-time tend to switch jobs more frequently and earn less money than their colleagues. A young adult with ADHD will be more likely to start off on the right foot if he spends time during high school considering what types of jobs might best suit someone with his particular strengths and weaknesses and working on developing his time-management and selfcare skills. Career counseling services are often available through the high school guidance office, and may be mandated under IDEA. Any job can be made more “ADHD-friendly” if the employee with ADHD knows how to alter his environment to better suit his needs and to advocate effectively for appropriate accommodations. Coping With the Workplace A teenager or young adult with ADHD who joins the workforce but finds a job too difficult should get some help in analyzing where the job-related challenges lie. Is he overwhelmed by paperwork? Does he get in trouble for arriving late on too many days? Does he put off tasks and thus fail to complete them? Does he forget his employer’s instructions? Does he find it impossible to concentrate with all the noise around him? Is it hard for him to get along with coworkers or his boss? Once he has identified his problem areas, he can brainstorm on his own or with coworkers, a job coach, a counselor or a psychologist, a family member, or members of his treatment team about ways to address them. He may decide to use a daily planner or computer software to manage daily tasks and appointments. A watch with alarms or a timer can help him keep track of work arrival time or deadlines, and any number of handheld devices can be used to record tasks to be accomplished. He may choose to carpool with a coworker to help him get to work on time, and to take regular, brief “exercise breaks” to work off excess energy. Asking Your Employer for Help If these self-help techniques prove insufficient, and if a young adult feels comfortable disclosing that he has some functional issues related to ADHD, he should consider asking his employer about accommodations that might be provided that could help him work at his best level. Accommodations might include a less distracting office or workspace, a daily review each morning of work to be done, help with breaking complex jobs into smaller tasks, or even flex-time or a transfer from a heavily detail-oriented, time-pressured job to one that better matches his strengths. It may be difficult for him to work up the courage to ask for such help at first, but chances are that his employer will make at least some effort to cooperate. His problems at work may have puzzled or displeased his supervisor if she did not previously understand their cause, and she will probably appreciate and respect her employee’s effort to improve his performance. As is the case in any aspect of his life, he is likely to meet with greater success on the job as he focuses on his strengths rather than his weaknesses. Adults with ADHD are often among the most creative, imaginative, energetic members of society. The more successfully he can understand and communicate to his employer his talents, strengths, and needs, the harder he or she may work to help him. It is important to remember, however, that ADHD symptoms are an explanation of why he is experiencing difficulty and not an excuse for them. The greater his understanding of how ADHD affects him and the better his self-esteem coming out of high school, the more likely he will feel empowered to effectively advocate for himself in a present or future job. An adolescent may be entitled to continue counseling services and assessment under an IDEA-mandated Individual Written Rehabilitation Plan. If this is not the case, however, he will need to be extra-vigilant regarding any ADHD-related concerns that are beginning to get out of hand, because routine accommodations are rarely provided by an employer. Make sure that your teenager has the names and phone numbers of physicians, job counselors, therapists, and other community resources who can help him with a variety of potential difficulties. The most helpful role as a parent may include providing nonjudgmental help or “reality checks” if he approaches you about these issues. Parents should remember that their role is to empower and not to enable or provide excuses for their adult child. If he is offered a health insurance plan by his employer, he should review it along with his job-related benefits to learn in advance what counseling or other support services he can obtain. He may also consider the possible benefits of using a coach to help with some of these transitions from adolescence to adult life. Again, a thorough understanding of his ADHD-related strengths and weaknesses, coupled with a determination to monitor and manage his symptoms, is the best way for your growing adolescent to join the ranks of other young adults with ADHD who enjoy stimulating, fulfilling, and successful careers. