Attention Deficit Hyperactivity Disorder (ADHD) (cont.)
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Can ADHD be seen in brain scans of children with the disorder?
Neuroimaging research has shown that the brains of children with ADHD differ fairly consistently from those of children without the disorder in that several brain regions and structures tend to be smaller. There is also a lack of expected symmetry between the right and left hemispheres. Overall, brain size is generally 5% smaller in affected children than children without ADHD. While this average difference is observed consistently, it is too small to be useful in making the diagnosis of ADHD in a particular individual. In addition, there appears to be a link between a person's ability to pay continued attention and measures that reflect brain activity. In people with ADHD, the brain areas that control attention appear to be less active, suggesting that a lower level of activity in some parts of the brain may be related to difficulties sustaining attention. It is important to reiterate that these laboratory observations are not yet sufficiently sensitive or specific enough to use to establish or confirm the diagnosis of ADHD or to monitor the effectiveness of treatment.
Can a preschool-aged child be diagnosed with ADHD?
The diagnosis of ADHD in the preschool-aged (under 5 years old) child is possible, but
it can be difficult and should be made cautiously by experts well trained in childhood neurobehavioral disorders. A variety of physical problems, emotional problems, developmental problems (especially language delays), and adjustment problems can sometimes imitate ADHD in this age group. It is certainly not mandatory that the preschool-aged child showing ADHD-suggestive symptoms be placed in a preschool. The first line of therapy for children of this age showing ADHD-like symptoms is not stimulant medication therapy but
rather environmental or behavioral therapy. This type of therapy can certainly be carried out in the home with appropriate training supplied to the parents. If the child is to be placed in a preschool, the caretakers must be equally trained in the techniques of behavioral therapy. Stimulant therapy can reduce oppositional behavior and improve mother-child interaction, but it's usually reserved for severe cases or when a child does not respond to environmental or behavioral interventions.
What is the impact of ADHD on children and their families?
Life can be hard for children with ADHD. They are often in trouble at school, can't finish a game, and have trouble making friends. They may spend agonizing hours each night struggling to keep their mind on their homework, only to forget to bring it to school. Family conflict can increase, placing added stress on exhausted parents and frustrated children. Adolescents are at increased risk for poor self-esteem, motor-vehicle accidents, tobacco and other drug use, early pregnancy, and lower educational attainment. School programs to help children with problems often connected to ADHD (social skills and behavior training) are not available in many schools. In addition, not all children with ADHD qualify for special-education services. To overcome these barriers, parents may want to look for school-based programs that have a team approach involving parents, teachers, school psychologists, other mental-health specialists, and physicians.
Next: What is the role of alternative therapies in ADHD? »
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