Attention-Deficit / Hyperactivity Disorder (ADHD)

From WebMD, the most well-trafficked consumer health information resource

  • Symptoms in children are vague and include “easily distracted,” “loses things,” and “daydreams”

  • Causes of ADHD are stated as not known, however, “several things may lead to it” like “heredity” and “toxins” but not “sugar” or “poor home life”

  • Treatments for ADHD are listed as:

    • Amphetamines are identified as the first of 8 medications… dietary supplements for essential fatty acids (omega 3) are also suggested.

    • Special education is listed as the first of several therapy options with references to resources such as “Bipolar disorder or ADHD” and “Scary Side Effects of ADHD Meds.”

  • Prognosis is as vague as symptoms with the statement that “many people live successful, happy lives.”

The Health Hippo experience

  • A thorough, well-cited listing of symptoms in children, since inattentiveness, impulsivity, and hyperactivity occur to some extent in all children. It is the persistence, pervasiveness, and functional complications of the behavioral symptoms that lead to a diagnosis of ADHD.  6 or more symptoms of hyperactivity and impulsivity or 6 or more symptoms of impulsivity including “occur often” and “impair function in academic, social, or occupational activities.”

  • Diagnosis is fully described since the symptoms of ADHD overlap with over 33 individually described medical conditions, including visual processing, auditory processing, developmental variations such as giftedness or coordination disorders, and sleep problems.  Further, as many as one-third of children with ADHD have an additional related health issue.  A thorough set of testing is necessary to confirm a diagnosis of ADHD and potentially related issues, and the method to get an accurate diagnosis is fully described. 

    • Can an ADHD diagnosis be confirmed if ADHD medications prove beneficial?  No.  Studies have shown that stimulant medications improve behavior in children with ADHD, children with conditions other than ADHD (eg, learning disabilities, depression), and normal control children.  The non-specific improvement in behavior that occurs with stimulant medication can mask other problems and/or delay the use of more appropriate interventions. 

    • Because ADHD is not a reportable disease, prevalence estimates vary widely, ranging from 2 to 18%, and rely on parent-reporting and information derived from medical records, billing or pharmacy records.

  • While the causes of ADHD are not fully understood, genetics appears to be a primary factor based on studies of twins, family-based and case-control studies, and population-based genetic testing.   Various environmental factors may play a secondary role.  Dietary factors, such as food additives, are being investigated along with prenatal medications and conditions (such as alcohol and tobacco smoke) and head trauma in young children.

  • Treatment options are fully resourced and triaged based on supporting evidence of effectiveness, including

    • Behavior therapy

    • Medication (note potential need for cardiac evaluation), for age 6 or above

    • Medication (note potential need for cardiac evaluation), for ages 4 and 5; amphetamines are not recommended

    • Combination therapy

    • School-based interventions including… (provide link to resources)

    • Psychotherapy interventions (if there are other related health issues)

    • Physical activity

    • Mindfulness

    • Dietary diets

      • Elimination diets

      • Essential fatty acid supplementation

    • Trigeminal nerve stimulation

    • Other alternative therapies including vision training, megavitamins, herbal and mineral supplements, neurofeedback / biofeedback, chelation, and applied kinesiology.

  • Prognosis is specifically described, and depends on severity of symptoms at onset, whether other related health issues also exist, intellect, social advantage, and whether the condition responds to treatment.   Issues to be concerned about include a potential higher rate of injury and self-injury, driving issues, academic functioning, and substance abuse.

Other resources To Consider 

  • National Initiative for Children’s Healthcare Quality toolkit.

  • US Agency for Healthcare Research and Quality’s comparative effectiveness review of interventions for preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD).