Center
for Disabilities and Development
Nationally
designated as Iowa’s University Center for Excellence on Disabilities
Center for Disabilities and Development 877-686-0031 (toll-free, voice)
CenterLines@uiowa.edu 866-686-0032 (toll-free, TTY)
http://www.uihealthcare.com/cdd 319-353-6900 (local)
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SPRING 2003
CenterLines
Front and Center with useful news for families!
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In this issue:
Kids Who Just Can’t Sit Still: Understanding ADHD
Modern
Medicine and ADHD
When Andy Saws Logs All Night: Snoring, Sleep Apnea and Your Child
Questions, Suggestions, and Comments
Breaking News!
What Behavior Can Tell You About Health
Coming Soon in CenterLines: The Winter ’03 issue of CenterLines
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Kids Who Just Can’t
Sit Still
Understanding ADHD
ADHD, or attention deficit hyperactivity disorder, has three
forms:
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• Some children, especially girls, only have
attention deficit —
problems with paying
attention and staying on task.
• Other kids are hyperactive (they can’t sit
still) and impulsive.
• And some children have both
attention deficit and hyperactivity.
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Children with ADHD have a physical problem. In ADHD, the
parts of the brain that control attention, restlessness, and impulsiveness
don’t work as well as they should.
Behaviors that suggest
ADHD
All children have problems at times with attention and
hyperactivity. Generally, as children get older, they can control their
behavior better. But children with ADHD continue to have problems.
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A child with ADHD often:
• Doesn’t pay attention
• Is disorganized, forgetful, loses things
• Can’t concentrate, is easily distracted
• Leaves tasks unfinished
• Doesn’t listen
• Talks too much, interrupts
• Answers before hearing all of the question
• Acts without thinking
• Can’t sit still, fidgets
• Doesn’t play quietly
• Doesn’t take turns
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Is it really ADHD?
A
child with ADHD has problems regardless of the setting. For example, a child
who does many of the things listed above when he’s at school, but is well
behaved at home, probably does not have ADHD.
Sometimes other conditions cause behaviors that suggest
ADHD. For example, if a child has vision or hearing problems, he may not
listen, be restless and unfocused, or not finish his work. A child who finds
class work too difficult or hard to understand may develop behaviors that look
like ADHD. A child who is dealing with lots of stress at home, or is a nervous
child, may also behave in ways that suggest ADHD.
Testing
for ADHD
Correct diagnosis is important, because it determines
treatment. If you think your child may have ADHD, testing can be done in a
health care setting or a school setting.
Your family’s health care provider or a local psychologist
can assess your child for ADHD. However, those who specialize in pediatrics –
children’s health care– are often better trained in diagnosing ADHD. In order to make an accurate diagnosis, it
is very important that they have behavioral reports from school and home.
If your child is in school or preschool, your local Area
Education Agency (AEA) may provide ADHD evaluation free of charge, although you
may need to ask for the evaluation.
Early
identification is important
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Left
untreated, kids with ADHD are more likely to have:
• Behavior problems
• Psychological problems
• Learning problems
• Difficulty getting along with teachers and
other children
• Accidents
• Drug abuse problems when they are older
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If you are concerned about your child and ADHD, it is a good
idea to have a complete evaluation. For children found to have ADHD, the best
treatment is often a combination of medication and a behavior management plan.
Are you concerned about ADHD and your child? Sharon Helt, CDD
educator, or Linn Noble, CDD psychologist, may be able to
help.
You can contact them at:
Sharon 319-356-3778
Linn 319-353-6129
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Modern
Medicine and ADHD
Treatment for people with ADHD typically includes some form
of medication. Usually stimulant medication is tried first. Stimulant
medications help the brain regulate the activity of neurotransmitters —
chemicals in the brain that transmit information from one cell to another.
Ritalin, Focalin, Metadate, and Concerta are one group of
stimulants. Another includes Dexedrine, Dextrostat, and Adderall. A new
medication, Strattera, works much like the others, but it is not considered a
stimulant so getting it refilled doesn’t require a new prescription each month.
The biggest difference between these medications is how
often they need to be taken. One dose of Concerta or Adderall XR usually lasts
all day. Other medications may need to be taken more than once a day. What is
important is that you use the medicine that works best for you.
Common side effects with these medicines are poor appetite,
stomachache, constipation, and mood swings. If you take them at the right
times, they shouldn’t make it hard for you to sleep. In the right dose, they
shouldn’t cause mood swings. Research shows that children with ADHD who are
treated with medication are less likely to use street drugs or get into
trouble.
For some people with ADHD, these medicines do not work or
need to be used in combination with other medications. Blood pressure medicines
called clonidine or Tenex are sometimes used. For some people, medications used
to treat depression, such as imipramine or Wellbutrin, are helpful.
The role of any ADHD medication is to help a person with
ADHD to focus better and be less impulsive. However, a behavior treatment plan
is also an important part of treatment.
Do you have questions about medications used to treat ADHD?
Joni Bosch, CDD Family Nurse Practitioner, may be able to help. You can contact
her at 319-356-4686, or joni-bosch@uiowa.edu.
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WHEN ANDY
SAWS LOGS ALL NIGHT
Snoring,
Sleep Apnea, and Your Child
We’re all familiar with snoring adults, but snoring kids?
You may be surprised to learn that at least one of every five children snores.
Most of the time, it’s nothing to worry about. But for some children, snoring
can signal a serious condition called sleep apnea.
