John Clark, Deseret Morning News

Dr. Russell A. Barkley, a professor in the Department of Psychiatry at the Medical University of South Carolina, is an authority on attention deficit hyperactivity disorder. He's the author of "ADHD and the Nature of Self Control" and "Taking Charge of ADHD."

He'll be sharing his expertise at the Feb. 4 conference of the Utah Association of School Psychologists, where he'll be the keynote speaker.

ADHD is a complicated subject. The definition alone is long and complex and seems subject to interpretation.

We asked him a few questions about recent developments regarding ADHD.

Deseret Morning News: What's the credible research showing regarding the causes of ADHD?

Russ Barkley: The disorder has now been shown to be highly genetically influenced. More than 80-90 percent of the variation in the behavior pattern in people, regardless of country, has been shown to be controlled by genetics. These studies, which are now very numerous, are all consistent in showing that social factors inside the home (parenting, TV, diet, videogames, etc.) play no significant role in causing the disorder. But events outside the home as well as unique events that can happen to a child (birth complication, pregnancy problem, head injury, disease, lead poisoning, etc.) may also be causing a smaller percentage of cases of ADHD.

Deseret Morning News: What's the credible research showing regarding the treatments or methods of helping a child with ADHD?

Russ Barkley: For most cases, a combination of medication (either stimulants or Strattera) with counseling of the parents on more effective methods for managing difficult child behavior, and consultation with schools on classroom and curriculum adjustments, works the best. Each of these approaches alone has weaknesses that the others can help correct. We have also learned that treating children for short periods of time produces no lasting benefits. Like diabetes, treatments have to be maintained longer to result in improvements that really matter.

Deseret Morning News: What would you tell parents who have just faced up to the fact that they have an ADHD child who is difficult to manage?

Russ Barkley: First, it's not your fault. As I noted above, the disorder is largely of genetic and neurological origins. So, give up the guilt. Second, while parents may not cause ADHD, they can determine just how impaired a child will be and whether that child goes on to also develop serious defiance or depression by how they deal with the child. Lax or abusive disciplining not only won't help but may contribute to additional problems.

Third, we know more about ADHD and its treatment today than at any time in history, so be thankful you weren't raising one of these kids 20-30 years ago.

Fourth, be careful what you learn from TV and the popular media, which often tend to sensationalize or scandalize stories about ADHD, medications or its causes.

Finally, realize that while you may not have gotten the perfect child you always wanted, these children can bring their own unique style and benefits to being a parent, not the least of which is that they challenge you to have to be a better, more proactive and more thoughtful parent than people who get easy-to-raise children. Rising to their challenge can be fulfilling in knowing that you are being tested as a parent and must meet challenges most parents don't have to face.

Deseret Morning News: What are the signs parents should be aware of that may indicate their child may have ADHD?

Russ Barkley: Serious problems with being overactive, restless, fidgety, distractible, unable to concentrate and highly impulsive beyond what you see in other children of the same age. Also, when other parents or teachers give you feedback that your child's behavior is different from others, take it seriously as it's often a sign your child does have real problems. Finally, if these behaviors result in your child being impaired in any major life activities (peers, family, school settings), it's a sign that this is more than just being an energetic child.

Deseret Morning News: What should parents do if they think their child has ADHD?

Russ Barkley: Of course, see your family physician assuming they are knowledgeable about ADHD. If not, find the nearest medical school and see a developmental pediatrician with special training in behavioral disorders.

Or, find a good child psychologist or psychiatrist, though most insurance plans want you to start with a primary care doctor first. If all else fails, see if there is a local CHADD group that you can contact for advice about professionals in the area who are good (www.CHADD.org is a good Web site for information).

Deseret Morning News: What about medications? Are there any new ones? What's on the horizon? How do they work? What is their effect?

Russ Barkley: Two recent developments have really helped treatment. First, there was the development of the new once-a-day delivery systems for the older drugs we had (methylphenidate or Ritalin, Dexedrine). These new delivery systems last 8-12 hours and mean kids don't have to take doses at school any more — a real benefit to kids.

Second, we have a new drug, Strattera (atomoxetine) that is not a stimulant, not a schedule II drug, and therefore is easier to prescribe, has no addiction potential, and may be of more help if your child has anxiety, depression or tic disorders, as it won't make those worse and may even help anxiety.

Deseret Morning News: Can children with ADHD be successful later in life? What will life likely hold for them? Can they be employed? What are the chances their children will have it?

Russ Barkley: Yes, they can be successful, provided that treatments have been sustained through childhood and adolescence and where serious conduct problems or antisocial behavior can be minimized. They are certainly employable, and many find that certain jobs fit with their symptoms, such as door-to-door salesperson, musician or performing artist, the military (very structured), the trades (hands on, less conceptual long-range thinking), etc.

If the ADHD is genetic, 25-35 percent or more of the children of that person will have the disorder.


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