Attention Deficit Hyperactivity Disorder

This is the fourth in a series of articles from the Wilkes Community Partnership for Children on disabilities. The purpose of this series is to increase awareness of diagnosed disabilities in young children.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most commonly studied and diagnosed disorders in children and adolescents. ADHD symptoms may begin in early childhood usually by age six to twelve. It is common in children and can continue to adulthood. Hyperactivity, impulsiveness and inattentiveness are symptoms of ADHD that can cause problems at home, school, work, or in relationships.

It is estimated that estimated that 3% to 5% of children have ADHD. Experts also estimate that ADHD may occur in 8% to 10% of school-aged children. (National Institute of Mental Health) It is unknown if children really outgrow ADHD which means ADHD may be more common in adults than previously thought.

Despite the fact that ADHD is being the most commonly studied disorder in children and adolescents, the cause in the most cases is ADHD unknown. ADHD is diagnosed approximately three times more often in boys than in girls. About 30 to 50 percent of children diagnosed with ADHD as a child continue to have symptoms as an adult.

Inattention in a child with ADHD is often shown by these characteristics: easily distracted; does not follow directions; not listening when someone is speaking; making careless mistakes; not paying attention; forgetful about daily activities; organizing problems; inability to sit still for a reasonable; losing things like personal items; daydreaming tendencies.

Hyperactivity in a child with ADHD is often shown by these characteristics: squirming, fidgeting, or bouncing; not staying seated as expected; difficulty playing quietly; moving, running and/or climbing things constantly; talking excessively.

Impulsivity in a child with ADHD is often shown by these characteristics: difficulties waiting for his/her turn; blurting out answers before question has been completed; interrupts often. Management of ADHD can involve counseling, medications, and changes in lifestyle. Medications are only recommended as the first treatment for children with ADHD when children have severe symptoms. Children with moderate symptoms who do not respond with improvement to counseling are considered for medication. The long-term effects of medication are not known and medication is not recommended for preschoolers.

Since the 1970’s ADHD and the diagnosis and treatment have been considered controversial. Health care providers accept the ADHD diagnosis with the debate being related to how ADHD is diagnosed and treated.

If you have concerns about your child, talk with your child’s physician. Visit the National Resource Center on ADHD for more information.

The Wilkes Community Partnership for Children is a Smart Start and United Way Funded Agency.

Cerebral Palsy

This is the third in a series of articles on disabilities from the Wilkes Community Partnership for Children.  The purpose of this series is to increase awareness of diagnosed disabilities in young children.

Cerebral Palsy, also known as CP, is a congenital disorder of childhood. In the United States approximately 500,000 children and adults are affected by CP.  It is one of the most common disorders existing before or during birth.  CP is a disorder that affects motor skills and the ability to move in a coordinated manner.   Muscle control, posture and movement are also affected.

Difficulty with swallowing along with eye muscle imbalance is common in people affected by CP. People with cerebral palsy have muscle stiffness and may have reduced range of motion at various joints.

Other health issues can occur from the brain damage caused CP.  These issues include learning disabilities, vision, speech, and hearing problems.  Because CP affects muscle tone and control, coordination is affected and a simple movement such as standing still is difficult.  CP also affects breathing, eating, and learning that involve muscles and motor skills.

The effect of cerebral palsy on functional abilities varies greatly. Some people are able to walk while others aren't able to walk. Some people show normal to near normal intellectual function, but others may have intellectual disabilities. Epilepsy, blindness or deafness also may be present.

The most common cause of CP is brain damage occurring before or during a child’s birth.  Brain damage during the first 3 to 5 years may also cause CP. The exact cause of CP is unknown.  Problems during pregnancy which damages the brain or doesn't allow the brain to develop normally is considered a cause of CP. This brain damage is created by infections, maternal health problems and/or a genetic disorder.  Anything that interferes with normal brain development could be considered a cause of CP. In some rare instances problems during labor and delivery can cause CP. A premature baby would be considered a higher risk for CP than babies that are carried full-term.  Babies weighing less than 3.3 pounds are considered a higher risk of as are other low birth weight babies and multiple births, such as twins and triplets.

