How is ADHD diagnosed?
ADHD is a neurodevelopmental disorder, which is defined as being distracted, difficulty in maintaining one’s attention, being hyperactive, fidgety, talking a lot, being impatient, and having problems in school, family and friend relationships due to these symptoms. In order to understand whether this disorder is present in a child, a psychiatric evaluation is made with the child and family. If necessary, information is obtained about the presence of symptoms in the school environment or whether they cause a problem. While obtaining this information, scales questioning some ADHD symptoms are used. The diagnosis of ADHD is made by this clinical evaluation. The information that the diagnosis is made with tests written in the media or social internet environments does not reflect the truth. In other words, the diagnosis is made by psychiatric evaluation with the family and the child. In this interview, detailed information about the symptoms is obtained and their effects on the child’s life are investigated.
Laboratory and imaging methods used in the diagnosis of ADHD are not used. Again, intelligence tests are not used for diagnosis unless there is an additional psychiatric problem related to ADHD. In case of additional problems, when differential diagnosis is required, intelligence and attention tests may be ordered to aid diagnosis. Approaches to diagnose ADHD with attention tests, which are applied by those who are not child psychiatrists, and to diagnose with these tests and treat them without clinical evaluation, are not correct. In this context, if families are worried about their child having ADHD, applying to a child psychiatrist will prevent wrong approaches and therefore delay in treatment.
What is done after application and diagnosis? To what extent do patients and families benefit from treatment?
ADHD is a disorder with a clear diagnosis and treatment. After diagnosis, treatment begins. When these children do not receive treatment on time, as I said above, they begin to have problems in school success. The child, who is active at first, cannot sit still, is distracted, and has problems in class success, gradually increases his problem with academic skills. Although mobility decreases in some children over time, problems in school success are accompanied by reluctance towards school, self-confidence problems, and sometimes behavioral problems along with depressive complaints. These children are both labeled at school and underperform at school. Sometimes they can be unwanted, expelled children from school. In cases that reach this point, treatment should be started quickly and support should be provided for the child’s adaptation to school and success. When treatment is started in cases with early symptoms, the above-mentioned problems related to school success, adjustment and relationships are intervened before they occur. When treatment is started, the majority of children show improvement. If the symptoms continue to decrease in a very small group, they are tried to be improved with additional treatment options.
Children with ADHD, such as those who have problems in school success due to distraction, improve their attention after treatment, and therefore their school success also improves. Again, those who have behavioral problems in school, friends and family relationships due to ADHD symptoms also improve, and they become more adaptable children with fewer or no relationship problems. Especially in the early period, school problems have increased a lot, and children who want to be expelled from school are tried to continue school with treatment and support, and then their school success becomes better. In my professional life, I have had many patients who were expelled from school, whom I helped return to school and who were able to continue their education life. Again, due to ADHD, I have had many patients whose school skills and relationships improved. Children who beat and injured their friends at school because of these symptoms left these behavioral problems and became more adaptable children. For this reason, I have had patients whose depressive symptoms improved with the improvement of their problems with school and relationships with the treatment of ADHD who showed depressive symptoms.
Families, in the face of their children’s difficulties in daily life due to ADHD, see that these symptoms do not improve by talking or punishing, and they feel helpless. They are relieved when they learn that the symptoms that occur in their children are due to the child’s structural characteristics, ADHD, and that this situation can be improved with treatment. When they grasp the characteristics of their children along with their reasons, they develop more accurate approaches and solutions for their children.
Is drug use necessary in treatment?
The most important cause of ADHD is genetic transmission from parents and the effect of environmental factors. In this disorder, structural and functional differences in the brain areas related to attention, impulsivity and mobility have been revealed. Therefore, ADHD is a neurobiological disorder. The drugs we use in the treatment aim to normalize this attention by rearranging these differences in the systems that regulate our mobility and impulsivity. That’s why we use curative drugs, and indeed these drugs correct the symptoms associated with hyperactivity, attention, and impulsivity.
There are special camps for such children in the USA. What kind of activities are carried out in Turkey?
I do not know if there are special camps for ADHD in Turkey. Although sports or activities are seen as areas where the hyperactive child can release his energy, it is also very important in terms of being in the social group, learning the rules of this social group, being able to control himself, taking responsibility, developing social skills, self-confidence, receiving positive feedback and being accepted. Children who are very active and have difficulties in adapting within the group should be directed to individual sports or activities. However, children with ADHD who do not receive treatment can get bored with these activities quickly because they get bored with everything. For this reason, it is important to start treatment especially for children who do not receive treatment in terms of continuing these activities.
