ATTENTION DEFICIT DISORDER: After the Diagnosis

Article excerpt

Once the diagnosis of attention deficit disorder, also called attention deficit-hyperactivity disorder (ADHD), has been made, there are several considerations.

What does the diagnosis mean to the family and child? What are the options for treatment? How are decisions made about school, psychosocial interventions, and medication? What types of therapy are most helpful? What are the medication options?

ADHD is a complex disorder. It has an impact on the child at home, at school, and in the community. When a child is diagnosed with this condition, parents are faced with myriad treatment options for him or her. Medications are clearly one important aspect of a multimodal treatment plan. Both child and parents must learn about the disorder and the potential role of medication in the child's daily life.

Developing a partnership in care that includes parents, extended family, physicians, therapists, and the child is important for helping him or her reach his or her potential. It is essential that parents and the child actively participate in all aspects of treatment, including decisions about; the use of medication.

First reactions

Just as the constellation of symptoms that leads to a diagnosis of ADHD is unique to each individual, so is the response to it. To some families, a diagnosis may be helpful because they suspected something was impairing their child's ability to function at home and at school. There may be a sense of relief that the evaluation determined there are no learning disabilities, such as problems acquiring math or language skills. The evaluation may clarify that there is no sign of other psychiatric disorders such as depression or anxiety. Understanding the strong biological basis of diagnosis of ADHD may help parents who feel they are to blame for their child's difficulties.

However, others may not welcome the diagnosis. Some may feel, at least initially, that it implies they have done something wrong. Similarly, the information that there is a hereditary, component to ADHD may lead to guilt or angry feelings in and between parents. For many, there is a wish to "find" the reason for ADHD. Rarely, it can be correlated with medical issues such as abnormal thyroid function or use of medications for asthma. In most cases, there is no clear etiology for ADHD.

Although children with ADHD know that their functioning at school and home has been difficult, hearing a diagnosis can be quite disturbing. Younger children may not fully understand and feel they are being punished or that their parents are trying to put blame on them. They may see the interactions with the physician as a time when they are "told on."

For older children and adolescents, for whom peer relationships are more important, the feeling of being different can be devastating. These feelings may be compounded as families begin to choose treatments such as special educational placements, therapy, or mediations.

Comorbidity

One important aspect of the evaluation for ADHD is the process of excluding other psychological and educational disorders. Almost half of all children with ADHD have other problems. For example, learning disorders and tic disorders are common for children with ADHD. Likewise, conditions such as anxiety disorders and mood disorders can either coexist or mimic the symptoms of ADHD. Other psychiatric diagnoses with "disturbance of conduct" are known to occur with ADHD, such as "oppositional/defiant disorder"--a disorder in which oppositional behaviors interfere with daily life at the extreme--and "conduct disorder." Children with conduct disorder have severe problems that include aggression toward other individuals, vandalism, and stealing.

When other conditions coexist, or are comorbid with ADHD, the treatment strategies may differ than those for ADHD alone. Therapeutic, academic, and medication options are tailored to the needs of both the child and his or her family. …