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3yr
ADHD in Children

ADHD is a disorder that manifests in childhood with two categories of core symptoms: hyperactivity/impulsivity and inattention. The prevalence of ADHD in school-age children is estimated to be between 9 and 15 percent, making it one of the most common disorders of childhood.



Hyperactive and impulsive behaviors almost always occur together in young children. The predominantly hyperactive-impulsive subtype of ADHD is characterized by the inability to sit still or inhibit behavior; symptoms typically are observed by the time the child reaches four years of age and increase during the next three to four years, peaking in severity when the child is seven to eight years of age. The predominantly inattentive subtype of ADHD is characterized by reduced ability to focus attention and reduced speed of cognitive processing and responding. Children with the inattentive subtype often are described as having a sluggish cognitive tempo and frequently appear to be daydreaming or "off task".



What are the most troubling symptoms seen in pediatric ADHD patients?



How willing are you to try newly approved innovative therapies instead of long-standing standard of care therapies?



Source:

• Wolraich, Mark L et al. “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics vol. 144,4 (2019): e20192528. doi:10.1542/peds.2019-2528


  • 3yr
    Coping skills
  • 3yr
    Peter Catalano, MD
    I’m an otolaryngologist working primarily with children and adults with sleep disordered breathing (SDB). About 50% of such children develop ADHD which is likely due to the adrenaline surges (micro-arousals) that occur during their sleep to help them breath through their airway obstruction. I just completed a study of 101 children w SDB and ADHD wherein I corrected their nasal breathing and measured executive function before and after surgery. The as yet unpublished data is very positive and shows that improving or correcting SDB can improve and/or reverse ADHD in these children. Lots more on this to follow as we comb through more of the data. The nasal surgery only takes 35 mins and the kids return to school the following day. This represents a big opportunity for many kids suffering with both of these conditions.
  • 3yr
    opposotional behavior disorder
  • 3yr
    The inability to concentrate is most troubling…I’m very willing to try new products
  • 3yr
    tolerance and dealing with side effects can be a problem for some patients. i look forward to new improved meds.
  • 3yr
    Trouble with attention
  • 3yr
    Yes
  • 3yr
    The most pressing issues are the tolerance and the side effects with the treatment of ADHD, as for using new agents, I am willing to do so if the agents are well tolerated and less addictive.
  • 3yr
    Most disturbing issue is lack of parents education , how to handle ADHD child and how to contain their frustration , this evolves to mutual frustration, irritability and anger, especially the child is looked at differently by his/her parents compared to siblings
  • 3yr
    There are so many facets to adhd. There is no “garden variety”. In dealing with the pediatric population in my office,I have seen not only the “standard”difficulties in maintaining focus, and impulsivity,but all social interactions in a child’s life can be compromised. Especially in my higher functioning spectrum kids. Also the impact on self esteem as they move towards being young adults.
    I am always open to using any method of therapy that would assist a child to do their best with their awesome adhd think out of the box mind!
    I would love to have more therapies that had less side effect profiles that don’t disrupt sleeping and eating.
    Also I love the idea of using tech like vr and gaming as adjunctive or single point therapy. I look forward to seeing new things down the line!
  • 3yr
    The most troubling symptoms include difficulty finishing school work carefully: incomplete assignments carelessly done, possibly not turned in. Disorganized approach to study, homework, and chores. Social deficits from failure to read social cues and impulsive intrusiveness., possibly irritability.
    I welcome any new treatment with evidence of safety and efficacy; current treatments, while showing dramatic short-term improvement for the majority of patients, do not work for all, and when they do work, do not have compelling evidence of long-term benefit. Further, the meds have troublesome side effects and palatability problems. We greatly need effective, safe treatments with enduring benefit.
  • 3yr
    Compliance with medication useage and weight loss are the most pressing issues I see in practice. I have no issues trying a new medication if the medication the patient is on is not effective or the side effects warrant a change
  • 3yr
    The most troubling symptoms are the co-morbid disorders that include symptoms not part of core adhd symptoms, can make treatment options limited or not respond to adhd treatments at all. ODD, Tics, mood disorders, autism and learning disorders are the usual ones we deal with. I'm always excited, then let down by most "new therapies" as they are usually just tweaked older meds with no new actual mechanism of action. Different lengths of effect, liquids, etc are great but not game changing.
  • 3yr
    there is often difficulty with treating overlapping sxs of anxiety, irritability, low mood, and impulsivity that also tend to reinforce each other, as such determining what may be the primary issue. trials with well tolerated, once daily, low abuse potential medications to gauge efficscy would be preferential.
  • 3yr
    Main concern is compliance & tolerance issues, as well as Chemical dependency.
  • 3yr
    the most complex situations for me, are when a patient's parents are convinced that a child needs stimulants, even if the diagnosis is unclear, or stimulants do not seem the best fit. I am very happy to try new modaiities
  • 3yr
    The most troublesome symptoms in pediatric adhd are inattention in multiple situations in which sustained focus is required with school performance most vulnerable to the above. Hyperactivity is often present as is poor impulse control. An irritable mood with anxiety and agitation are often present. Comorbidities of anxiety disorders are often missed. With regard to new treatments, I am often skeptical because most new treatments are just different delivery systems of stimulant meds that target noradrenergic systems.
  • 3yr
    I rarely treat minors, though I have family members who were treated for ADD or ADHD at some point as minors. Disruptive behaviors at home or at school are notable, causing conflict or discord with siblings or classmates. As for innovative new treatments, they all seem variations of Methyl Phenidate or Amphetamine salts.
  • 3yr
    I think that some of the most troubling symptoms are aggression toward others and mood changes with medication treatment.
  • 3yr
    I am willing to try new products in combo with older ones.

