| Attention Deficit-Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders of children. Approximately 3-5% of children around the world have this disorder. About 50% have another psychiatric disorder with ADHD. In the past, it has been thought that this was only present in boys. However, we now know that many people with Restless Leg Syndrome have it, too. You are probably reading this because a family member, pupil, or friend has the disorder. Criteria for Diagnosis A. Signs and Symptoms Six or more of the following symptoms of inattention must persist for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level: Inattention
Hyperactivity-impulsiveness Six or more of the following symptoms must persist for at least 6 months to a degree that is maladaptive and inconsistent with the developmental level:
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years. C. Some impairment from the symptoms is present in two or more settings (e.g., at school and at home). D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. There are three kinds of ADHD: 1. Combined type- symptoms and signs of both attention deficit and hyperactivity-impulsiveness. 2. ADHD without hyperactivity- symptoms and signs of attention deficit only. 3. ADHD, hyperactive-impulse type- symptoms and signs of hyperactivity-impulsiveness only. Recent studies have shown that people with ADHD have some other interesting problems: Clumsiness-- Children with ADHD tend to fall down more, tip over more things accidentally, and have worse fine motor skills than other children. While some of this is related to their hyper- activity, a good part of it is not. This is partly the reason that people with ADHD have more accidents, have poorer handwriting, and always seem to be spilling things. This poor coordination predicts a poor outcome as adults. Those children who have marked coordination problems and ADHD are much more likely to have trouble with the law, reading problems, work difficulties and substance abuse problems as adults. Time perception-- To be coordinated and get things done, we need to have a stable internal clock. People with ADHD have much more difficulty figuring out how much time has really passed either in the short term (while trying to coordinate a movement) or in the long term (trying to decide how fast to work to get something done in a certain time frame). (53) This inability to judge time does improve with medication. Planning things out-- Difficulties with executive functioning. ADHD at each stage of development The examples below are for the combined type of ADHD. Persons with either the inattentive type or impulsive hyperactive type will only have some of these signs and symptoms. Infant It is not uncommon that parents can see signs of ADHD even before children can walk. When compared to other babies they are often more squirmy and are a less able to cuddle. Infants who will go on to develop ADHD often have a more difficult temperament. They are more impatient, easily frustrated, and require more attention than the average baby. They have more colic. On the other hand, many children that will grow up to have ADHD show no abnormalities at this stage. I have never seen or heard of an infant referred for ADHD. Toddler (1-3) For many children, the first point at which signs of ADHD become apparent is as a toddler. Here are the findings: Attention-- Toddlers naturally have a short attention span. They usually can entertain themselves for a few minutes and often can work on an activity with their parents for a little bit longer. Toddlers with ADHD can not even sustain their attention that long. What this means is that conversations are interrupted by any distracting sound or sight. Eye contact during conversations is poor. The toddler with ADHD will often automatically develop responses to requests like, "huh?" or "What?". Most toddlers with ADHD will be able to sustain their attention for a few favorite activities - certain videos, wrestling, and playing at a playground. If you are the caregiver for a child like this, you are spending more time than usual in direct one to one contact with the child to keep her occupied and to keep her out of trouble. I have never seen a toddler with ADHD in which the chief concern was attention span. At its most severe end, Children with ADHD can only concentrate on things like running or wrestling. Toys, books and games are played with for a few minutes only and then either ignored or destroyed. Impulsiveness-Hyperactivity-- Toddlers are known for their high activity levels. They also spend a lot of time doing things without thinking. Since they are naturally very hyperactive and impulsive, one would assume that it would be impossible to be more hyperactive than the norm. Unfortunately, this is not the case. Children with ADHD at this stage can be incredibly hyperactive. They are often so squirmy they can not really cuddle. They want to be running or in motion at all times. Their lives can consist of climbing, destroying or messing up wherever they are. Often they are too busy to sit still and eat. They can be too hyperactive to sit still to use the toilet. They are constantly breaking things up. If someone winds them up, it can take hours before they are relatively calm. When there is a lot of stimulation, they can be absolutely wild, hitting everyone, screaming uncontrollably, and looking as if they are only distantly related to human beings. For most children, impulsiveness goes with hyperactivity. Just as the normal hyperactivity of toddlers is magnified in ADHD, normal impulsiveness is also. Toddlers with ADHD jump off of decks, jump out windows, take more than their share of cleaning product overdoses, have more accidental falls, and tend to do other normal impulsive things more frequently. They break toys more often, write on walls more frequently and run into the roads more frequently. This hyperactivity and impulsiveness can be absolutely exhausting. It means that every minute of the child's day must be supervised or else the child gets hurt or things get wrecked. What is even more exhausting is that toddlers with ADHD often have sleep problems. They can be incredibly difficult to settle, do not sleep soundly through the night, and can be up around 5 a.m. Sometimes a toddler with ADHD will wake up in the middle of the night and be ready to play, go to the playground, or just run around. This leads to a horrible cycle. First there is not enough sleep in the ADHD child or the parent. This leads to a more inattentive, irritable, and hyperactive child. It also leads to a more irritable, frustrated, exhausted, and impatient parent. This usually leads to worse sleep for the ADHD child and so on. When I have had to see toddlers with ADHD it is often because they were very hyperactive and did not sleep. On the other hand, there are many children who will develop ADHD who do not show signs of it in the toddler age. This is because you have to have pretty severe ADHD to stand out from an age group in which inattentiveness, impulsiveness, and hyperactivity are the norm. Preschool (3-5) Attention-- In this stage children usually are still relatively inattentive. However, there are a few new things they are expected to do. They should be able to sit and do some activity on their own for a few minutes. They should be able to do some pre-school work like sitting at a table. They should be able to listen to a story. They should be able to listen a little to other children and a fair amount to their parents. When pre-schoolers have ADHD, they are usually unable to consistently manage these sorts of things. This is the age when a difference usually appears between how attentive the child is to things he is interested in versus those that he is not. A child with ADHD at this age may be able to play cars and trucks on his own without problems but would be unable to concentrate on coloring or being read to. The biggest problem at this stage is that some children are so inattentive to their surroundings that they are falling a lot, spilling more than usual, and have a hard time playing with other children. The pre-schooler with ADHD is ready to change activities every few minutes, but a normal child will want to keep with something for 10-15 minutes at least. If a ADHD child is playing with another child, this need to constantly do something new usually leads to the normal child feeling frustrated. All things considered, the problems of attention in pre-schoolers are fairly mild. I have never seen a child of this age in which attention was a serious issue. Hyperactivity-Impulsiveness-- With every increase in development, the hyperactivity- impulsiveness part of ADHD gets them into bigger and bigger trouble. Pre-schoolers with ADHD are often starting to get into fights. They are running into streets without looking. They are falling out of windows, starting cars, falling out of trees, and getting bit by dogs they have bothered. Pre-school sometimes is a problem in that many "school" oriented programs require too much sitting time. Some ADHD kids at this age will be thrown out of pre-school. ADHD kids at this stage are in a big hurry and sometimes are unable to sit for a meal, to use the toilet, or to speak clearly. Some children with ADHD will become very, very talkative at this point. Their best friends, if they have them, are other very active children. It is usually unsafe behavior plus being thrown out of multiple day care or pre-school programs which brings children with ADHD to my attention at this stage. However, there are many children who will get ADHD who show no sign of the disorder at this stage. Toddler and Preschooler ADHD can destroy families and children. Recent studies have shown that this group has very serious deficits. They are very aggressive and have very poor social skills. They are associated with severe family stress (three times normal). They disobey twice as much as normal children. They behave inappropriately five times as much. Not surprisingly, parents felt that the stress in their lives was three times what you would see in a family without a preschool ADHD child. What does this mean? Preschool ADHD leads to mom's (and occasionally dad's) becoming mentally ill. It can lead to marriage break ups. It can lead to other siblings becoming quite dysfunctional. Early Elementary Attention-- To successfully complete grades primary through two requires a huge step in a child's ability to sustain attention. More importantly, the child must be able to sustain his attention on things which he or she is not really interested in. Outside of school there is an increase in the attentional demands, but not as much as in school. You need to be able to attend to other children's interests, emotions, and abilities to maintain friendships. The biggest problems are at school. Children with ADHD will be able to start nearly any task and often be relatively enthusiastic about it. However, their attention drifts away and the work is not completed. Some will hurry in every aspect of their work and it will be messy. Others will never actually get the crayon or pencil to the paper. They are too distracted by everything that is going on in a classroom and by their own