Mistake #2: Not everything that is hyper is ADHD.
There is a saying in Pediatrics that all that wheezes is not asthma. Similarly, not all hyperactivity, impulsivity, or inattention is ADHD.
Several disorders have behavioral phenotypes with findings similar to ADHD:
· Extreme prematurity
· Fetal alcohol syndrome
· Spina bifida
· Genetic syndromes
· 22Q11 deletions (velocardiofacial (VCF) syndrome, DiGeorge syndrome)
Other conditions need to be considered when children present with symptoms of ADHD. Other medical conditions can cause similar symptoms, including:
· Learning disorders
· Speech disorders
· Brain injury
· Mood disorders, including depression and anxiety
· Other psychiatric or neurodevelopmental disorders
· Seizure disorders
· Sleep problems
· Thyroid problems
· Vision or hearing problems
Mistake #3: Dosing problems.
The pediatrician is faced with a number of issues in following patients with ADHD once they have been placed on medication. One common response from parents is “my child’s body got adjusted to it.”
The Multimodal Treatment of Attention-Deficit/Hyperactivity Disorder (MTA) study may provide some insight into this challenge.
The study included nearly 600 7-year-old to 9-year old children randomized to 1 of 4 treatment modes over a 14-month period:6
· Intensive medication management alone.
· Intensive behavioral treatment alone.
· Combination therapy.
· Routine community care (the control group).
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3. Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder (ADHD). Data and statistics about ADHD. Available at: https://www.cdc.gov/ncbddd/adhd/data.html, Accessed July 17, 2019.
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6. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56(12):1073-1086.
7. Centers for Disease Control and Prevention (CDC). Children’s mental health. Data and statistics on children’s mental health. Available at: https://www.cdc.gov/childrensmentalhealth/data.html. Accessed July 17, 2019.
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11. Yoshimasu K, Barbaresi WJ, Colligan RC, et al. Written-language disorder among children with and without ADHD in a population-based birth cohort. Pediatrics. 2011;128(3):e605-e612.
12. Stein RE, Horwitz SM, Storfer-Isser A, Heneghan A, Olson L, Hoagwood KE. Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Ambul Pediatr. 2008;8(1):11-17.
13. Stein RE, Storfer-Isser A, Kerker BD, et al. Beyond ADHD: how well are we doing? Acad Pediatr. 2016;16(2):115-121.
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15. Wilens TE, Adler LA, Adams J, et al. Misuse and diversion of stimulants pre-scribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(1):21-31.
16. Pham T, Milanaik R, Kaplan A, Papaioannou H, Adesman A. Household diversion of prescription stimulants: medication misuse by parents of children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2017;27(8):741-746.
17. Edmundson M, Berry DTR, Combs HL, et al. The effects of symptom information coaching on the feigning of adult ADHD. Psychol Assess. 2017;29(12):1429-1436.