What can be recommended to the families of children diagnosed with ADHD for the summer vacation?
Families often tend not to use drugs during their summer vacation. This is wrong. If physicians deem it necessary during treatment, they may discontinue the medication in the summer and want to look at the ADHD picture. Families should not stop taking their medications except on the recommendation of a physician. Again, these children are children who have problems in daily life and relationships due to ADHD symptoms. In other words, they have problems while eating at home, playing games, going somewhere and passing time. However, in summer, these children need to have a good and trouble-free time with their families and peers, and be able to continue some activities like playing games. Again, it is children who are at high risk of accidents. Fall fractures are more common in these children. In this respect, it seems important to continue the treatment in children at risk. Along with the treatment, suitable holiday or activity options should be offered to children who are active and energetic. Summer vacation or daily programs can be made according to the child’s approval and interest. This was mentioned above. It should be taken into account that pre-school children get bored quickly, while choosing games, new and different games can be chosen that can attract their attention. In group games, they may need the supervision of adults when playing with their peers when they get bored quickly, do not follow the rules and cause problems.
What is recommended for families who insist on not taking medication?
Sometimes, families are surprised when they are told that they really need to start medication, and they may not want to start. Because according to them, starting medication for a very active child who has no organic cause is not something they expect or bring to mind. The most important way to solve this problem is for families to talk to their doctors about all their questions and concerns. The most important pillar of child psychiatry interviews is the section where we inform families about the disease we call “psychoeducation”. Physicians inform their patients about the child’s condition, diagnosis, treatment options, what they will face if there is no treatment, and what the course of the disease will be if treatment is given. When this information is done well, most of the families’ worries disappear and they decide to start treatment in a comfortable way. If families who receive and understand the information correctly still insist on not starting medication, they are followed up with the physician for a while without medication, and in the meantime, the family’s approach and the child’s progress are checked. However, some families may search for non-drug treatment options on the Internet or seek other appropriate treatment options based on hearsay advice. These options are a waste of time. It results in the child and family contacting us again when the problem grows. Meanwhile, the child suffers many losses and additional problems arise.
Do the drugs used have an addictive effect?
There are two groups of drugs that we use in Turkey for treatment. One of them is with a red prescription and the other is not with a red prescription. So we also have red over-the-counter drugs on hand. One of these is the drug called methylphenidate, which is sold with a red prescription. This drug, like other addictive substances, is a drug that has the potential to be addictive when used outside of the doctor’s control. However, when used under the supervision of a physician in patients with ADHD, it does not cause addiction when used as recommended by the physician. On the contrary, the untreated group of children with ADHD and conduct disorder is at risk of becoming addicted to other substances. But when this group was treated with methylphenidate, they significantly reduced the risk of future substance abuse. In fact, considering this information, we can say that ADHD treatment protects children from substance abuse. The other drug is atomoxetine. The efficacy of both drug groups is similar. The therapeutic efficacy of both drugs is very high. So this means that most of these kids get better when we start one of the two drugs.
What are the side effects of these drugs?
Both drugs mentioned above regulate the amount of chemicals in the brain that cause ADHD symptoms. These substances need to be regulated in order for the brain regions that regulate behavior related to attention, mobility and impulsivity to function normally (for these symptoms to be at a normal level) in children with ADHD. Methylphenidate and atomoxetine used in ADHD are quite safe compared to many drugs used in medicine and have less side effects. Methylphenidate is a drug with short (two to three doses per day) and long-acting (one daily dose in the morning) forms. The most common side effects of methylphenidate are headache, abdominal pain, loss of appetite, weight loss, and insomnia. More rarely, side effects such as palpitations, withdrawal, nervousness, tics, and increased mobility may occur. Atomoxetine is taken once a day. It is effective for twenty-four hours. The most common side effects of atomoxetine are nausea, abdominal pain, dry mouth, irritability, weakness, fatigue, and loss of appetite. Side effects seen during the use of both drugs often subside within a week or two. The dose is reduced in case of persistent and severe side effects that disrupt the child’s daily life. Families should inform their doctor when side effects occur. Doctors will take the necessary measures to reduce the resulting side effects.
Assoc. Dr. Seher Akbaş