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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52 | 2018-04-19 03:04:33 | Encouraging Independence in Teenagers with ADHD | Encouraging Independence in Teenagers with ADHD Page ContentThe teenage years can be a special challenge. Academic and social demands increase. In some cases, symptoms may be better controlled as the child grows older; however, frequently the demands for performance also increase so that in most cases, ADHD symptoms persist and continue to interfere with the child's ability to function adequately. According to the National Institute of Mental Health, about 80% of those who required medication for ADHD as children still need it as teenagers.Parents play an important role in helping teenagers become independent. Encourage your teenager to help herself with strategies:Using a daily planner for assignments and appointmentsMaking listsKeeping a routineSetting aside a quiet time and place to do homeworkOrganizing storage for items such as school supplies, clothes, CDs, and sports equipmentBeing safety conscious (e.g., always wearing seat belts, using protective gear for sports)Talking about problems with someone she trustsGetting enough sleepUnderstanding her increased risk of abusing substances such as tobacco and alcoholActivities such as sports, drama, and debate teams can be good places to channel excess energy and develop friendships. Find what your teenager does well and support her efforts to "go for it."Milestones such as learning to drive and dating offer new freedom and risks. Parents must stay involved and set limits for safety. Your child's ADHD increases her risk of incurring traffic violations and accidents.It remains important for parents of teenagers to keep in touch with teachers and make sure that their teenager's schoolwork is going well.Talk with your pediatrician if your teenager shows signs of severe problems such as depression, drug abuse, or gang-related activities.Additional Information on HealthyChildren.org:ADHD and Substance Abuse: The Link Parents Need to KnowTreatment & Target Outcomes for Children with ADHDBehavior Therapy for Children with ADHDCommon ADHD Medications & Treatments for ChildrenHow Schools Can Help Children with ADHDAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/10/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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53 | 2018-04-19 03:04:40 | Girls and ADHD | Girls and ADHD Page Content Article BodyThe fact that many more boys than girls are diagnosed with ADHD—at a ratio of approximately 2 to 1 or 3 to 1—has led to the mistaken belief among many parents and teachers that ADHD is a “boys’ disorder” that rarely occurs in girls. In fact, more girls than boys qualify for the diagnosis of ADHD, but more girls remain undiagnosed because they have the inattentive type of ADHD, and tend to be overlooked entirely or do not attract attention until they are older. This means that girls are less likely to be referred for evaluation and to receive the help they need. Even when diagnosis and treatment have been obtained, girls with ADHD are further disadvantaged by the fact that most ADHD research to date has focused on boys. Little is known about potential differences between the genders in the development of the condition over time or response to medication and other forms of treatment. Compared with other girls, girls with ADHD experience more depression, anxiety, distress, poor teacher relationships, stress, external locus of control (the feeling that “the winds of fate” control their destiny instead of themselves), and impaired academics. Compared with boys with ADHD, girls with ADHD experience more difficulties from feeling anxious, distressed, or depressed, and less of a feeling that they can take control in solving problems that they face. If your daughter has been referred for evaluation for ADHD, or if you suspect that she may have the condition, it is important not to discount the possibility just because she is female. Teachers tend to under-refer girls for evaluation, even when their symptoms are the same as boys’, and girls are less likely than boys to receive sufficient medical treatment once they have been diagnosed. Be aware that some sociocultural beliefs about girls (that they tend to daydream, that they just are not interested in academics) may mask a real problem in your child’s ability to function. If your daughter is diagnosed with ADHD, ask the pediatrician to keep you updated on ongoing research about the development of ADHD in girls, the particular challenges girls with ADHD are likely to meet, and the different ways in which they may respond to various forms of treatment Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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54 | 2018-04-19 03:04:50 | Health and Safety of Children with ADHD | Health and Safety of Children with ADHD Page Content Article BodyA growing number of studies have shown that adults with ADHD may be at greater risk for health- and safety-related problems than their peers without ADHD. Their greater risktaking behaviors and frequently erratic driving practices (inability to follow driving rules, inconsistent operation of vehicles) increase the chances of injuries. During adolescence and young adulthood, they may also have more unprotected sex with a greater number of partners than those without ADHD, and are therefore at greater risk for acquired immunodeficiency syndrome (AIDS) and other sexually transmitted infections. It is important that your child be informed as early as the preteen and early teen years about these areas of increased risk. A healthy and proactive stance for a young adult with ADHD includes monitoring his risk-taking behaviors closely. In general, the more fully he understands that his health and safety are his own responsibility, and that monitoring his risktaking behavior will always be an important part of his life, the better prepared he will be to meet these challenges. Switching to long-acting stimulant preparations or making sure symptoms are under control when driving or well into the evening hours may also help with critical decision-making and problem-solving skills affected by uncontrolled ADHD symptoms. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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55 | 2018-04-19 03:04:58 | Healthy Children Radio: ADHD | Healthy Children Radio: ADHD Page Content Article BodyDevelopmental pediatrician Andrew Adesman, MD, FAAP, comes on the Healthy Children radio show to discuss the diagnosis and treatment of ADHD. Segment 1: The Often Devastating Effects of ADHD Segment 2: Helping Your Child Understand Their ADHD Medication Therapy Segment 3: Your Child's Diet: A Cause and a Cure of ADHD? Last Updated 1/23/2016 Source American Academy of Pediatrics (Copyright © 2012) |
