How is ADHD diagnosed? ADHD is a neurodevelopmental disorder. Psychiatric evaluation is made with the child and family to determine whether this disorder is present in a child. If necessary, information is obtained about the presence of symptoms in the school environment or whether they cause a problem. While obtaining this information, scales that question some ADHD symptoms are used. The diagnosis of ADHD is made by this clinical evaluation. The information that the diagnosis is made with tests written in the media or social internet environments does not reflect the truth. In other words, the diagnosis is made with the psychiatric evaluation made with the family and the child. In this interview, detailed information is obtained about the symptoms and their effects on the child's life are investigated.
Laboratory and imaging methods used in the diagnosis of ADHD are not used. Again, unless there is an additional psychiatric problem related to ADHD, intelligence tests are not used for diagnosis. In case of additional problems, when differential diagnosis is required, intelligence and attention tests may be requested to assist the diagnosis. It is not correct to apply only attention tests to diagnose ADHD, especially by those who are not child psychiatrists. Diagnosis cannot be made without clinical evaluation. Likewise, treatment practices related to conditions that are not properly diagnosed are not correct. In this context, if families are worried about their child having ADHD, applying to a child psychiatrist will prevent both wrong approaches and delays in treatment. is a disorder. After diagnosis, treatment begins. When these children do not receive treatment on time, as I said above, they begin to have problems in school success. The child, who is active at first, cannot sit still, is distracted, has problems in class success, and the problem with academic skills increases gradually. Although the mobility decreases in some children over time, the problems in school success, reluctance towards school, self-confidence problems and sometimes depressive complaints can be treated. It is accompanied by niche problems. These children are both stigmatized at school and underperform at school. Sometimes they can be unwanted, expelled children from school. In cases that reach this point, treatment should be started quickly and support should be provided for the child's adaptation to school and success. When the treatment is started in the early cases, the above-mentioned problems related to school success, adjustment and relationships are intervened before they occur. When treatment is started, the majority of children show improvement. If the symptoms persist in a very few groups, however, they are tried to be improved with additional treatment options.
Children with ADHD, for example, who have problems in school success due to distraction, can improve their attention after treatment, and therefore their school success may also improve. Again, those who have behavioral problems in school, friends, and family relationships due to ADHD symptoms also improve, and they become more adaptable children with fewer or no relationship problems. Especially during adolescence, school problems have increased a lot, and children who want to be expelled from school are tried to ensure their attendance at school first with treatment and support, and then their school success becomes better. They see that these symptoms do not improve by punishing them and they feel helpless. They are relieved when they learn that the symptoms that occur in their children are caused by the child's structural characteristics, ADHD, and that this condition can be improved with treatment. When they comprehend the characteristics of their children, together with their causes, they develop more accurate approaches and solutions for their children. . In this disorder, structural and functional differences in the brain areas related to attention, impulsivity and mobility have been revealed. Therefore, ADHD is a neurobiological disorder. The drugs we use in the treatment aim to normalize this attention by rearranging these differences in the systems that regulate our mobility and impulsivity. That's why we use drugs in the treatment and really These drugs also improve the symptoms related to hyperactivity, attention and impulsivity.
There are special camps for such children in the USA. What kinds of studies are carried out in Turkey?
My ADHD in Turkey I do not know if there are special camps for the patient. Although sports or activities are seen as areas where the hyperactive child can release his energy, it is also very important for him to be in the social group, to learn the rules of this social group, to be able to control himself, to take responsibility, to develop social skills, to have self-confidence, to receive positive feedback and to be accepted. Children who are very active and have difficulties in adapting within the group should be directed more towards individual sports or activities. However, children with ADHD who are not treated can get bored with these activities quickly because they get bored with everything. For this reason, it is important to start treatment especially for children who are not treated, in terms of continuing these activities.
What can be recommended to the families of children diagnosed with ADHD for the summer vacation?
Families often tend not to use drugs during the summer vacation. . This is wrong. If physicians deem it necessary during treatment, they may discontinue the medication in the summer and want to look at the ADHD picture. Families should not stop taking their medications except on the recommendation of a physician. Again, these children are children who have problems in daily life and relationships due to ADHD symptoms. In other words, they have problems while eating at home, playing games, going somewhere and passing time. However, in summer, these children need to have a good and trouble-free time with their families and peers, and be able to continue some activities like playing games. Again, it is children who are at high risk of accidents. Fall fractures are more common in these children. In this respect, it seems important to continue the treatment in children at risk. Along with the treatment, suitable holiday or activity options should be offered to the active and energetic children. Summer vacation or daily programs can be made according to the child's approval and interest. This was mentioned above. It should be taken into account that preschool children get bored quickly, while choosing games, new, new, different games can be selected. When they get bored quickly in group games and do not follow the rules and cause problems, they may need the supervision of adults while playing with their peers.
What is the advice for families who insist on not taking medication?
Sometimes, families are surprised when they are told that they really need to start medication, and they start off. may not want. Because according to them, starting medication for a very active child without an organic cause is not something they expect or bring to mind. The most important way to solve this problem is for families to talk to their doctors about all their questions and concerns. The most important pillar of child psychiatry interviews is the section where we inform families about the disease we call "psychoeducation". Physicians inform their patients about the child's condition, diagnosis, treatment options, what they will face if there is no treatment, and what the course of the disease will be if treatment is given. When this information is done well, most of the families' worries disappear and they decide to start treatment comfortably. If families who receive and understand the information correctly still insist on not starting medication, they are followed up with the physician for a while without medication, and in the meantime, the family's approach and the child's progress are checked. However, some families may search for drug-free treatment options on the Internet or seek other appropriate treatment options with hearsay recommendations. These options are a waste of time. It results in the child and family contacting us again when the problem grows. Meanwhile, the child suffers many losses and additional problems arise.
Do the drugs used have an addictive effect?
There are two groups of drugs that we use in treatment in Turkey. One of them is with a red prescription and the other is not with a red prescription. So we also have red over-the-counter drugs on hand. One of these is the drug called methylphenidate, which is sold with a red prescription. This drug, like other addictive substances, is a drug that has the potential to be addictive when used outside of the doctor's control. However, when used under the supervision of a physician in patients with ADHD, it does not cause addiction when used as recommended by the physician. On the contrary, the untreated group of children with ADHD and conduct disorder is dependent on other substances. there is a risk of being But when this group was treated with methylphenidate, they significantly reduced the risk of future substance abuse. In fact, considering this information, we can say that ADHD treatment protects children from substance abuse. The other drug is atomoxetine. The efficacy of both drug groups is similar. The therapeutic efficacy of both drugs is very high. So this means that when we start one of the two drugs, most of these children get better.
What are the side effects of these drugs?
Both drugs mentioned above are the ones that cause ADHD symptoms in the brain. regulate the amount of chemicals. These substances need to be regulated in order for the brain regions that regulate behavior related to attention, mobility and impulsivity to function normally (for these symptoms to be at a normal level) in children with ADHD. Methylphenidate is a drug with short (two to three doses per day) and long-acting (one daily dose in the morning) forms. The most common side effects of methylphenidate are headache, abdominal pain, loss of appetite, weight loss, and insomnia. More rarely, side effects such as palpitations, withdrawal, nervousness, tics, increased mobility may occur. Atomoxetine is taken once a day. The most common side effects of atomoxetine are nausea, abdominal pain, dry mouth, irritability, weakness, fatigue, and loss of appetite. Side effects seen during the use of both drugs often subside within a week or two. The dose is reduced in case of persistent and severe side effects that disrupt the child's daily life. Families should inform their doctor when side effects occur. Doctors will take the necessary measures to reduce the side effects.
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