What is ADHD? What do children with ADHD typically exhibit?
Dr. Xiaoyan Ke: ADHD is actually a neurodevelopmental disorder that causes hyperactivity (or impulsivity) and attention deficit in children.
In daily life, on the one hand, parents and teachers will find that children with ADHD have attention deficits, such as children are always careless, lose things, have a bad memory or are distracted in class, inattentive, etc. On the other hand, parents and teachers will also find that these children are always hyperactive and impulsive, such as excessive activity, can not wait patiently, emotional impulsivity, etc.
What are the effects of ADHD on children?
Dr. Xiaoyan Ke: ADHD can lead to some changes in the executive functions of the brain, which can affect all aspects of the child, such as the child’s perception of self, emotional control and behavioral will.
What are the learning problems of children with ADHD?
Dr. Xiaoyan Ke: Children with ADHD also exhibit a variety of problems during the preschool years, but it is not easy for parents to pay attention to them at this time, or it is difficult for parents to distinguish ADHD from naughtiness and good behavior. When children start school, they have a lot of academic tasks, and it is easy to notice that they are not the same as other children in the group. For example, teachers can easily find that these children are distracted in class, and parents can easily find that their children are sloppy when doing homework, always missing questions or even making careless mistakes. Of course, parents usually pay more attention to these problems when they affect their child’s academic performance.
Besides learning, does ADHD also have an impact on the child’s psychology and personality?
Dr. Xiaoyan Ke: ADHD is actually a problem with the executive function of the child’s brain center, which means that it affects the child’s ability to manage his or her emotions, thinking and other aspects. It affects not only academics, but also peer interaction and time management. In life, children with ADHD can cause headaches for parents, such as waking up in the morning as if they are not awake, dawdling or missing things when brushing their teeth and washing their face, and not being able to plan things and get into the swing of things right away. In terms of emotional and behavioral control, children with ADHD may be impatient, unable to wait, procrastinate on homework, and delay going to bed.
Is ADHD also the cause of a child’s poor relationship with his or her peers?
Dr. Xiaoyan Ke: Interpersonal interaction is an interactive process, and some children with ADHD who are impulsive, unable to wait, and unable to notice changes in other people’s interactions are bound to make other children feel uncomfortable or even annoyed.
Does ADHD often occur in conjunction with other disorders? What is the probability of ADHD co-morbidity?
Dr. Xiaoyan Ke: ADHD is a neurodevelopmental defect that, in general, rarely exists alone because it affects not only the executive functions of the brain’s prefrontal lobes, but also other functions of the child’s brain. Therefore, ADHD often co-exists with other developmental problems, such as problems with intellectual development, socialization, learning ability, and motor coordination, which are co-morbidities.
Also, when a child with ADHD carries these developmental imperfections or deficits with him or her, and the child is subjected to chronic stress during interactions with family and school, a number of co-occurring disorders can occur. The most common is oppositional defiance, i.e., disobedience, disobedience to teachers and parents, etc., which can occur in up to 40% of cases; some children also develop tics, which manifest as eye-rolling and involuntary throat sounds, which account for about 11% of cases; some older children, in particular, also develop anxiety disorders, which approach 40% of cases.
Are these co-morbidities caused by ADHD?
Dr. Xiaoyan Ke: There are two cases. In one case, there is a problem with the executive function of the prefrontal lobe of the child’s brain, leading to the co-occurrence of ADHD and other neurodevelopmental problems, such as hyperactive co-occurring learning disabilities, co-occurring motor coordination dyspraxia, co-occurring autism, and mental retardation. Another condition is a co-occurrence that occurs secondary to both neurodevelopmental and life environmental influences during the development of ADHD, as a result of the interaction between the child and the environment.
What are some of the issues parents should be aware of regarding ADHD and its co-occurring disorders in their children?
Dr. Xiaoyan Ke: It is difficult to detect ADHD and its co-occurring disorders in children, and parents or teachers or even doctors cannot understand all aspects of a child’s problems at once. When we get to know a child, it’s like a blind man feeling an elephant, it’s a gradual process. A parent may first notice that the child has learning difficulties, and then go to the hospital, where the doctor determines that the child has an attention deficit, but only after a deeper understanding does the child also have spelling and reading difficulties, as well as a tendency to make small movements, bite nails, and have some anxious behaviors.
Therefore, first, parents need to understand their child’s possible problems comprehensively, not just focus on ADHD, and give feedback to the doctor in a timely manner about conditions other than ADHD, so that the doctor can understand the child comprehensively and develop a corresponding treatment plan.
Second, children often have good and bad results in the process of treatment. When treatment is not working well, parents are usually advised to go back and re-examine their child for co-occurring conditions, and if co-occurring conditions are found they need to further refine the treatment plan.
If the child is cured of ADHD, are all co-morbidities cured as well?
Dr. Ke Xiaoyan: We can’t make a generalization, but it depends on the severity of the co-morbidity. In the treatment process, the most important or preferred treatment goal is usually chosen according to the severity of the disease, depending on the individual child.
Do I need to treat my child’s co-occurring disorder separately during the treatment of ADHD?
Dr. Xiaoyan Ke: A diagnosis of co-occurring disorders indicates that a certain level of severity has been reached. If the co-occurring disorder is having further effects on the child, such as emotional management, interpersonal skills, and learning ability, then targeted treatment is needed. Ideally, both the primary problem and the co-occurring disorder should be treated, but of course, in order of priority.
How do you choose the order of treatment in general?
Dr. Xiaoyan Ke: The order of treatment depends on the severity of the symptoms. For example, if a child with ADHD has co-occurring tic disorder, if the child has very mild tic symptoms, and the problem is mainly attention deficit and hyperactivity, and the impact on school is serious, the attention deficit and hyperactivity should usually be treated first. And the vast majority of children will have their tic symptoms alleviated during the course of treatment for ADHD. However, if this child’s co-occurring tic disorder is a severe form of Tourette’s syndrome that is having a significant impact on the child’s attention span, socialization, and learning, improving the symptoms of the tic is the primary goal of treatment. After the tics are controlled to a certain level, the treatment of the child’s ADHD symptoms will continue.
Besides medication, do I need to supplement with behavioral therapy or home management?
Dr. Xiaoyan Ke: ADHD is a type of neurodevelopmental problem with a long course, and its effects can last from childhood to adolescence, and some may even develop into adult ADHD. Therefore, the treatment of ADHD is a very slow process, and medication needs to be accompanied by psychological and behavioral management.
Overall, ADHD requires comprehensive treatment, which means that non-pharmacological treatments are included in addition to medication. Non-pharmacological treatment usually includes parent education, behavior management, school cooperation, and some physical therapy and attention training, which is a complete treatment plan.
Within this complete treatment program, the treatment approach varies at different stages. Some studies have shown that in the early stages of treatment, i.e., the first year of treatment, about 70% of the effectiveness comes from medication and only 30% from non-medication; however, as treatment continues, by the third year, the effectiveness of treatment may be split 50/50 between medication and non-medication.
Can medications for ADHD be used to treat co-occurring disorders?
Dr. Xiaoyan Ke: Some medications can be used to treat co-occurring disorders, such as tomoxetine, which treats attention deficit and hyperactivity disorders in children, and is also useful for mood management, relief of tic symptoms, and for symptoms related to learning disabilities.
Do certain medications for ADHD interfere with the treatment of other disorders?
Dr. Xiaoyan Ke: Because each medication has its own indications and contraindications, some medications for ADHD can also affect the treatment of other disorders. For example, if a child with ADHD has epilepsy, some ADHD medications may not be combined with anti-epileptic medications. Therefore, the choice of medication should be made on a case-by-case basis.
In addition to ADHD medication, does my child need anti-anxiety or anti-depressant medication?
Dr. Xiaoyan Ke: The treatment of ADHD and its co-morbidities is generally the same. It usually depends on which is the dominant symptom and which is the most severe symptom of the co-morbidity and ADHD, and then choose the primary treatment target. For example, if the anxiety and depression are very severe, the anxiety and depression should be treated first; if the accompanying anxiety and depression are very mild, then attention deficit and hyperactivity disorder are the primary treatment targets, along with mood-improving medications. However, if the child already has symptoms of psychosis, the psychiatric disorder should of course be treated first.
Will the combination of multiple medications affect my child?
Dr. Xiaoyan Ke: Each medication has its own treatment cycle and course of treatment. Although, in principle, it is best to use a single medication for ADHD and its co-morbidities, if the condition requires it, the medication should be combined and the doctor will make a reasonable treatment plan.
Can the symptoms of ADHD and co-occurring disorders be relieved with medication?
Dr. Xiaoyan Ke: Medications are certainly not a panacea. In treating ADHD, more than 80% of children with ADHD will be treated effectively if the right medication is used and the right method of administration is used. The reason it is not 100% effective is because there are individual differences in how different children respond to medication.
Dr. Xiaoyan Ke’s consultation guide: The team at the Child Mental Health Research Center at Nanjing Brain Hospital has more than a dozen doctors, and there is a child mental health clinic every day from Monday to Sunday. Sunday is a special clinic for ADHD and learning difficulties. My clinic hours are Monday morning and Thursday afternoon. You can make an appointment online or by phone a week in advance, and a small number of numbers are available at the clinic registration window that day, so you can wait in line to register for a consultation.