Number of kids with ADHD continues to grow

The number of children diagnosed with Attention Deficit Hyperactivity Disorder increased by 22 percent between 2003 and 2007, according to the Centers for Disease Control and Prevention. That's now about 10 percent of all children between the ages of 4 and 17.

Dr. Jon Hallberg spoke with MPR's Tom Crann on Friday about how the disorder is diagnosed and treated. Hallberg is a physician in family medicine at the University of Minnesota and director of the Mill City Clinic in Minneapolis.

Tom Crann: First, let's start with the basic definition. For years I heard ADD. Now it's ADHD. What are we talking about here?

Dr. Jon Hallberg: Well, the pendulum has swung a little bit. I think it started off as ADHD [and] we kind of lost the H and now we're back to the full. And the reason is that there really are two major camps within this umbrella statement.

So you're got the inattention part, the part where it's hard to focus, hard to complete things, hard to organize life. And then on the other hand, you have the hyperactivity part. We can all imagine what that looks like, that kids just simply can't sit still. They're squirmy. They just really can't sit and listen to things. And so you have these two major camps.

And then the minority of children that have this condition actually really have the full spectrum, they have both of those. So, most of the kids have one or the other.

There are actually about 15 to 20 different criteria that you have to look at. So it's not as easy as you might think. There's a lot of checking off of boxes that need to occur to actually make this diagnosis.

Crann: Tell us how it's done.

Hallberg: Well, if a kid comes in, and this is to a physician's office or a psychologist's office, if we're really going to go through this, we'll print off a checklist, but it's more than that, of course. And you really have to look at how are teachers feeling that a child is doing, how are parents feeling. There's a lot of observation that goes along with this, and history. This is not something that you make a quick decision about. It's not something that's been going on for a month or two. This is typically much longer than that.

Crann: Cases up 22 percent between 2003 and 2007 &emdash; more cases or just more correct diagnoses?

Hallberg: I think in this particular case, it's a little bit of both. Certainly more awareness, parents are more and more aware of it. Teachers are more aware of it ... We've got such pressure in the schools now for performance, and if kids are not able to meet certain performance marks, teachers are wondering, parents are wondering. So I think it's an education piece, and perhaps we are actually seeing more and more true cases of it.

Crann: What's the treatment here for it?

Hallberg: The easy answer is medication, and this may seem odd, but most of the medications we use for this are actually stimulant medications. It seems like it's the exact opposite.

Crann: It seems counterintuitive.

Hallberg: Counterintuitive, but in fact what is does is it stimulates part of the brain that allows us to focus, to sit still, to zone in and actually pay attention to things, complete tasks. At least that's been the way it's been traditionally. These are Ritalin, for example, methylphenidate, medications like Adderall, and they're basically amphetamines. There's a new category. There's a new medication called Strattera, atomoxetine, and this medication has the same affect, but it's not classified as a stimulant. And this is really opening up a new area of treatment.

Crann: So what is life like for kids who are diagnosed with ADHD?

Hallberg: Well, life can be really difficult, both at home and at school and with anyone who's involved with caring for kids. They can come across as being very funny, sort of entertaining, in a way, but it's really tough when you have a classroom and there's several kids that are running around, simply can't sit still. They're not completing their homework. They are interrupting, asking questions. I mean we've all kind of seen that, or at least we've had that sense that we've seen kids like that.

Crann: Some of us may have even been kids like that. When you and I were kids, they said you had ants in your pants and you need to exercise more self control. But this is beyond that.

Hallberg: This is beyond that. I think everyone expects if you have a classroom of first, second, third, fourth graders, there's going to be a lot of activity going on. But as we get older, we gain that sort of control. We have that ability to sit still and complete things. So I think that it becomes much more obvious as kids rise in the elementary school years and get in to junior high.

Crann: In the end, is this something that kids can grow out of or that may be okay without treatment?

Hallberg: Well, sure. In fact, I think it's really important to note that treating kids for this is not a simple activity. I mean some parents absolutely want their kids treated. Many parents are very, very opposed to it. So it's not without controversy, and for good reason. When we prescribe these stimulant medications, these are Schedule II drugs. They're potentially [addicting] medications. So we have to be really, really careful about them. So yes, kids do seem to grow out of it to some extent. There's a thought that perhaps 40 percent of kids who have ADHD will go on to become adults with ADHD. So almost half the people that have it will continue with it, or so the thinking goes. Crann: Into adulthood, and that leads us to our next discussion. Jon and I will talk more about ADHD in adults as well on Monday.

(Interview edited and transcribed by MPR reporter Madeleine Baran)

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