thoughts. If you think about it, if you have a hard time with extra stimulation and distractions, there is no worse place than a busy classroom. Usually children with ADHD will occasionally amaze their teachers because the task at hand is something they are very interested in for one reason or another, or it is one of their better days. A page of mathematics that the child could not do at all a week ago comes back 90% correct. The next day they can hardly recall any of it. This uneven performance begins at this stage and starts to drive teachers and parents crazy. They know that their child is smart, but she only shows it rarely. Besides these problems, organizational skills start to be noticeably lacking. What is supposed to go home doesn't. What is supposed to go back to school never gets there. Since work is frequently not finished at school, it has to make that trek home, and that is often a difficult one. Children lose backpacks, get distracted on the way to school and on the way home. Some children will be lucky and have these signs but be so intelligent that they can still successfully complete these grades without ever organizing themselves and really working. Others will have teachers who do not require a lot of organization or who will mark a child based on their best effort rather than an average over time. Many parents will be told their child is lazy, uninterested, and not trying. There is difference. In ADHD children can not pay attention. In lazy children, they will not. Impulsiveness-Hyperactivity-- By the time a child is in second grade, he spends as much time sitting at his desk as the average adult. While the attentional demands make a big increase, the demands to sit still increase even more. This is what usually sinks children at this stage. Children are expected to work carefully in groups and then shift to another activity with only a few breaks in the day. They are expected to listen to the teacher, take turns, and immediately calm down after a break. Children with ADHD often can not do this at this stage. They can not sit still or even sit. They are up walking around the room before they even realize it. They climb over furniture and they bug other kids. Others are just constantly talking and interrupting. Waiting in line and playing with others can be a real problem. Some kids are so wound up that they just run around by themselves. Others do many, many dumb things that get them in trouble. This is often because they are not watching the teachers to make sure no one is looking. Most children will wait until they are not being watched before they do something wrong. Children with ADHD will impulsively throw the stone even when the supervisor is looking right at them. As a result, they are caught 90% of the time, while a less impulsive child will be only caught perhaps 25% of the time. This combination of doing more impulsive activities and getting caught for more of them often leads to the child being labeled as a troublemaker. The worst thing that can happen is to have recess restricted as a result of this trouble. Then the child has even less of a chance to blow off her steam. If a child is quite hyperactive at school, the parents usually hear about it from the school all week long. At home it can be just as much of a problem. Here it is often a safety issue. Bikes are going off big jumps, children are never looking before they do anything. Children with ADHD have more accidental poisonings, more fractures, and more lacerations needing sutures. Many can best be described as an accident waiting to happen. Often by this time the child will have found a few activities which can sustain her attention. Video games, computers, and legos are often in this category. Many children are mostly outdoors if they can be. Homework begins at this stage on an occasional basis for most kids but on an almost daily basis for ADHD children. They don't finish the work at school so it is sent home to be done. So the parent must change the environment and supply what the child does not have. The parent usually must sit down in a quiet dull spot and go through the work at the child's side. The parent will have to bring the child's attention back to work many, many times. What could take a normal child 5 minutes takes an hour. It usually drives parents around the bend. To have ADHD, you must show either attention problems or impulsiveness-hyperactivity by age 7. Some children will show both and come to clinical attention. Some will be able to get by even though these problems are present and not require clinical attention. These are usually the children with primarily attention problems and little or no hyperactivity. It is unfortunate that the children with only attentional problems are rarely thought to be anything more than lazy, eccentric, or immature. Later Elementary School Attention-- There is a fairly big gap in Canada between second and third grade. Work begins in earnest in third grade. There is more work in class and more homework. The work is often the type that requires multiple steps and planning. This includes things like book reports and other projects. Outside of school, most children are spending an hour or so on an activity and often there will be almost as much organization required for play as at school. It is the organizational demands that tend to sink children at this stage. Children with ADHD often have great ideas and either don't get started or quit part way through. Left to their own, everything is late. However, they will still mystify their teachers and family by occasionally doing brilliant work on something