Frequently Asked Questions Attention-Deficit/Hyperactivity Disorder (ADHD)

Q: What is ADHD?

A: If a loved one is experiencing problems in life because of inattention or hyperactivity he or she may have Attention-Deficit/Hyperactivity Disorder (ADHD), a mental disorder that is usually diagnosed during childhood. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria for this disorder requires one of two patterns of symptoms:

1. The individual must exhibit six or more of the following symptoms of inattention. These symptoms must have persisted for at least six months, and must be causing significant impairment in functioning:

   Inattention

   • Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
   • Often has difficulty sustaining attention in tasks or play activities
   • Often does not seem to listen when spoken to directly
   • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
   • Often has difficulty organizing tasks and activities
   • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
   • Often loses things necessary for tasks or activities (toys, school assignments, pencils, books, tools, etc.)
   • Is often easily distracted by irrelevant stimuli
   • Is often forgetful in daily activities
2. The individual must exhibit six or more of the following symptoms of hyperactivity-impulsivity. These symptoms must have persisted for at least six months, and must be causing significant impairment in the child’s functioning:

   Hyperactivity

   • Often fidgets with hands or feet or squirms in seat
   • Often leaves seat in classroom or in other situations in which remaining seated is expected
   • Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults it may be limited to subjective feelings of restlessness)
   • Often has difficulty playing or engaging in leisure activities quietly
   • Is often "on the go" or often acts as if "driven by a motor"
   • Often talks excessively

   Impulsivity

   • Often blurts out answers before questions have been completed
   • Often has difficulty awaiting a turn
   • Often interrupts or intrudes on others’ conversations or games

In addition to exhibiting one of the two patterns of symptoms mentioned above, it is necessary that hyperactive-impulsive or inattentive symptoms occur in two or more settings, such as school (or work) and home. Sometimes people are diagnosed with ADHD later in childhood, adolescence, or adulthood. However, ADHD symptoms must have been present before the age of seven in order to meet criteria for the diagnosis.

It is important to note that children are generally more inattentive and hyperactive than adults. Also, there is normal variability among children: some are generally more hyperactive, inattentive, and impulsive than others. In all cases it is important to consider whether or not a child is exhibiting behavior appropriate to his or her age. Keep in mind that it is normal for kids to appear inattentive when things they are not naturally interested in are occurring (for example, a lecture).  Many children find it difficult to endure long periods of sitting or organized activity. As a result, some children appear "hyperactive" or "impulsive" when "bored" and "restless" are more accurate descriptions. When the child's hyperactivity, distractibility, poor concentration, or impulsivity begins to affect performance in school, social relationships with other children, or behavior at home, ADHD may be the cause.

Complete the ADHD Symptom Checklist, but keep in mind that only a trained professional can make a proper diagnosis. Also keep in mind ADHD symptoms must be displayed in two settings (for example, home and school.)

Q: How common is ADHD?

A: Surveys suggest that between three and five percent of children have ADHD, which means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.¹ Boys are more likely than girls to have ADHD.² However, the estimated ratio of boys to girls with ADHD ranges from 3:1 to 9:1.²

Q: Do children outgrow ADHD?

A: No, at least not in the short run. Children with ADHD are not likely to simply "outgrow" the problem. Symptoms may improve over time as children and their families receive treatment or develop tools on their own to cope with this disorder.

Q: What treatments are helpful for ADHD?

A: It is important for families to work with their doctor to determine what treatment will be most effective for their child. Behavior therapy and stimulant medications such as Concerta^® Metadate^®, Ritalin^®, and Adderall^®, are all effective treatments for ADHD. In addition to drug therapy, behavior therapy is recommended to help young people understand their feelings and learn appropriate actions. Behavior therapy is often successful in changing undesirable behavior and replacing actions with more appropriate responses. Learn how to set and enforce rules, help your child understand what he needs to do, use discipline effectively, and encourage good behavior. More

A lot of problems experienced by young people can be helped or treated with behavioral interventions or a relatively quick dose of behavior therapy.

Stimulant medications work to help children with ADHD focus their thoughts and ignore distractions. As with any medication, there is a risk that children can develop side-effects. More

It has been suggested that a combination of both behavior therapy and medication is more effective than either treatment alone.² Some practitioners recommend medication as a first line intervention, and adding behavior therapy only when medication does not work. The argument behind this is that medication is cheaper and easier to administer than behavior therapy. Others argue that behavior therapy should be used first because it is necessary to treat all functional impairments. It may reduce the dosage of medication, and eliminate the need to give children psychoactive substances.² Every child and family dynamic is different. Your doctor can help you evaluate which treatment is right for you.

Q: How do I locate professional to treat ADHD?

A: You can contact any of the following organizations, which have referral capabilities:

• Locate a TRICARE Provider
  Individuals enrolled in TRICARE or insured under TRICARE Reserve Select (TRS), find a provider online or call 1-888-TRIWEST for assistance.
• Association for the Advancement of Behavior Therapy
  or call 1-212-647-1890.
• American Psychological Association
  or call 1-800-964-2000.
• National Association of Social Workers—Search Clinical Register
• American Academy of Child and Adolescent Psychiatry

Q: Do I have to see a specialist in order to get help for my child?

A: No. You and your PCM may decide that stimulant medications are the best treatment for your child, and he or she may be able to prescribe them for you. If your doctor believes it is necessary to seek specialty care, they will be able to assist you to that next level of care. There are also a number of steps you can take on your own to address ADHD symptoms. Check out the self-help tools offered on this site. Sometimes family, friends, teachers, caregivers, or clergy can be the best sources of support when facing a challenging behavioral change.

Q: Is ADHD a covered TRICARE benefit?

A: TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed medical or psychological disorder. The disorder must be one listed in DSM-IV and must be of a severity not only to cause the patient distress but also to interfere with the patient’s ability to carry out usual activities.TRICARE beneficiaries are eligible for eight behavioral health care visits per year without a referral or pre-authorization. Active duty military personnel always need a referral for care outside a military treatment facility. More

References:

¹National Institutes of Mental Health (2003). Attention Deficit Hyperactivity Disorder, Revised. Retrieved 4/10/06.

²Pelham, W. E., & Waschbusch, D. A. (in press). Attention-deficit hyperactivity disorder (ADHD). In J. E. Fisher & W. O’Donohue (Eds.). Practitioner’s guidelines for evidence based psychotherapy. New York: Kluwer.