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56 | 2018-04-19 03:05:01 | Homeopathic Treatments for ADHD | Homeopathic Treatments for ADHD Page Content Article Body Homeopathy, a therapeutic approach developed in the 1800s that is especially popular in Europe, springs from the concept that illness results from a disorder of “vital energies,” and that these energies must be restored if a patient is to recover. Vital energies can be restored through the use of diluted animal, plant, or mineral extracts designed to treat specific symptoms. These treatments have been shown to be more effective than placebos in reliable scientific studies, though the reason for this is not yet known. Homeopathic treatment for ADHD, increasingly widespread in the United States as individual accounts of success have spread, has been demonstrated effective in one initial study in improving ADHD-type behavior, although the study failed to use a fully double-blind design. Though the mechanisms underlying this treatment are still not scientifically defined, the success of the study merits further investigation of homeopathy as a treatment for ADHD, but it cannot be recommended as a proven therapy at this time. If you do become interested in using this approach, be sure to discuss your plans first with your child’s physician. Some extracts can interact negatively with medications your child may be taking. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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57 | 2018-04-19 03:05:08 | How ADHD Treatments Are Proven Effective | How ADHD Treatments Are Proven Effective Page Content Article BodyYou may have noticed that the media seem to report on a new treatment for ADHD frequently. If so, you may wonder why so many alternative treatments exist for ADHD, and why they so easily gain credibility with the general public. One reason is that, as opposed to such medical conditions as diabetes, the results of a given treatment for ADHD are difficult to measure objectively—that is, there is no blood, urine, or other laboratory test that can prove conclusively that the treatment has worked. Instead, as you will see, the effectiveness of treatments for ADHD are judged through rigorous studies of groups undergoing the treatment compared with those who are not. Because effects of these treatments are determined through relatively subjective methods, such as changes in teachers’ and parents’ observations, and ratings of behaviors over time—not by objective blood, urine, or magnetic resonance imaging studies—it is often more difficult, even with careful statistical analysis, to clearly establish that any proposed standard or alternative treatment for ADHD is wellfounded. If a treatment cannot quickly and objectively be proven effective, it is easier for its proponents to just claim that it works. Thus claims for a particular approach can be greatly exaggerated and widely disseminated long before it has been sufficiently studied. Yet there is a standard, reliable process for deciding whether a new treatment is effective. This process is called the scientific method, and through it investigators can subject any treatment approach to a reliable series of tests or studies to evaluate its effectiveness. There is a great deal written these days about “evidence-based medicine,” which is a set of procedures, resources, and information tools for appraising the strength of the scientific evidence to assist practitioners in applying research findings to the care of individual patients. The medical community now expects treatments strongly recommended for the treatment of ADHD to meet these standards of evidence-based medicine. Studies of treatments for ADHD conducted according to the scientific method make use of research tools, including structured observations, rating scales, and objective tests of the child’s functioning, whenever possible. They are structured so that extraneous factors that might influence results are taken into account and designed so that they can be reproduced by other researchers to make sure similar results are achieved. According to the scientific method and evidence-based medicine, we can only rely on the results of studies relating to a particular treatment if the researchers have Formulated a clear hypothesis. The researcher must state what she wants to determine through the study. For instance, she might state the hypothesis, “Because diet and nutrition are known to affect brain development, a diet fortified with extra vitamins will have a positive effect on ADHD symptoms.” This then will be proved or disproved by a wellconducted study. Created a detailed plan to test the hypothesis. The researcher must then define the nature of the treatment (for example, state which vitamins will be administered, at what dose, and how frequently), how it will be administered (by parents, by a physician, by the children themselves), how it will be monitored (by counting the number of pills left in the bottle at the end of the study), and how the effects will be measured (through a daily dosage checklist, parents’ reports, physicians’ records, teacher