A study published in 2001 in
Journal of the American Medical Association, indicated that children with AD/HD
were more likely to need medical care.
The investigators followed the medical
histories of more than 4000 children for nine years. The median medical costs
for the non-AD/HD children was $1944 as compared to $4306 for the AD/HD group.
The AD/HD children had higher rates of accidents and medical illnesses than the
children without AD/HD.
The AD/HD children were more likely to
end up in an emergency room with an injury. They had more visits to their
primary care doctors and to hospital clinics. They had more infections, asthma,
and interpersonal problems.
It is interesting to note that the
study did not count mental health visits or prescription drug costs. If these
had been factored in, the cost difference might have been much higher.
Past reports have noted that adults and
children with AD/HD are more likely to experience bone fractures, car accidents,
and chronic medical conditions.
What can we learn from this data?
Parents and teachers should be alert for situations that might put an AD/HD
child at risk for injury. The very child who runs out to skateboard without
helmet and knee pads is actually the child who most needs these safety devices.
Childproofing should extend well beyond the baby years.
If your children are more likely to
need emergency services, ask your child’s doctor about your local emergency
rooms. Some emergency rooms are better than others at handling a young
hyperactive child. Some hospitals have separate emergency areas for children and
adolescents with doctors and nurses who specialize in treating children. Some
may even provide a staff member to help with an active sibling while the parent
is comforting the injured child. Other emergency rooms lack pediatric
specialists and leave the parent and children to fend for themselves in an open
noisy area with dangerous (but fascinating) medical devices all around.
Families affected by AD/HD must have
access to insurance and adequate medical care. Those who are unable get
insurance should get documentation of the child’s medical and psychiatric
conditions and talk to their doctor about whether the child might qualify for
one of the “gray zone” insurance programs.
Health care practitioners should screen
AD/HD children carefully for non-psychiatric illnesses and spend time educating
Read our other
articles on Attention Deficit/Hyperactivity Disorder in Children and Adults
Adult Attention Deficit Disorder:
Diagnosis, Accommodation and Mastery
Gifted Student with ADD: Between Two Worlds
Women and Attention Deficit Disorder
the Adult with ADHD
Deficit Disorder in Children and Adolescents
How Computers Can Help Individuals
slides from our presentation on AD/HD in Adults
Links related to ADHD
This Site By Key Words
There has been controversy about the use
of medications to treat both children and adults with Attention Deficit Disorder There
have been articles debating whether Ritalin is over or under prescribed. When people ask
me about this, I tell them that I can only answer for the children and adults that I have
evaluated or treated. Yes, there probably are some individuals who have received
medication when some other treatment might have been better. On the other hand, there are
probably others who were not been diagnosed for years and could have benefited from
medication. Finally, even if someone has attention deficit disorder (ADHD) and is on
medication, is it the best medication, dosage and timing?
Medication can be quite helpful if prescribed in the right context.
First the individual needs a thorough evaluation. If medication is prescribed, it should
be followed closely. Small changes in timing and size of doses can make a difference.
Although Ritalin is the best known medication for ADHD, there are a
number of other useful medications. For individuals who have an incomplete response to one
medication, the doctor can often work with the patient to find another medication or
combination that does control symptoms. Some of the secondary medications may require
closer monitoring during the initial phase of treatment.
Sometimes medication failure is due to lack of communication between
patient and doctor. (and sometimes school) The doctor, patient and family should be clear
about exactly which symptoms they expect the medication to treat. Patients should ask
questions. They should inform the doctor if there are side effects or if the medication
does not seem to be working.
If medication is still not working as expected, it may be time to
re-evaluate the diagnosis. Individuals with ADHD may also have other disorders at the same
time. Anxiety and depression may superficially resemble ADHD. Occasionally a medical
illness may masquerade as a psychiatric condition.
Medication can only take the individual part of the way to recovery.
Therapy, community support, coaching and the individuals own determination are important
parts of treatment.
Carol Watkins, MD