A Perspective on ADHD
By Raul Silva, M.D.
In this column I would like to share with the readership my own perspectives on what is probably the most common neuropsychiatric condition in our schools today. Attention Deficit Hyperactivity Disorder (ADHD) affects approximately 6 percent of children and can have serious implications on their academic and lifelong potential. ADHD, ADD, or hyperactivity, as the illness is frequently referred to, should not be ignored. There are three primary sets of features that can comprise the clinical picture of ADHD, which include motoric overactivity, impulsivity and lack of attention.
One of the difficulties parents often face is putting off the proper identification of this illness. Many well-intentioned parents hope and wait to see if their child will outgrow these behaviors and often let the ramifications of the condition go unchecked and untreated. The life-long curse of ADHD is that frequently the motor hyperactivity decreases in adolescence and adulthood, but the inattentive and impulsive components persist. The decision of how to proceed is complicated by the fact that most children with ADHD also have other psychiatric conditions that require treatment. Treatment often consists of cognitive behavioral approaches and medications.
Nowadays there are many different medications that are used to improve concentration and reduce the hyperactivity, including the traditional stimulants (methylphenidates and amphetamine based agents) and newer agents such as atomoxetine, clonidine and guanfacine. The stimulants have been used to treat the symptoms of this illness for over 50 years. Many parents worry about the agents’ potential for abuse and opening the door to future substance abuse. A number of recent studies have looked at this very issue and have not confirmed an association. The one group of disorders that often coexist with ADHD and which should not be ignored are the learning disorders. This group of disorders requires specific testing and alternate learning strategies, the medications used to treat ADHD will not in and of themselves overcome the academic struggles of those who have learning disorders. #
Dr. Raul Silva is the Vice-Chair and Assoc. Prof., Dept. of Child and Adolescent Psychiatry, NYU Child Study Center and Exec. Dir., Rockland Children’s Psychiatric Center.
