With ADHD diagnoses on the rise, MUSC expert explains types and treatments

Parents of children with attention deficit hyperactivity disorder have plenty of stories to share. There’s the third grader who couldn’t stop moving around when his class was on stage for a presentation, distracting the other kids and the audience. The girl who dipped her fingers in a classroom inkpad then left prints all over a classroom column. The kid with no concept of personal space who alienated other children by getting too close to them without realizing it was a problem. The child who seemed to be paying attention in class but really was tuned out.

Those are all challenging ADHD behaviors that Angela LaRosa, M.D., a developmental behavioral specialist at MUSC Children’s Health, said can be eased with the right kind of help. 

 

The demand for that help is growing. The Centers for Disease Control and Prevention recently reported that one in nine children in the United States between the ages of 3 and 17 has received a diagnosis of ADHD. 

LaRosa and other mental health experts point to the pandemic as a possible cause for the increase. There were a couple of things going on there. First, the pandemic was stressful for a lot of people, so they sought help. Some were diagnosed with ADHD along with anxiety and/or depression. And second, the pandemic made ADHD symptoms worse in some cases, making it clear that people needed treatment.

LaRosa also wonders if social media, which can give users quick hits of dopamine, is contributing to the increase in ADHD diagnoses. A report in Psychology Today found a correlation between social media use and ADHD, which means there is a statistical link, but it does not say that one thing causes the other.

Types of ADHD

LaRosa said it’s important to understand the different forms ADHD can take. “There are three types of ADHD. The type that everybody knows is that kind of overactive, hyper-impulsive child who has trouble sitting still, keeps getting out of his seat, runs around. That’s the hyperactive-impulsive presentation.”

There’s also the inattentive presentation. “These children are often not diagnosed until later. They sit still; they don’t cause any trouble. They don’t make any noise. They look at you like maybe they’re paying attention, but inside, they’re internally distracted, and they struggle. They fall behind, and people don’t understand why.”

The combined presentation is just what its name suggests, LaRosa said. “You have both the hyperactive and inattentive characteristics, where you not only have trouble sitting still and not being impulsive, but you also can’t focus.”

Recognizing ADHD

LaRosa said there are several characteristics parents can keep an eye out for when it comes to ADHD. While kids with inattentive ADHD may be harder to spot, children with the hyperactive-impulsive presentation are easier to flag. 

“Young children with ADHD often have more intense temper tantrums. They have a hard time recovering from a temper tantrum. They’re often very overactive, constantly touching everything. They may get in your personal space. That can be a problem socially.”

When behaviors become problematic, LaRosa said, they can have a big effect on children’s lives. “Are you not making friends? Do peers not want to play with you because you’re bossy, always want to do things your way, don’t follow the rules? Are you not able to succeed academically? Are you constantly being corrected or scolded at home?” 

When these answers are yes, it can cause children to have negative views of themselves, leading to impairments socially, academically and with family interaction. 

Treating ADHD

Types of treatment for ADHD include behavioral therapy and medications. When it comes to children under 6, the American Academy of Pediatrics recommends that parents get training in behavior management before trying medication for their children. The academy suggests combining medication with behavioral therapy for children 6 years and older.

In the Developmental-Behavioral Services program at MUSC Children’s Health, when it comes to children with suspected ADHD, pediatricians, psychologists and social workers evaluate children’s medical, social and educational histories. They also talk with teachers, therapists and other health care professionals. They may conduct physical and neurological exams and do tests and observe the children’s behavior. Finally, they make recommendations for the best way to help the child.

Sometimes that includes medication. LaRosa said medications for ADHD get a “bad rap.” “Stimulant medications have been prescribed since the 1960s. They’re probably the most studied medications that we give to children. The stimulant medications may have side effects, such as decreased appetite, moodiness or irritability and weight loss, which are monitored. However, there are a variety of medications available now that usually, we can find a good fit for a child.” 

Sometimes, people assume stimulants are something to be avoided. “Like they’re going to turn you into a zombie. Or if you take this medicine, it’s going to be a crutch, and it’s actually not,” LaRosa said. “Taking medicine allows you to practice attending to a task, starting a task, planning a task.”

Medication doesn’t have to involve a stimulant such as Adderall or Ritalin, LaRosa said. There are non-stimulant medications for ADHD, including clonidine, guanfacine, atomoxetine (Strattera) and viloxazine (Qelbree).

The best treatment outcomes are seen in children treated with medication and behavioral therapies, LaRosa said. “Parent-child behavioral therapy is an evidence-based therapy available for children 2 to 7 years of age. Older children can benefit from specific ADHD behavioral interventions in the school and home and cognitive behavioral therapy.”

Sleep is also a key aspect of ADHD management. “Children with ADHD often do not receive adequate sleep, and this can exacerbate issues with attention and disruptive and overactive behavior. Education on sleep and behavioral strategies to improve sleep is important,” LaRosa said.

ADHD plus other conditions

Treating ADHD sometimes involves recognizing that a child has related conditions as well, LaRosa said. “Children with ADHD are at higher risk for anxiety, depression and disruptive behavior. Sometimes, treating ADHD can help these symptoms, but sometimes additional treatment is needed.” 

The diagnosing and management of ADHD and co-existing conditions can make a big difference in terms of the child’s self-perception and social and classroom success, LaRosa said. 

ADHD’s effects as children grow up

While doctors used to think people outgrew ADHD, they don’t anymore. One study found that 60% of children with ADHD continued to show symptoms as adults. Medications, cognitive behavioral therapy and other behavioral accommodations are often used to treat adults with ADHD, LaRosa said. 

You can find the full CDC report on kids and ADHD in the Journal of Clinical Child & Adolescent Policy here. Access should be free of charge.