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At a pediatricians' conference this weekend, the American Academy of Pediatrics revised 10-year-old guidelines regarding when children can be diagnosed and treated for ADHD, expanding the age range from between 6 to 12 years old to what is considered the full age range of childhood: from age 4 to age 18.
ADHD is now the most common neurobehavioral disorder in children, and with this reclassification, the number of diagnosed children is sure to climb. The last Center for Disease Control and Prevention survey reports that 9.5 percent of US children had been diagnosed with ADHD in 2007, a steady 5.5 percent increase annually for the previous four years.
The point of changing the stated age range, however, is not to include more children in the diagnosis: it's to ensure that treatment and intervention take place as early as possible. In an interview with Vitals on MSNBC.com, Dr. Mark Wolraich (a pediatrician at the University of Oklahoma Health Sciences Center), said, ”Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school.”
But as always with ADHD, some doctors (and many parents) voice concerns that these new guidelines will lead to even more children being medicated with psychostimulants like Adderall and Ritalin, which stimulate the brain to release the attention-stabilizing brain chemicals dopamine and norepinephrine. For the youngest end of the age range, it is recommended that children be treated with behavioral therapy, in an effort to retrain them to control some of their impulsive, disruptive behaviors. But -- if the child's impulsivity and lack of attention do not respond to these treatments and these habits are disrupting his or her ability to learn, make and keep friends and acquire developmentally appropriate skills -- then medicine should be considered, say pediatricians.
I wait for the predictable outcry about overmedicating our children. As the mother of an 8-year-old boy who was recently diagnosed with ADHD after almost three years of attempting to understand my son's personality and difficulties, I can report from my end that, in fact, the symptoms of ADHD -- behavioral problems or problems in school, as well as symptoms of inattention, hyperactivity and impulsiveness in various settings -- were definitely quite present in Zack at a very young age. He's also very gregarious and outgoing, which masked some of the other tendencies of ADHD. He was always in trouble at school for his lack of self-control-- with patient teachers who tried to teach him methods to self-manage -- but when he landed an inflexible teacher in second grade, everything went downhill and Zack's grades started to drop dramatically, along with his self-esteem.
Finally getting the diagnosis helped us explain to the teacher and the school what was happening behind Zack's impulses and lack of self-control. And in the end, I did decide to medicate him, because the two years of behavioral therapy and three years of psychotherapy hadn't changed much in his actions, though it did help with self-understanding. But nonetheless, he was severely distressed and confused by his inability to stop certain behaviors -- even when it was just the two of us at home, in a safe place, in a calm state of mind. It was seeing the confusion and fear in his eyes when I'd ask him to try to stop (running, talking, slapping, touching, anything-ing) that made me do something I never, ever thought I would: choose medicine. He is not a different boy on meds, and in fact, his ADHD behavior is still present when he is medicated; the medicine simply creates the necessary pause between impulse and action to give him a still-pretty-long-shot chance of being able to learn to control himself.
He once tried to use ADHD as an excuse for some unacceptable and typical 8-year-old talking-back behavior. I laughed and said, "Oh, no. That is never going to be an excuse for you. The medicine and the diagnosis don't take away your responsibility. You still have to do the hard work of learning self-control; the medicine just makes it possible for your brain to hear that message." He shrugged. Kid's gotta try to work his angles, was what he seemed to be saying. Totally normal, right? It's good to have some normal.
So he's on his way on the long, slow road of learning to master himself. But believe me, if I had been able to give myself and Zack the