that they are especially interested in. At this point the amount of work is great enough that most parents can not help the child to keep up unless they spend over an hour a day in homework. This is usually just as frustrating to all parties as when they were younger. It is at this stage that children with ADHD without hyperactivity will start to come to clinical attention. Those are the lucky ones. Since they are often quiet, and not a behavior problem, some of these kids will just drift through these years using only a fraction of their capabilities. Most are thought to be lazy or uninterested. Impulsiveness-Hyperactivity-- Most children with ADHD will settle down a little by this stage. Most can sit in a chair, but are quite squirmy. They are less likely to walk around and more likely to talk out of turn, bug other kids, or become class clowns. Outside of class they still have a hard time staying still and spend a lot of time doing things outside. The big problem is impulsiveness. If you have ADHD, the older you get, the more trouble impulsiveness can get you into. Shoplifting muffins, taking apart vacuum cleaners, starting fires, getting into fights, nearly drowning, nearly getting killed on their bikes, climbing on roofs, and saying very stupid things to people in authority are some typical ones. Evil children will also do these things, but are less likely to get caught. They are "pre-meditated" crimes. ADHD kids do these things for no real reason and are almost always caught. I see many extremely impulsive children at this stage because their parents can see where things are headed and they don't want their child to go down that road. Very impulsive and hyperactive kids at this stage are often labeled as criminals of the future because they are doing dumb things and getting caught. But anyone who spends a lot of time with the child will realize that this is not an evil and cruel person. Junior and Senior High School When ADHD persists into this age range, a whole new set of problems emerges. As a result of these, ADHD in teenagers can be devastating. Why? Often the answer has to do with Executive Functioning. Attention in teenagers-- At this point, the attentional demands on adolescents are the greatest. This is because they have little choice over the courses they take and yet have to do very adult things. The distractions between classes are immense. The adolescent with ADHD at this stage is part of the group who didn't outgrow it at puberty (see Prognosis section). For the most part, they start failing in a big way. Often their attention span is still that of a fourth grader or less, but the demands for sustained attention to boring things is very great. So, they don't do any work. Or they just fail because they are not trying. Or they become the clown to keep from working. At this point, even the most dedicated parents can not keep a child going (see above example of Megan). There is too much work. At this point it is sink or swim, and most start to sink. Many will drop out, skip classes, get in trouble, or only do a few things that actually interest them. It is common to see a child who has failed three times in Junior High be able to teach other kids how to do something which they have not learned themselves. At this point, the schools have basically written off the child as trouble or not able to do academic work. I will see kids in this age group for the first time when the parents have found that they could not do what they did in grade school (see Megan example above) and are seeing their child fail. Impulsiveness-Hyperactivity-- Children are usually fidgeting and restless at this age with ADHD, but unless you spend a fair amount of time with them, they don't seem that hyperactive. However, there is usually a clear preference for activities that don't involve sitting quietly. It is the impulsiveness that is sinking them. At this point, children are suspended for skipping school, disrespectful remarks, fighting and other stupid mistakes. The most impulsive will be involved with drugs, alcohol, smoking, and minor vandalism. Others will do something really stupid like crash a car and be paralyzed, hit a RCMP officer, or accidentally shoot a gun and kill someone. These are all examples I have seen. There are a lot of adolescents with ADHD who are only minimally impulsive and hyperactive, and they are less likely to get in quite so much trouble. They are more likely to just be frustrated, depressed, and drink. By late adolescence, severe ADHD is a horrible problem and can be life threatening. Attention Deficit Disorder in Adults While some adults with ADHD will outgrow it, about 30% will continue to have it. the lucky ones are like Shawn and find a combination of the right partner, the right job, and sometimes the right medicine. The unlucky ones go on to have failed relationships, troubles with the law, drug and alcohol abuse, and occupational failure. All the adults I have ever seen with ADHD have come for help because their children had been diagnosed and successfully treated for ADHD. Either the adult with ADHD or their partners and friends suggested they check out treatment, too. Subtypes of ADHD So far I have described children and adolescents who have both the inattentive symptoms and the hyperactive-impulsive symptoms. However there are some children who have only problems with hyperactivity and impulsiveness and other who have no hyperactivity or impulsiveness at all. Hyperactive-impulsive subtype These are children who are able to perform academically quite well, as long as someone is keeping them busy. They are