observations, etc). In this way, the study results can be systematically explained (perhaps it did not work because the children reported taking the vitamins but did not always do so, for example), and other researchers can confirm the results by using the same methods with different sets of children. Defined the group to be tested. This is an important and sometimes difficult part of creating a reliable study. Can a child be allowed to participate in the study solely on the basis of whether he looks hyperactive to the researchers? Must he have been diagnosed by his pediatrician? Or have the researchers made their own diagnosis according to rigorous research criteria? The group under study must also be large enough for the treatment results to apply to the population as a whole—1, 6, or even 100 children may not be enough, depending on the research question. The group receiving the treatment must be compared with a group not receiving the treatment, and/or another group or groups receiving a different type of treatment for ADHD. The members of the groups under study should otherwise be as similar as possible, and children who might be affected by extraneous influences, such as coexisting disorders, high or low extremes in intelligence, and unusual family circumstances, are sometimes screened out. Depending on the question to be answered, the researcher must limit as many other variables as possible, aside from the treatment under study. Eliminated the power of suggestion. One way to test whether a treatment is effective is to compare the proposed treatment with a placebo treatment. People often tend to respond to placebos—inactive medications or treatments they believe may work— whether or not the treatment is actually effective in the long run. A person with a headache who is given a “sugar pill,” believing it is pain medication, may report that the headache is gone a short time later. In many studies placebos can be shown to be somewhat or very effective. One way to test whether a treatment for ADHD is effective, for example, is to make sure that the subjects do not know whether they are really receiving the proposed treatment or a placebo treatment. In the vitamin treatment example, then, half of the subjects in the study might receive actual megavitamins and the other half would receive an inactive, neutral, but identical-looking pill. Depending on the type of investigation, the study design may work even better if used in a “double-blind” experiment—that is, if the subject, his family, his teacher, and the researcher do not know whether the actual pill or a placebo was used in a particular patient until the study has ended. That way there is no danger that the researcher has inadvertently communicated this information to the subject, his family, or teacher, or that he misinterpreted the results because of what he knew. Of course, if the treatment has specific effects, such as an unusual taste difficult to mimic in the placebo, it may be impossible to keep everyone in the dark about which person got the experimental treatment. Placebo treatments are more difficult to create when the treatment involves a procedure, such as psychotherapy, rather than a pill. Still, researchers must make every effort to make the real treatment and the placebo treatment equally convincing to the subject. Having independent evaluators who are unaware of the treatment being used, called blinded, to whether the treatment is the megavitamin or the placebo preparation improves the accuracy of the study. Provided a valid means of evaluating the results. Some treatment results are easier to evaluate than others. As you’ve already read, in the case of ADHD, results can be difficult to judge because they cannot be measured through precise laboratory tests or other fully objective measures. Still, researchers can standardize test results through such techniques as quantifying behaviors (having teachers report how many times per day a child interrupted a conversation, got out of his seat without permission, or failed to hear someone talking to him), using standard rating scales, comparing the study subjects’ performance to that of the other groups in the study who received different treatments, and measuring changes in the behaviors being studied at predetermined intervals throughout the course of the investigation. Treatments can be evaluated by standardized tests (such as performance on standardized math tests), as well as in terms of the child’s performance in the real world (measures of classroom behavior or improvements in family relationships). Rigorous statistical techniques are then used to find any significant differences in results among the groups in the study. The methods and results of any study are then reviewed by other experts in the field. This process, called peer review, is required before the study is published in a reputable scientific journal. If a treatment proves successful, it is also helpful to follow up with the children on the treatment for longer than the period that was studied to make sure that the beneficial results continue and do not cause any serious long-term side effects. Which Treatments Have Been Shown to Work? The treatments for ADHD supported by the strongest evidence are stimulant medications and behavior therapy techniques, often used together. These forms of treatment have been the most studied and validated by the types of rigorous scientific research described previously. For this reason, pediatricians can feel secure in recommending these approaches as proven, safe, and effective, evidence-based, first-line treatments for ADHD. Many other forms of treatment for