    Families seem to be more comfortable with that idea.
  • 3yr
    Behavioral control, disreuptive behavior & no official clinical guidelines is the hardest part. I am mote than willing to try new products.
  • 3yr
    Worry ab out lack of treatment in pediatric ADHD. If treated (but not adequately) still possibility of residual academic and social deficits. I am willing to try new products.
  • 3yr
    Worst is lack of treatment for pediatric ADHD. Even if treated (but not adequately) still residual academic and social deficits are possible. I am willing to try new products.
  • 3yr
    I always worry about the longer effects and symptoms that occur with the lack of treatment, like substance abuse and other mental health conditions. Poorly treated patients drop out of school and end up in emergency rooms with much greater frequency that those without ADHD or those who are properly treated. I also worry about teenage pregnancies that might also be the result of poor impulses in untreated patients.
  • 3yr
    Thanks for your wonderful contributions! How do you advise parents on the efficacy and prognosis of newer therapies?
  • 3yr
    Overall functionality should be assessed and open to new evidence based treatments always!
  • 3yr
    loss of appetite and emotional lability as medication wears off are the two major complaints
    a constant delivery system of medication that works evenly all day would be perfect
    ready to go in the am without the ups and downs of dosing meds during the day
  • 3yr
    we had a childwith adhd that we adopted the strain on the family is the worst because the one child needs all the attention the impulsive behavior resulted in a motor vehicle accidentdeath we have to live with our failure it is very hard almost unbarablefor thefamily
  • 3yr
    With children, symptoms typically are poor academic performance, sleep problems, wt loss, depression, poor self esteem. I am willing try innovative treatment options. Important to rule out other potential causes of child’s symptoms, such as organic etiologies and abuse.
  • 4yr
    The most challenging cases are the undiagnosed or non treated cases for various reasons. I had the honor to work with Dr Winsberg 2001-2005 that discovered the dopamine transporter gene deficiency in patients that are non respondent to stimulants. I would live to hear about new products with new actions or different responses.
  • 4yr
    Pediatric ADD/ADHD has detrimental effects on school performance, social interactions, family dynamics and overall health and safety. These patients struggle with many comorbid mental health illnesses. Due to the many side effects with current treatments I would be very open to trying new therapies.
  • 4yr
    Poor school performance due to the inattention. I am certainly willing to try new products for this condition, provided that they are deemed safe and efficacious.
  • 4yr
    Family conflict. ADHD is something that affects the entire family. I am willing to try new products.
  • 4yr
    For young children, disrupting the class w/ADHD or not identified early if ADD; wt loss; sense of self/worth w/school failure. For older children the issue is more in executive functioning leading to school failure, and their ability to relate to others.
  • 4yr
    poor school performance. weihgt issues. sleep issues. irritability. i am willing to try new products

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