children who can stand at their desk and walk all around it while still doing their work or reading. Often these children will be in fights, engage in risky behaviors, yet be able to do their work without too much difficulty. Although they might not get a failing grade for bus riding, often they are above average in school work. Little is known of this group. In my practice, only about 5% of children with ADHD have this picture. ADHD without hyperactivity subtype Children with ADHD without hyperactivity are different in many ways from ADHD kids. First of all, they often have lower energy than normal. Often they are less assertive than normal. As a result, they are usually quite popular in elementary school compared to ADHD kids. They are much more likely to have learning disorders (especially Math) than ADHD kids. They are much less likely to have ODD or conduct disorders. There is no difference between ADHD and ADHD-D children in the frequency of other co-morbid conditions. ADHD-D children and adolescents do not get identified early in school, which is a shame. They are more likely to quietly daydream and never accomplish much. As a result, in a busy classroom, the child is not the "squeaky wheel". These children have a tendency to just drift through school. Nevertheless, it can be a very horrible illness. About 15% of ADHD children have this type. The treatment of ADHD without hyperactivity is just the same as ADHD. However, some of the behavioral interventions are not the same, since impulsiveness is not an issue. The two types of causes are genetic and environmental. Genetic About 90% of ADHD is genetic. Studies of adults with ADHD have found that about 50% of their children will also have ADHD. It is certainly possible that ADHD that disappears at puberty will be less inherited than this, but there are no data on that issue. Some researchers have found that if a mother has ADHD, it is much more likely to be passed on than if the father has it. The other problem is that more often than by chance two people with ADHD will marry each other. From basic genetics, one would then estimate that 75% of the children would have ADHD. Another common problem is that people with ADHD marry people who have learning disabilities, which are also strongly inherited. So what exactly is being inherited that causes ADHD? The answer isn't totally clear yet, but researchers are a lot closer to knowing than they were five years ago. A chemical called Dopamine is involved in ADHD. Researchers think that changes in the genes that make the chemicals that transport Dopamine and bind it in the brain may be what is inherited. Alcoholism in parents is also associated with an increased risk of ADHD. If a parent has alcoholism, their child is about twice ask likely to have ADHD. If both parents have alcoholism, the risk is three times as high. It is unclear whether this is from being related to an alcoholic parent or from living with them. Environment As far as ADHD goes, the most important part of the environment is that in the womb and the birth. About 15% of ADHD cases are related to birth trauma or problems with the pregnancy. Women who smoke during pregnancy are more likely to have a child with ADHD. ADHD is more common in most genetic syndromes and is also common in cases of mental retardation. Severe head trauma can produce ADHD, too. About one out of five children with head trauma will develop ADHD. (6) A common question I am asked is if you can "make" a child have ADHD from things like abuse? No one is sure, but probably not. What is certain is that you can worsen ADHD by family chaos, deaths or separation of parents, poverty, abuse and neglect. Food colorings and additives may also worsen ADHD in some cases. Brain findings Over the last few years, researchers have looked at the brain in people with ADHD and have found some clear abnormalities. MRI scanners take a very detailed picture of the brain in cross section. They show that parts of the base of the brain associated with attention are smaller on the right in people with ADHD. The part of the brain that connects the left and right front of the brain has also been found to be smaller in a couple of studies using MRI. When researchers look at how much work different parts of the brain are doing, they have found decreased activity in the front parts of the brain in ADHD. On the other hand, no change is found off and on Ritalin in brain activity with these tools, even though the children are better on the drug. All of these studies suggest that the parts of the brain which we know are involved in planning, attention, and controlling motor activity show some minor abnormalities. They can not be used to test for ADHD, but they certainly confirm its biological basis. Co-morbidity in ADHD When diseases tend to occur together more often than chance would predict, it is called comorbidity. A familiar example is Diabetes and high blood pressure. Identifying comorbid conditions when ADHD is present has led to better treatments and great advances in child psychiatry. When a child is assessed for ADHD, it is absolutely essential to see if any of the other common comorbid disorders are present. The presence of these comorbid problems predicts which treatments will work and what the long-term prognosis is. About 50% of children have ADHD plus some other disorder. Here is a brief description of the common disorders comorbid with ADHD. Virtually all the child hood psychiatric disorders are more common in ADHD. GiRestless Leg Syndrome tend to have more comorbid disorders than boys. Conduct disorder-- This is an inherited