“ADHD stands for attention deficit hyperactivity disorder. It’s a chronic disorder usually diagnosed in childhood that affects a multitude of aspects of daily living — behavioral, emotional, social, and academic functioning,” explains Dr. Ritchie.
Dr. Ritchie says that ADD — attention deficit disorder — is an outdated term. “It used to be that they separated the diagnoses based on what symptoms you had. But nowadays, they call everything ADHD, and then after that, they’ll use a subtype classification.”
According to Dr. Ritchie, ADHD is one of the most common disorders of childhood, and around 8–11 percent of school-age children have it: “So it’s pretty high. And it’s more common in boys than girls, as far as diagnosis goes.”
Dr. Ritchie says that there are three different things that are considered when making a diagnosis: inattention, hyperactivity, and impulsivity.
Signs of inattention include daydreaming or approaching daily activities sluggishly; not paying attention to details and a hard time maintaining attention; losing objects easily; and being easily distracted.
“As far as hyperactivity and impulsivity, a lot of times in kids they go hand in hand. What will happen is you’ll get reports from teachers or even notice yourself a lot of fidgetiness or excessive fidgeting. They can’t stay seated for very long. A lot of times they just look and act restless all the time. They have a hard time playing quietly,” Dr. Ritchie explains.
Excessive talking can be a sign too, which can look like blurting out answers really quickly and frequently interrupting others. Those are signs of hyperactivity and impulsivity.
“We can’t pinpoint exactly what causes the disorder. But it’s generally thought to be a combination of genetic and environmental factors, with genetic factors playing a more predominant role. A lot of times you’ll get a history of a parent with ADHD, and that can clue you into the diagnosis as well,” Dr. Ritchie says.
According to Dr. Ritchie, ADHD diagnosis is a combination of a history and an interview with the parent and the patient. And included in that history is how the functioning is at home and in school.
Dr. Ritchie says there are some questionnaires and computer-based models that are used for diagnosis.
But in general, children have to have six symptoms of hyperactivity and/or impulsivity or they have to have six symptoms of inattention. And they have to be present both at home and in another environment, usually at school.
There are quite a number of approaches for ADHD, which vary depending on age.
For school age children, the first line therapy is often stimulant therapy — an oral medication that can also be combined with different types of therapies.
There are also different kinds of cognitive-behavioral therapies, other nonstimulant medications, and interventions you can do at school and at home to help with behavior.
The non-drug treatment has three categories, according to Dr. Ritchie.
1. Child-focused treatment is focused on the patient. It includes things like behavior therapy or psychotherapy sessions once or twice a week to help them learn skills so that they can perform better.
Because we have the symptoms of ADHD both at home and in school, the schools participate a lot in helping the child create an environment that’s going to set them up for success.
2. Family therapy or training helps parents understand the ways their child thinks. And they can learn techniques to help foster more positive interactions with their child so that their child feels better supported in their diagnosis.
3. School-based interventions are common because symptoms of ADHD show up at home and at school. Schools participate by helping the child create an environment that’s going to set them up for success. For example, teachers have skills to help manage behavior in the classroom. They can have special resource room support. There are modifications that you can make to the classroom to accommodate the student a little better so that their inattentive symptoms are better addressed, like sitting at the front of the classroom, for example.
There are two types of medication prescribed for ADHD — stimulant and non-stimulant.
Stimulant medications are generally first-line therapy for kids older than the age of six. “If the patient is younger than that, a lot of times we start with behavioral therapy first. But if you’re older than six, first-line treatment will be medication,” Dr. Ritchie says.
There are two main types of stimulants: methylphenidates and amphetamines.
Dr. Ritchie says the brand names of methylphenidates that people probably know the best are Ritalin or Concerta. And the brand name amphetamine that people probably know is Adderall. As far as non-stimulant therapy, there aren’t many drugs in that category.
“Sometimes you can try them by themselves, or you can use them in conjunction with the stimulant to see if that helps with symptoms a little bit better. There are three that are most common — Strattera or atomoxetine, guanfacine, and clonidine. Those are all medications that are commonly used,” says Dr. Ritchie.