ADHD: Get the basics from a Children's Hospital psychologist

What is ADHD and how common is it?

Attention Deficit Hyperactivity Disorder (ADHD) is one of most prevalent psychiatric disorders among children in the United States. It is diagnosed at increasing rates, and according to the CDC, about one in nine children is diagnosed with ADHD in the US. In the United States about 11% of the population has ADHD, and the rates are even higher in Louisiana.

As a neurodevelopmental disorder, symptoms of ADHD impair functioning in multiple settings such as home, school, and social interactions. As the name implies, the primary symptoms of ADHD include deficits in attention, and problems with hyperactivity and impulsivity. Primary concerns from parents and school staff are that a child with ADHD is easily distracted, unable to complete his or her schoolwork and cannot sit still for long periods of time. However, there may be additional impairments with executive functions like problems with working memory, organization, motivation, activation, effort, and emotional regulation. Kids have problems with organizing and prioritizing tasks, processing speed, sustaining focus, and shifting attention to tasks, as well as regulating alertness. There may also be problems managing frustrations or controlling emotions, as well as problems with monitoring and self-regulating actions. Children with untreated ADHD may have disruptive behavior in the classroom, academic failure, under-performance, poor frustration tolerance, and inability to stay on task or complete tasks with a time limit.

How is ADHD diagnosed?

ADHD can be diagnosed by psychologists, psychiatrists, and physicians. There are many other factors to consider when assessing ADHD, including learning disabilities, depression, anxiety, trauma or stress-related issues, sleep deprivation, or other behavior disorders such as Oppositional Defiant Disorder. Children will benefit most from an evaluation where healthcare providers, parents/caregivers, and school staff all work collaboratively. It is important to conduct a comprehensive evaluation and diagnostic interview that addresses medical, developmental, educational, and psychosocial factors to identify the correct diagnosis and the most appropriate treatment.

There may be other factors that lead to problems with inattention or hyperactivity. If a child is undergoing significant psychosocial stressors or adjustments in their life like going to a new school, being bullied, or experiencing significant family problems, inattention and/or behavioral problems can emerge. Additionally, educational problems such as learning disorders or learning deficits can lead to poor focus and/or disruptive behaviors in the classroom setting. Psychological testing can provide assessments of attention and intellectual and academic functioning. School staff helps to provide important diagnostic information through behavioral observations in the school setting and can provide educational testing to help differentiate ADHD from a Learning Disorder.

How do you treat ADHD?

The comprehensive evaluation should lead to a diagnosis and identify the problem which would then point to the most appropriate treatment. For example, if the evaluation identified a Learning Disorder or academic struggles, school staff can assist in providing educational testing and support. Increased tutoring both at school and home may be necessary. The school staff can help set up a behavior management plan for the classroom. Other behavioral strategies at home can involve parent training or positive behavior interventions, such as establishing a routine and appropriate and consistent disciplining strategies that use reward and consequences for target behaviors.

Similarly, if there are any mood related problems or family stressors that contribute to difficulties, our team would refer the child to individual or family psychotherapy. Sleep issues also need to be addressed. Children between the ages of six and 11 need approximately ten hours of uninterrupted sleep each night. If they are not getting enough sleep and are sleep deprived, they will likely have problems with memory, processing of new information, difficulties learning, decreased attention, inconsistent performance, and increased irritability and mood swings. If the child is not getting the amount of sleep that they need, improving the sleep routine is very important.

ADHD is a neurobehavioral disorder, which is why successful treatment approaches may require both behavioral and pharmacological interventions that address the issues. Pharmacological interventions involve medications that increase certain neurotransmitters, such as nor-epinephrine and dopamine, in the prefrontal cortex that affects functions of attention, focus, restlessness and executive functions.

Stimulant medications are the primary and most effective treatments for ADHD. Stimulant medications fall under two major categories: Amphetamine medications such as Adderall, Vyvanse, Dyanavel and Methylphenidate medications such as Focalin, Concerta, and Quillivant. Non-stimulant medications are also used but are not as effective as the stimulant medications. Some examples of non-stimulant medications are alpha agonists medications, Wellbutrin, and Strattera.

Most medications are typically dosed in the mornings and their effects last anywhere from 5 hours to about 10 hours, depending on if it is short-acting or a long-acting medication. In the last 5 years, we have seen the development and introduction of new stimulant medications come into the market. The newer medications typically have a longer duration of action. The parent and the doctor should discuss different medication options to choose what would work best for the child. Medication dosage and changes to the medication regimen should be based on needs and if the ADHD symptoms are causing significant impairment in the child’s functioning. It is important for the parents to collaborate with the treating doctor because these medications can also carry side effects. Feedback from parents and school staff is useful to determine if the medication is effective.

Medical Psychology Clinic

At Children’s Hospital New Orleans, our team of medical psychologists have specialized training and expertise in diagnosing and treating ADHD in addition to other behavioral and emotional disturbances including Anxiety, Depression, and ODD. Our medical psychology team collaborates with and receives referrals from local pediatricians or other providers. In our Medical Psychology Clinic, psychological evaluations are conducted to assist with diagnostic clarification and recommendations for treatment. Interventions may include psychoeducation about sleep hygiene and academic issues, consultation with school staff and other treatment team members, individual and/or family psychotherapy, behavior management, and medication management. If psychopharmacological treatment is appropriate, the medical psychologist will prescribe medication and monitor for response to treatment. Once the symptoms have improved and the child’s functioning is stabilized, the treatment is transferred to the pediatrician who provides long-term care.

If you feel that your child can benefit from an appointment at the Children’s Hospital Medical Psychology Clinic, call 504.896.7272 or.

Mayling Walker, PhD
Dr. Mayling Walker is a medical psychologist at Children’s Hospital New Orleans. She earned her doctoral degree in psychology and a master’s in clinical Psychopharmacology at Alliant International University in Queens, New York. With more than 15 years of experience, Dr. Walker helps children function up to their greatest potential, valuing patient relationships as the foundation of any successful intervention. Her little something extra is that she is bilingual in English and Spanish, giving her the skills to help both English-speaking and Spanish-speaking families.