disorder characterized by cruelty, violence, and disregard for the rights of others. When it is present with ADHD, it is a bad sign. Approximately 25% of ADHD children also have this. Children and adolescents with ADHD without hyperactivity do not have an increase in Conduct disorder. A third of ADHD children who also have conduct disorder will have committed multiple crimes by the time their teenage years are over compared to 3-4% of children who have only ADHD. Children with ADHD and Conduct disorder have a higher rate of becoming criminals as adults, too. Oppositional Defiant Disorder-- This is a disorder characterized by aggression, bad temper tantrums, and a desire to irritate and oppose others. About 80% of children with this also have ADHD. Children and adolescents with ADHD without hyperactivity do not have an increase in Oppositional Defiant disorder. Tic disorders-- Sudden movements of the body or sudden sounds which are not voluntary are characteristic of Tourette's and related problems. ADHD and tics often go together. Tics can certainly change the treatment of ADHD. Anxiety Disorders-- Anxiety disorders are not uncommon in children, but ADHD children are twice as likely to have them. One-third of ADHD children have anxiety disorders. They predict school failure and strongly influence the treatment of ADHD. Children with ADHD and anxiety are less hyperactive and impulsive than children with ADHD only. On the other hand, children with AHDD plus anxiety have more difficulty with difficult work and get "bogged down" more frequently. Depression-- Varying degrees of depression are present in many children with ADHD, especially after about age 10. This changes the treatment and predicts a worse outcome. About 40% of children with ADHD have marked depression. Often a child with ADHD will have relatives with depression. In some families, some relatives will have ADHD and others depression. Children with ADHD and depression are not more likely to commit suicide. Learning Disabilities-- Many children with these have ADHD. It makes life even more frustrating and difficult. About one third of ADHD children have learning disabilities. Children with ADHD without hyperactivity have more learning disabilities. If a child with just learning disabilities is given stimulant medication for ADHD, it will not improve their learning. However, if a child with ADHD and learning disabilities (especially a reading problem) is given stimulant medication, their reading improves markedly. Mania-- Mania is quite rare in children. It is the opposite of depression. About 90% of manic children have ADHD. This is a very, very severe problem when it occurs. Autism and related disorders-- ADHD is present in about a quarter of this group, about five times what you would expect. Enuresis and Encopresis-- Not being in control of your feces or urine is much more common in ADHD than in children without ADHD. Having ADHD can make it harder to control these problems. On the other hand, many times the treatment of ADHD will improve these problems also. About 30% of children with ADHD have enuresis. Developmental Coordination Disorder-- Being exceptionally clumsy and poorly coordinated is much more common in ADHD children. This combination can lead to very poor self-esteem, especially in boys. Speech-Language Disorder-- This is one of the most well documented connections. ADHD is much more common in this group. ADHD can make speech therapy much more difficult. Epilepsy-- About 20-30% of children with epilepsy also have Attention Deficit Hyperactivity Disorder. In a recent study, 70% responded positively to medications for Attention Deficit Hyperactivity Disorder. (11) The medications for Attention Deficit Hyperactivity Disorder are safe with most seizure medications. Auditory Processing disorder-- These persons hear all right, but they have a hard time filtering out sounds that are not important. About 50% also have ADHD or one of the sub-types of ADHD. Substance abuse-- If you go to drug and alcohol programs for teenagers, you will find many more cases of ADHD than you would expect. However, the good news is that this is not due to ADHD, but due to Conduct Disorders. That is, ADHD alone is not associated with an increased risk of substance abuse, outside of cigarettes. Conduct disorder is associated with a marked increase in substance abuse. So if your child has conduct disorder and ADHD, there is a great risk of substance abuse. But if the child just has ADHD, he or she is not at a higher risk for drug abuse as a teenager. (22) There is some evidence to suggest that if a person still has ADHD as an adult, even without conduct disorder, they will be at a greater risk for alcoholism. ADHD is a very serious condition. Some children will grow out of it and have few problems. Many will not. It is in these children that treatment is essential. My view is that ADHD should be treated aggressively. Children should be treated early. A number of different interventions should be tried. Parents should learn all they can about this condition and demand the best possible treatment for their children. The prognosis can be very bleak, but that doesn't mean that it is hopeless. I have seen children and adolescents with multiple co-morbid conditions and other bad prognostic features do well with treatment that involves a little bit of everything. Unfortunately, I have also seen many children who seemed immune to any intervention. <== Back ==> Need Solutions? Get a free consultation here. |
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Attention Deficit-Hyperactivity Disorder
