Host: A lot of kids at school seem to be daydreaming and not focusing, and the teachers are concerned; maybe the kid has some kind of a focusing problem. What's that all about?
Steven Pavlakis: Well, there is such a thing as Attention Deficit Disorder with or without hyperactivity, and these are children that have problems with concentration, distractibility, impulsivity, and they maybe hyperactive as well. They don't have to be. The boys that have it are more likely to be hyperactive, girls are less likely to be hyperactive, but they don't have to.
Host: What's the ratio between boy and girl?
Steven Pavlakis: I don't know the exact number but I think its 2:1 or 3:1; boys more commonly have it than girls. It's also probably under-diagnosed in girls.
One of the problems with this whole condition is that, the teachers worry about it if the kid is hyperactive, because they are disrupting the class. That's not necessarily something that we are all worried about, it's really the teacher's problem in that situation. Whereas, you might have a child that sits there and is inattentive and doesn't learn anything, and the teacher doesn't worry about that child because the child is not disruptive. That child is actually one that we don't want to miss, because that child might be the one that's truly falling behind.
Host: How can we diagnose this, are there any test we can do?
Steven Pavlakis: Well, ADHD is just in general, its usually a genetic condition. These children tend to be disorganized, felt to be immature. The key thing to know about ADHD is it does and can get better as you get older. It's an immaturity of attention, and that's really what it should be looked at. It's not really a disease as such, but its an immaturity of concentration, where your concentration improves.
Host: Is there any written test that can be done for that?
Steven Pavlakis: And what we do is we can do tests for it. There are several ways of diagnosing it. One way is by a standard scale that has been validated. Sometimes parents look at this and say, well, this is ridiculous, but it does work, where we give a scale that's checkoff list to the parents and to the teachers, and we can score that scale and make a diagnosis that way.
Host: What's the main test?
Steven Pavlakis: There are different tests. There is a Conners, which is most commonly used. There is a Vanderbilt, there is also a snap form that I tend to like. This is generally the way we diagnose it.
Once we diagnose ADD or ADHD, the treatment is really three fold. First is educational. These children need more structure, discipline, and consistency, and that's really the first thing to do.
Host: For some kids it might be all you do?
Steven Pavlakis: That's right, that's right. Some kids, all they need is a little bit of structure and discipline and they do very well, and their attention gets better as they get older, and that's really the first step.
Host: What percentage of kids truly diagnosed do you think would be better with better structure?
Steven Pavlakis: Well, I don't know that answer, I am not sure that anybody really does know that answer. ADHD is a little more complicated than just taking a percentage, because some children with ADHD have other issues too. They are more likely to have learning disabilities, depression. Again, most of them don't, but if you take, they are more likely than other children to have other issues. Obsessive compulsive behaviors, ticks.
So it's a very complicated disease or constellation of symptoms. So I don't really know the percentage, but the first step I think is to give structure, discipline, and consistency, and that in part to pick and choose your battles.
Host: If you were going to treat the kid, how would you treat the kid?
Steven Pavlakis: Well, picking and choosing your battle sometimes -- some behavioral inventions with the parents and the kids can be helpful. In that, sometimes children have a hard time doing a certain task, and if the parent keeps pushing it, all you are going to do is get resistance, and there should be certain structure to that.
Then after this, if a child is falling behind academically or socially, or if they are getting frustrated and feeling badly about themselves because of the ADHD, those children sometimes do best with a crutch, and the crutch would be medication.
Host: Of the medicines, there are different types. Can you just talk a little bit about the different types of medicines?
Steven Pavlakis: Sure. The first line medications that we use are the stimulants, and they include such things as Ritalin, Concerta, Adderall, Dexedrine, Focalin; these medications are very similar, have similar mechanisms of action, and similar side effects. They work very well in a child with ADHD for the time that the child is on it, but of course in some children, there are side effects.
I should stress that there is no evidence that these medications have a long-term effect. In other words, if I put a child on Ritalin, it's not that the child would be a better student when they are 18, all it affects is when you are on the medication in terms of testing or the like.
Host: If we start medicine, does it mean its for life, can it be stopped?
Steven Pavlakis: Yes, as I said, the course of ADHD for most people is one of improvement, and some patients may only need it at certain times. ADHD is usually picked up in kindergarten or first grade. If it's a little milder, it may get picked up in third grade, when a child has long duration, it's very hard to concentrate. If it's even milder, there might not be a problem until a child is in middle school, when they are changing classes, and they fall apart organizationally. So there are different degrees of it.
Very often children may only need it for a couple of years and then can stop it. There are adults however that need stimulants to keep their lives, marriages, and work environment together.
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