ADHD have been tested in studies using the scientific method. Some, such as traditional psychotherapy and cognitive therapy, have been shown through convincing research not to demonstrate positive results in treating the condition’s core symptoms. Another group of potential treatments for ADHD has been tested to some extent, but the studies have been too few in number or were conducted with some flaws in study designs, or the results were too ambiguous to prove that the treatment works. Evidence of a treatment’s effectiveness may be insufficient if the Studies involve too few subjects, so that results cannot be generalized to the ADHD population at large “Proof” relies on anecdotal evidence, such as parents’ testimonies or one physician’s experience with his own patients, rather than on a large group that has been part of a well-designed scientific study Study results have not been subjected to the scrutiny of experts who would have reviewed the study prior to publication to identify any possible flaws in the study design or the results Last Updated 1/1/2004 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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58 | 2018-04-19 03:05:14 | How Schools Can Help Children with ADHD | How Schools Can Help Children with ADHD Page ContentYour child's school is a key partner in providing effective behavior therapy for your child. In fact, these principles work well in the classroom for most students. Classroom management techniques may include: Keeping a set routine and schedule for activitiesUsing a system of clear rewards and consequences, such as a point system or token economy Sending daily or weekly report cards or behavior charts to parents to inform them about the child's progressSeating the child near the teacherUsing small groups for activitiesEncouraging students to pause a moment before answering questionsKeeping assignments short or breaking them into sectionsClose supervision with frequent, positive cues to stay on taskChanges to where and how tests are given so students can succeed (e.g., allowing students to take tests in a less distracting environment or allowing more time to complete tests)Federal laws to help children with ADHD:Your child's school should work with you and your pediatrician to develop strategies to assist your child in the classroom. When a child has ADHD that is severe enough to interfere with her ability to learn, 2 federal laws offer help. These laws require public schools to cover costs of evaluating the educational needs of the affected child and providing the needed services. The Individuals with Disabilities Education Act, Part B (IDEA) requires public schools to cover costs of evaluating the educational needs of the affected child and providing the needed special education services if your child qualifies because her learning is impaired by her ADHD.Section 504 of the Rehabilitation Act of 1973 does not have strict qualification criteria but is limited to changes in the classroom, modifications in homework assignments, and taking tests in a less distracting environment or allowing more time to complete tests.If your child has ADHD and a coexisting condition, she may need additional special services such as a classroom aide, private tutoring, special classroom settings, or, in rare cases, a special school. It is important to remember that once ADHD is diagnosed and treated, children with it are more likely to achieve their goals in school. Additional Information on HealthyChildren.org:Treatment & Target Outcomes for Children with ADHDBehavior Therapy for Children with ADHDCommon Coexisting Conditions in Children with ADHDCommon ADHD Medications & Treatments for ChildrenAdditional Resources:The following is a list of support groups and additional resources for further information about ADHD. Check with your pediatrician for resources in your community. National Resource Center on AD/HD Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) or 800/233-4050Attention Deficit Disorder Association or 856/439-9099Center for Parent Information and Resources National Institute of Mental Health or 866/615-6464Tourette Association of America or 888/4-TOURET (486-8738) Article Body Last Updated 1/10/2017 Source Understanding ADHD: Information for Parents About Attention-Deficit/Hyperactivity Disorder (Copyright © 2007 American Academy of Pediatrics, Updated 6/2016) |
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59 | 2018-04-19 03:05:19 | Integrating ADHD Management Into Your Family Life | Integrating ADHD Management Into Your Family Life Page Content Article BodySuccessfully managing ADHD takes a great deal of time and effort on your part as well as your child’s. If you, your partner, or any of your other children also have ADHD (not unlikely because the condition can run in families), the amount of time and effort spent is further compounded. Family members without ADHD may resent the time and attention that they feel are taken from them to meet the needs and address the issues of those who have it. It is no surprise, then, that the pressure to satisfy everyone’s demands sometimes becomes overwhelming. One way around this is to formally schedule regular personal time with each child and with your spouse as well. These periods do not have to be lengthy—half an hour at a time may do—but they should be frequent and as predictable (daily, for example) as possible, and you should make sure they actually happen. When you are spending time with one of your children or your spouse, make it a policy not to bring up divisive issues. Try to keep your time positive and focused on the present relationship so that