Apnea means “not breathing.” A child with sleep apnea
briefly but repeatedly stops breathing while asleep. Each time, breathing will
stop for at least two breathing cycles, or at least 10 seconds.
Sleep apnea can happen because something blocks the nose or
throat. For example, enlarged tonsils or adenoids can do this. Another form of
apnea is caused by problems with the part of the brain that controls breathing.
This “central” apnea is most common in premature babies. Some children have
both obstructive apnea and central apnea.
Symptoms. Sleep apnea
produces symptoms when children are awake, as well as when they are asleep.
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Symptoms during the
day
• Grumpiness when
waking up
• Very sleepy during
the day
• Breathing through
the mouth rather than nose
• Behavior problems
like hyperactivity, aggressiveness
• Learning problems
• Resisting going to
bed
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Symptoms
at night
• Snoring
• Breathing hard,
choking, gasping
• Breathing stops
repeatedly but briefly
• Restless sleep,
frequently wakes during the night
• Odd sleeping
positions
• Heavy sweating
• Wetting the bed
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Diagnosing sleep apnea. If you think your child may have
sleep apnea, talk to your doctor or pediatrician. Ask for a careful exam for
your child, beginning with taking a detailed health history. The physical exam
should pay special attention to ears, nose, and throat. It should also include
a complete neurological assessment. One goal of these exams is to rule out
other disorders.
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Untreated sleep apnea can contribute to:
• Delayed growth
• Hyperactivity
• Learning disorders
• High blood pressure
• Heart disease
• Stroke
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If the exam suggests sleep apnea, the next step is to map
your child’s sleep patterns. A sleep
diary may be helpful. You health care provider can talk with you about how to
do this.
Finally, to confirm a diagnosis of sleep apnea, an overnight
sleep study should be done. Pediatric sleep study centers, such as the CDD
Pediatric Sleep Disorders Service, can perform such a study. Depending on the
situation, a daytime nap study (multiple sleep latency tests) may also be
needed. If the study confirms the diagnosis, the doctor will talk with you
about the best treatment for your child.
Why
worry about sleep apnea?
Apnea
–> Ill health. Letting a
child’s apnea go untreated can cause serious, long-term health problems. It can
contribute to high blood pressure, heart disease, and stroke. It may slow a
child’s growth as well.
Apnea
–> problems with school. Sleep apnea
can also cause real problems for a child at school. That’s because children can
react differently than adults when they don’t get enough sleep. While sleep
deprivation usually makes an adult slow moving and groggy, a sleep-deprived
child often becomes very restless, and can’t focus or pay attention. Several
studies have shown that children have been misdiagnosed with attention deficit
hyperactivity disorder (ADHD) when they are actually sleep deprived due to
sleep apnea. When their sleep apnea was treated, their ADHD symptoms disappeared.
Do
you have questions about sleep apnea? Deborah Lin-Dyken, MD, director of our
Pediatric Sleep Disorders Service, may be able to help. You can contact her at
319-353-6132, or deborah-lin-dyken@uiowa.edu
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QUESTIONS?
SUGGESTIONS?
COMMENTS?
We’d
love to hear from you!
Send your questions, suggestions, and comments to:
CenterLines
Center for Disabilities and Developments
University of Iowa Hospitals and Clinics
100 Hawkins Drive - Rm 217
Iowa City, IA 52242-1011
Or
e-mail CenterLines@uiowa.edu
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BREAKING NEWS!
What Behavior Can
Tell You about Health
When a baby has an earache, her behavior — ear rubbing,
fussiness — tells you. Behaviors can also alert you to illness in older
children and adults. For example, your elderly aunt with Alzheimer’s may not be
able to explain how she feels, but her behavior can tell you if something is
wrong. “Listening to What Behaviors May Be Telling Us,” a new series of free
fliers, describes the behaviors found with specific conditions. To learn more,
or to get your own copies of these fliers, you can:
Visit http://www.uihealthcare.com/cdd and then click on "Center for Disabilities and Development"; then click on "Info resources" (on the left tool bar); then click on "Digital Library" and then click on "Behavior Cues"
E-mail CenterLines@uiowa.edu
Call 1-877-686-0031 (toll free, voice)
1-877-686-0032
(toll free, TTY)
Coming Soon
in CenterLines
This
winter’s CenterLines will focus on:
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• How you can help your child stay dry at night
• Constipation - What causes it, how to prevent
it, and how to treat it
• Encopresis - What it is, and how to deal with
it
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The
role of the information in this newsletter is not to provide diagnosis or
treatment of any illness or condition. We strongly encourage you to discuss the
information you find here with your health care and other service providers.
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CenterLines, the newsletter of the Center for Disabilities and
Development at the University of Iowa Hospitals and Clinics, is published three
times a year. It provides families with current information on child and adult
development, issues affecting people with disabilities, and CDD resources
available to them and their families. The newsletter is available in print, and
also online at http://www.uihealthcare.com/cdd and then click on "Center for Disabilities and Development" and then click on "Centerlines for Families".
Newsletter staff
Editors
Susan Eberly
Elayne Sexsmith
Graphics editor
Lori Popp
Editorial board
Joni Bosch
Barbara Nidey
For
correspondence relating to the newsletter, or to request permission to
reproduce information
from
it, please contact:
Barb Nidey
Center for
Disabilities and Development
University of Iowa
Hospitals and Clinics