If we're too busy we're sleep-deprived, we haven't had our caffeine will feel
more inattentive or restless. That's certainly intrusive. The key, you
have to remember that ADHD is a disorder and a disorder means that we struggle
with something more than the average person in that setting our age. So when
you're dealing with three-year-olds lots of luck they're all generally going to
be pretty hyperactive and you're gonna have to repeat yourself. But once you get
into a school setting where you can put a child next to 20 other kids their age
and have them do tasks that are typically normal for the age, like
sitting in a desk for 15 minutes, pay attention to a teacher while she's
talking, complete 10 minutes of math in the given time frame, then you can start
to see where these things might cause problems. So if you're so off task you
don't get your work done, you can't hear the instruction, you're so restless that
you can't stay in the seat or you're disrupting other people around you or
you're so impulsive that you have any much harder time
managing your anger than another child your age, then we have a problem. And
then that's typically when the term ADHD might get used and that's really and
only when we should consider treatment for the disorder. I hear ADD, I hear ADHD,
are the two terms interchangeable? Largely, we used to have to separate by
suppose diseases. Recognizing that maybe kids who are purely and intentive are a
little bit different than kids are permanently hyperactive. It turns out
they're much more similar than they are different so we tend to use the
catch-all term of ADHD but recognize that some kids can be more prominently
or visibly inattentive where some kids can be more visibly hyperactive.
Dr. James Waxmonsky is our guest for Ask Us Anything About... ADHD from Penn State
Health. We welcome your questions and your comments, just add them to the
comment field below this Facebook post and won't be sure to pose those
questions here to the doctor. You talked a little bit about how ADHD is detected
like for example in the classroom setting. So there obviously is not a
blood test or a clinical type test. It's really behavioral i guess? Mostly, we're
dealing with observations interacting with the children and most importantly
getting feedback from parents and teachers. The latter which can be a
little bit challenging sometimes but to call something a disorder we want to here
that there's impairment in the setting. So that's why it's really particularly
critical to get not only feedback directly from parents about how their
child is behaving but particularly from teachers. Teachers are fantastic. They may
not necessary be experts on ADHD but they know what a
seven-year-old supposed to be able to do in a 45-minute class and if the child's
not doing it, again, that's that marker of impairment. So the standard of care,
obviously interact with the child, you have parents fill out rating forms or
complete an interview and then you have the teacher fill out rating forms about
both symptoms like hyperactivity and impulsivity but most importantly how
actually is the child doing in the classroom and if you have the symptoms
and you have the impairment especially at home in school, we're pretty
comfortable making the diagnosis. You can get more high-tech and we can run kids
through EEGs and you can actually MRI brains and there is a kind of prototype
of an of an ADHD brain but the problem is it's, A, too expensive B, there's
too much variability so you can't definitively use it to say one child has
ADHD and one child doesn't but you could take a hundred kids with ADHD and a
hundred kids without ADHD and you could see an average difference in their brain
functioning. That's certainly true. Not necessary for diagnosis? Oh no, we don't even
recommend it. Really, rating scales, sitting down with kids, your average
pediatrician can largely establish the diagnosis. What do we know and even
not know about causes and risk factors for ADHD. Yeah, it's a very good question.
The brain is probably the most complex part of our body so it's very
challenging to understand exactly what causes ADHD there are some clear risk
factors. It is a hereditary disorder so if you have a parent who had traits of
it as a child or still has traits of it as an adult, you have maybe a one in five
one in four chance of having a child who has the disorder a few things like,
nicotine exposure in utero. So, smoking during pregnancy has been clearly
established as a risk factor. There's a whole bunch of theorized things from
pesticides of the most probably intensely debated one is modern media.
So if you put infants and toddlers in front of too many screens are we actually
physiologically shortening their attention span and that's debatable.
There's certainly value with monitoring screen time but we're not really clear
yet if it's causing ADHD in any way. What do we know about the prevalence?
I've read online anywhere between, depending on the article you read, it could be
three percent could be twelve percent of the population? Right. So most studies now
will center around six to seven percent including those from
across countries. We use slightly different diagnostic criteria than some
of the European countries. They tend to be a little bit more strict requiring
hyperactivity. We don't actually require it as long as you're prominently
inattentive. So that's one of the reasons.
The thing the studies do is they go out in the community and ask families, has your
child ever been treated for ADHD? Have you ever been told your child has ADHD? Then
that's a bit different than a diagnosis. Those rates will push up to about 11 ish
percent and then most importantly the rates of treatment are about 5% so you
go into a classroom and five percent of American school kids have been on
medication for ADHD. Meaning that more than one in every classroom are probably
going to have been treated at some point. We'll definitely talk more about
treatments in a little bit here on Ask Us Anything About... ADHD from Penn State Health
I'm Scott Gilbert. This is, Dr. James Waxmonsky. He is a chief of child
psychiatry here at the Milton Hershey Medical Center and he welcomes your
questions about this topic. Whether you're watching this video live or even
if you're watching it on playback. And regardless of how your or when you're
watching it, please do click on the share button and share this content with other
people in your feed to help get the word out about some of this important
information. You know, I would like to ask about, back. I guess, some people feel that
ADHD is a relatively new diagnosis so you know it's common for adults to say
well back when I was a kid there was no ADHD. Was there and perhaps we just
didn't call it that? Sure. Well certainly, there was. Whether or not this has
become slightly more prevalent over the last several decades? It's probably we're
getting better at diagnosing it. Again, we may debate things like modern media
exposure but certainly the prevalence was there when we go back. If you go back,
there's German nursery rhymes for the turn of the 19th century that
clearly show hyperactive kids falling off walls and having all these awful
things happen to them like many old school Nursery Rhymes do. So the
construct was there. The original term was this fun thing called minimal brain
dysfunction which dates back to the 20s or 30s. The first treatment for it was
back in the 1920s when they realized that stimulant medicines like Adderall,
they were being given to treat pain post spinal taps for headaches and lo and
behold the kids behave better. So the actual treatments themselves date
back 75 years. In the 50s, a small percent of kids were treated and then over the
course of the 80s and 90s we really had a boom both in diagnosis and treatment.
Mostly because we got better treatments and because we got more aware that it
isn't just a young kid disorder, it kind of hangs out and cause more problems
later in life so we wanted to do more to identify and treat it. We have talked a
little bit about treatments. Let's delve into those a bit more. What medications
are out there that can help people with ADHD? So let me step back a second,
because we always tend to think of medications when we think of ADHD
because everybody's heard of Ritalin and Adderall for good or for bad, at the end
of the day behavioral treatments are just as helpful AND in many ways possibly
more useful than certain medications their preference for kids who are very
young who may have a hard time handling medications and when you're young the
behavioral treatments pull the parents in as much as the child because it's
very hard to teach a four-year-old a new skill. It's much easier to work with
their parent and help them kind of redirect the child in the minute and to
consistently reward good behavior and consequence bad behavior. I was wondering,
how much of it is training the parents to work with a child to help them
through? RIght, and young kids that's mostly it and you can get as large
effect for benefit for ADHD with the behavioral therapies as you can with the
meds and you have less side effects. The trade-off is it's sometimes hard to find
people who do those things and then also it takes time. The meds are wonderful and
that they work right away, you get a visible reduction in hyperactivity kids
can sit longer, they can stay focused longer in an
activity and that's instantly, whereas, the therapies obviously take time and
effort. But when we look down the road when they're older
and whether they're better off for treatment. The behavioral treatments
really start to have clear benefit. I imagine that some parents too may have
some concerns, some very well founded concerns about not wanting to rush to
put their children on medication for something like this? Yes and we A,
try to be very careful with the diagnosis we want to make sure that the
symptoms are persistent and causing impairment ideally at home and at school
before we identify diagnosis. Secondly, we want to offer treatment that
goes after the impairment. So you can be a hyperactive but if it
bother anybody, I don't necessarily need you to be calmer. If you're so
hyperactive that you're disrupting your learning or other people's learning, then
we want to treat you. So linking the treatment to the actual problems that
kids have are probably works better. It's easy to do with behavioral therapy
because we can shape the treatment to go after whatever the problem is. The meds
though are effective and there's certainly a very reasonable part of
treatment. They're the most commonly used treatment, they significantly reduce
hyperactivity, they significantly improve attention span and they significantly
improve impulsive behaviors whether they're blurting out in class or whether
they're getting overly frustrated in the minute. You're watching, Ask Us Anything
About... ADHD from Penn State Health. Dr. James Waxmonsky is chief of child
psychiatry here at the Milton S. Hershey Medical Center. We welcome your questions.
Stacey has entered a question here, she's asking, ADHD and OCD - Do the children
grow out of these or are they on medication the rest of their lives?
That's a good question becasue we're talking about children here but [cough] excuse me. um
What about the long-term? Right! So that's a fantastic question and starting
with ADHD if you had asked this question 20 years ago the answer would have
largely been "yes." It kind of stops being a problem around middle school. But now
we know when we start to track people actually longer that what goes away is
there physical hyperactivity. You can't see me run around the room when I'm
thirty but you can still see me struggle with inattention or being impulsive such
as making quick and problematic decisions. So the visible symptoms go
away a bit but the more internal symptoms, it actually caused most of the
impairment hang out about two-thirds of the time. Now that doesn't necessarily
mean you need medication lifelong. In fact, with kids, we're always looking for
opportunities to see, "hey, have they made enough development?" "Have they made enough
gain?" That in fact, they don't need meds but if you do need meds they're largely
safe developmentally and there are people who use them all the way through
their life and they are just as helpful for adults as they are for young kids or
teenagers. Can having ADHD makes someone more prone to other conditions? Yes, and
that's where, maybe not so much OCD per se but certainly depression and
anxiety, substance use actually the rates of cigarette use are much higher because
sadly nicotine is slightly improves your engine span. But you can imagine if you
struggle in school, if you struggle to maintain friendships because other kids
find you Restless, impulsive or inattentive, you're going to get rejected
more and if you're frustrating at home you're going to get punished more or
even yelled at more and that affects rates of depression, rates of anxiety and
can lead to things like school dropout and substance abuse later into
adolescence. Now that's not necessarily the course for everybody but we know
that both those disorders and the things that we don't want our kids to do like
quit school or get arrested or use drugs are a little more likely with ADHD not
gigantic risks but those are the things we do have to watch for. If parents
suspect that their child may have ADHD, what's a good next step? Should they
speak with their primary care provider or reach directly out to a specialist?
In most cases, it makes sense to reach out to your primary care provider. ADHD
is like the ear infections of child mental health. Almost every primary care
provider season on a regular basis .They are aware of the treatments, many of them
are comfortable with the medication treatments and some of them know where
to find the behavioral treatments here at Penn State Hershey in Pediatrics
our pediatricians are excellent at this. With good awareness
about both the meds and the behavioral treatments and also we have specialists
embedded right within primary care so you can work with a mental health
professional in the same place you go to get your vaccinations for your child. Not
every place has that but yes starting with a primary care doc is a very good
bet if for some reason that's not your preference,
you can reach out to a specialist and this is where our field gets confusing.
I'm a psychiatrist which means I'm a medical doctor which means I happen to
do behavioral treatment because I think it's important but most psychiatrists
will focus on assessment and medications. Whereas counselors, social workers
therapists will be behavioral based and it really depends on what treatment you
want to start with where you go. And there is no best answer. It's partly more
what you're comfortable with and what your child's comfortable with. Sounds
good! And of course, we will put a link below this Facebook post to the division
of child psychiatry here at the Milton S. Hershey Medical Center. So if you have
some questions you can reach out to Dr. Waxmonsky's division.
Thanks a lot for your time today. Good talking with you. Anything else you would like to add as
we bring things to a close? I would mention that certainly some kids don't
respond to initial treatments and for those particularly interest in using
behavioral treatments, it really is one of the focuses of our division here at
Penn State Hershey. So we have a broad number of counseling programs, behavioral
interventions and even medication treatments that are available through
families and the our information is on the website if you look under the
Children's Hospital or Penn State Psychiatry. We have a wider range of
treatments that would fit I think every family. So please, look us up. Good! Dr.
James Waxmonsky is chief of child psychiatry here at the Milton S. Hershey
Medical Center. He's been our guest today. Thank you so much for watching and feel
free to add your questions. Again, whether you're watching this live or on video
playback, we'll get answers to your questions about ADHD from Dr. Waxmonsky.
Thanks for watching, Ask Us Anything About... ADHD from Penn State Health.
For more infomation >> GF VIP 2: complotto contro una concorrente amata | M.C.G.S - Duration: 3:39. 
For more infomation >> 金庸劇中的六版小龍女，你喜歡哪一個？ - Duration: 2:25. 
For more infomation >> Uomini e Donne, accesa lite tra Gemma, Marco e Gianfranco: ecco il motivo | K.N.B.T - Duration: 4:13. 
No comments:
Post a Comment