both of you will have more emotional energy for the rest of the family later on. If you are the parent taking most of the responsibility for dealing with issues related to ADHD, it is also a good idea to try to delegate other daily chores as much as possible. Allow your partner, older children, or other relatives to take over duties that free up your time and, when possible, take advantage of time-saving services such as online banking, drive through services, and so on. Every minute you save from these errands is a valuable minute you can give to your child with ADHD, other family members and, just as important, yourself. Partnering in Your Child’s Care Management Becoming your child’s care manager means serving as the vital link connecting all aspects of his treatment plan at home, at school, and in the community. This requires a great deal of thought, organization, and support, and can make an enormous contribution to your child’s progress and your family’s welfare. Organization needs to extend beyond some of the aspects already discussed, such as calendars and time management. For example, a child with ADHD accumulates a lot of records—from teachers, physicians, mental health professionals, medical insurance companies, and so on. Keep these papers neatly filed and available when you need them. By organizing reports and treatment decisions chronologically, you can create an excellent database for future discussions with treatment providers and school personnel about how your child is progressing. Always keep a pen and pad of paper or your handheld device available as well to record any information you feel might be useful at the next treatment review meeting with your child’s pediatrician. Because concrete, quantitative information is so valuable in evaluating his progress, you will want specific notes on your child’s behavior rather than general, half-remembered impressions. Once you have instituted these organizing principles, you will likely find that you have more complete records than any of your child’s physicians, psychologists, or teachers, and that you have indeed become the true care manager. Whenever possible, partner with the care manager in your medical home. In caring for your child with ADHD, the American Academy of Pediatrics recommends creating a “medical home." This term and concept is gaining increasing attention among pediatricians and parents. Despite the name, a medical home is not a building, nor is it a house. Instead, it is an approach to providing your child with high-quality, comprehensive care. It is an ongoing partnership between your family and your pediatrician and other members of your treatment team, and is based on the needs of the whole child and his family. It is defined as care that is coordinated, accessible, continuous, comprehensive, family-centered, compassionate, and culturally effective. Educating Family Members While you, your child with ADHD, and other adults involved in his care have probably focused a great deal of attention on learning about the nature of his condition, it is important to keep in mind that your other children and relatives are likely to understand much less. They will need your help in learning how to respond to your child’s behavior and to support his efforts to function successfully. If family members seem to resent or blame your child for his actions, take the time to talk privately with them about the challenges he faces. Discuss treatment decisions with everyone in your family, explaining the reasons for your choices. If you are implementing behavior therapy techniques in your home, other family caregivers will need to learn to implement them as well. (Fortunately, all the tools and techniques you will learn through parent training apply equally well to other children in the family and can be equally helpful.) Teach other family members to frame ADHD-related challenges positively and to work with your child to solve problems. You might ask them to write down any issues they have (such as, “Frances interrupts me all the time!”) and then think about how to rephrase them in ways that will help solve the problem (“I need for Frances to wait until I’m finished talking before she talks.”). Once this is done, family members can discuss possible solutions, try one out and evaluate it, and move on to another solution if that one does not work. Sometimes family members refuse to cooperate, express chronic resentment, or seem unable to act in positive ways. These are common issues; you might consider locating an ADHD support group in your area and/or seeking family therapy to help everyone adjust. In the meantime, let your child communicate directly to his other family members whenever possible instead of always “defending him” yourself. Such conversations can be quite effective in smoothing relationships and helping your child become a respected part of the family. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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60 | 2018-04-19 03:05:22 | Learning, Motor Skills, and Communication Disorders | Learning, Motor Skills, and Communication Disorders Page Content Article BodyLearning Disorders Reading Disorders Reading disorders, the most common and best studied of the learning disabilities, account for 80% of all children diagnosed as learning disabled. Children with reading disorders are able to visualize letters and words but have difficulty recognizing that letters and combinations of letters represent different sounds. Most reading disorders involve difficulties with recognizing single words rather than with reading comprehension. The cause often lies in the area of the child’s “phonologic awareness”—difficulty perceiving how sounds make up words. Reading disorders—even including letter reversals—have little to do with vision. These problems make it quite difficult for children to add new words to their reading repertoire and become good readers. While their listening and speaking skills may be adequate, they may have trouble naming objects (such as quickly coming up with the word for “computer” or “backpack”) and/or remembering verbal sequences (such as “The boy saw the man who was driving the red car.”). A smaller group of children also have reading disabilities that involve comprehension, and these children tend to have poor receptive language skills—that is, difficulty understanding language even when it is spoken to them. A reading disorder, depending on how it is defined, is not necessarily a lifelong condition, but these problems do persist into adulthood in at least 40% of children. Like all other learning disabilities, reading disorders cannot be detected through neurologic tests, such as special examinations, electroencephalograms (EEGs: brain wave tests), or brain scans like computed tomography and magnetic resonance imaging. They are identified when a child’s reading level or language achievement scores are significantly lower than those of his classmates. In assessing reading disabilities, it is important to identify each component of your child’s problem so that specific treatment measures can be applied. It is also important to address the attentional and behavioral aspects of the ADHD so that your child can make optimal progress at school. Mathematics Disorder Mathematics disorder can be thought of as a type of learning disability in which spoken language is not affected, but computational math is. Children with mathematics disorder also may have difficulties with motor and spatial, organizational, and social skills. Children with coexisting ADHD, or even ADHD alone, can have additional problems in math—such as delays in committing math facts to memory, the making of careless math errors, rushing through problems and impulsively putting down the wrong answers or not showing their work, and making errors because they misaligned columns during addition or long division. Although math disabilities are about as common as reading disabilities, they are not well studied. It is not known whether math skills stem from the innate abilities of children to understand the concepts of magnitude or quantities and compare numbers, or whether they arise in brain areas that are responsible for language, visual-spatial, or attention and memory systems. It is generally agreed that children with mathematics disability have a deficit in recalling math facts. Accurate and fluent recall of single digit math facts is felt to be important in freeing up higher brain areas for learning and applying more complex tasks. Children with both reading and math disabilities struggle particularly with word problem-solving. Written Expression Disorder Children with written expression disorder can have difficulty composing sentences and paragraphs; organizing paragraphs; using correct grammar, punctuation, and spelling in their written work; and writing legibly. Children with spoken-language problems can develop problems with written language as well as math. Children with ADHD can also have difficulty with taking the mental time to plan their writing, and their handwriting can be immature and sometimes unreadable without necessarily having a written expression disorder. When handwriting problems are more a function of ADHD than a written expression or motor skills disorder, they sometimes improve rapidly and dramatically with appropriate stimulant medication treatment. Nonverbal Learning Disability Nonverbal learning disability is a condition that is not yet formally categorized as a disorder but that has been the subject of increasing interest. It is particularly important to consider in children with ADHD because it relates to attentional functioning. It is often difficult to decide whether a child with ADHD has a coexisting NLD or whether he just has an NLD that mimics ADHD—especially the inattentive symptoms. Nonverbal learning disability accounts for about 5% to 10% of children with learning disabilities. It consists of a cluster of deficits, including poor visuospatial skills, problems with social skills, and impaired math ability. Problems with disorganization, inconsistent school performance, and social problems may lead to an evaluation for ADHD. In some cases this makes children with NLD difficult to differentiate from children with Asperger disorder. General functioning in children with NLD younger than 4 years can be relatively typical or only involve mild deficits. Following this period, children can develop disruptive behavior and may develop hyperactivity and inattention. They are frequently thought of as acting out and hyperactive, and are commonly identified by their teachers as overtalkative, trouble makers, or behavior problems. As they grow older, their high activity level can disappear. By older childhood and early adolescence, problems can tend to be more internal, characterized by withdrawal, anxiety, depression, unusual behaviors, and social skills problems. Interactions with other children may become more difficult, and their faces can seem unexpressive. These behaviors can be accompanied by deficits in how they judge social situations, judgment, and interaction skills. Children with NLD are particularly prone to emotional problems over the course of their development, as opposed to children with other learning disabilities. Nonverbal learning disabilities are less prevalent than languagebased learning disorders. Where it is estimated that about 4% to 20% of the general population have identifiable learning disabilities, it is thought that only 1% to 10% of those individuals would be found to have NLD. Children with NLD are often not identified until late elementary school or middle school, when the peer problems increase and academic tasks become more complicated. They frequently develop symptoms of depression and anxiety. Academic Problems As was pointed out earlier in this chapter, children with ADHD frequently experience significant challenges at school and elsewhere that cannot be formally categorized as disabilities or formal disorders. Forty percent of children with ADHD, for example, who do not qualify for a diagnosis of learning disability still experience learning problems that lead to underachievement at school. These learning problems may include Inattention and distractibility Lack of persistence and inconsistent performance A tendency to become easily bored or to rush through or not complete work Impulsive responses and careless errors Difficulty self-correcting mistakes A limited ability to sit still and listen Difficulty with time-limited tasks and test taking Problems with planning, homework flow, and work completion Difficulty taking notes or performing other forms of multitasking Difficulty memorizing facts Difficulty organizing and producing written work Immature and slow handwriting that can also create obstacles in expressive writing Difficulty with reading comprehension Stimulant medications that decrease your child’s ADHD symptoms are likely to help her address many of these problems. Behavior therapy techniques aimed at increasing or decreasing specific behaviors at home and in school can also prove beneficial. Specific behavioral goals, such as improving completion of assignments, can be addressed by understanding your child’s individual strengths and weaknesses and collaborating with school staff in using positive reinforcement, appropriate behavioral techniques, daily report cards, and ongoing monitoring. Motor Skills Disorder Motor skills disorder, also known as developmental coordination disorder, is diagnosed when motor skills problems significantly interfere with academic achievement or activities of daily living. It is frequently overlooked in children with ADHD due to its nonspecific cluster of symptoms—yet it can affect children’s lives by interfering with writing and other academic activities or preventing children from participating at their classmates’ level in sports and play. Children with ADHD and other learning disabilities frequently have motor skills disorder as well. Motor skills disorder involves a developmental delay of movement and posture that leaves children with coordination substantially below that of others of their age and intelligence level. These children seem so clumsy and awkward they are rarely picked for teams at school. As the years pass, they tend to fall further behind in terms of motor skills, and their confidence diminishes as a result. By adolescence, most children with motor skills disorder not only perform poorly in physical education classes, but may also have a poor physical self-image and perform below expectations academically. Motor skills disorder may be first identified when a preschooler or kindergartner is unable to perform age-appropriate skills, such as buttoning buttons and catching a ball, or when an elementary school child struggles with writing or sports activities. A child with motor skills disorder may have difficulty with the mechanics of writing, with planning motor actions, or with memorizing motor patterns. While many young children with ADHD but no motor skills disorder may seem clumsy in their younger years, their awkwardness is related more to inattentiveness or impulsivity than to poor motor control and it is frequently outgrown. However, a child with ADHD and coexisting motor skills disorder may not outgrow his clumsiness. If your child is diagnosed with developmental coordination disorder, he may be referred to a pediatric occupational therapist for individualized therapy and, particularly if his deficits negatively affect his academic performance or daily skills, be recommended for special gym activities at school to promote hand-eye coordination and motor development and improve specific skills. Communication Disorders Communication disorders—conditions that interfere with communications with others in everyday life—involve not only the ability to appreciate language sounds (phonologic awareness) but also to acquire, recall, and use vocabulary (semantics) and to deal with word order and appropriately form or comprehend sentences (syntax). Subcategories of these disorders have been identified, including expressive language disorder, mixed receptive-expressive disorder, phonologic disorder, articulation (word pronunciation) disorder, and stuttering. Because there is such a close association between communication and social relationships, these language deficits are often accompanied by social skills difficulties. Children with ADHD without a language disorder may also have difficulties in using language, particularly in social situations. You may notice that your child has problems with excessive talking, frequent interruption, not listening to what is said, blurting out answers before questions are finished, and having disorganized conversations. Last Updated 11/21/2015 Source ADHD: What Every Parent Needs to Know (Copyright © 2011 American Academy of Pediatrics) |
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