Any brain damage that occurs during infancy or early childhood would be considered a risk factor.  Brain damage from being shaken as an infant (shaken baby syndrome), lead poisoning, being in a car accident while not restrained properly in a car seat, bacterial meningitis, or malnutrition would create a greater risk for CP.

There are three types of CP.  Ataxic cerebral palsy causes an unusual sense of balance and depth perception.  Spastic cerebral palsy creates stiffness and movement difficulties.  The individual with Athetoid cerebral palsy has involuntary and uncontrolled movements.

A thorough medical history and examination is required t obtain information leading to the diagnosis of cerebral palsy. A health care professional can identify potentially treatable causes of a child's impairment. The health care professional evaluating the child with possible cerebral palsy should be experienced in neurological examination and assessment of impaired children and well-versed in the potential causes of cerebral palsy. Often, but not necessarily, this practitioner should be a pediatric neurologist. Once the examination is complete, depending on the findings, the practitioner may order laboratory tests to help in the assessment.

There is no single test to diagnose cerebral palsy.  Since cerebral palsy can be caused by multiple different factors, the tests performed are used to identify specific causes. Blood and urine tests may be used. Brain imaging studies can also be used to detect any changes in the brain’s structure. The studies are achieved by using a sensitive brain imaging study-MRI examination. Further testing may be required to define specific needs of the child.

Regardless of all of the tests it may not be possible to answer parents questions such as "Why does my child have cerebral palsy?" or "Will my child be normal?" In many cases a severely impaired young infants will grow up to be independent, while other less impaired children will require lifelong care.

 

There is no cure for CP, but treatment, therapy, special equipment, and, in some cases, surgery can help a child who is living with the condition.  For more information on Cerebral Palsy contact your local physician.  Additional information on Cerebral Palsy may be found at http://ucp.org/

Wilkes Community Partnership for Children is a Smart Start and United Way Funded Agency. 

Fragile X Syndrome

This is the second in a series of articles on disabilities from the Wilkes Community Partnership for Children.  The purpose of this series is to increase awareness of diagnosed disabilities in young children.

The most common cause of inherited intellectual disability is Fragile X syndrome (FXS).  It is estimated that about 1 in 4,000 males and 1 in 6,000 to 8,000 females are born with FXS.  FXS occurs in all racial and ethnic groups.

 Some of the signs of FXS include developmental delays.  Examples include not talking, walking, and/or sitting at the same time as children of the same age.  Another sign could include learning disabilities such as trouble learning new skills.  FXS signs include social and behavioral problems that are exhibited in not making eye contact, trouble paying attention, acting and speaking without thinking, frequent tantrums, and hand flapping.  Children with FXS can also have anxiety and mood problems and be sensitive to light and touch.

Males who have FXS usually have some degree of intellectual disability that can range from mild to severe. Females with FXS can have normal intelligence.  Only about one-third to one-half of affected females has some degree of intellectual disability.

Physical signs of an individual with FXS, that are subtle that become more obvious with age, are long, narrow face, large ears, large head, overly flexible joints (especially the fingers), and prominent forehead and chin.   Girls with FXS generally have fewer physical signs of the condition than males.

 A diagnosis of FXS is confirmed through testing a person's DNA by a blood test.  This test is ordered by a doctor or genetic counselor.  The blood sample is sent to a laboratory and checked to determine if there is a gene mutation (change).   Around 35 to 37 months (three years of age) boys are diagnosed.  Girls are diagnosed later at forty-one months.

A diagnosis of FXS helps the family understand the reason for a child’s intellectual disability and behavior problems.  An early diagnosis also helps the family learn more ways  to help the child reach his or her full potential. 

 Most children with FXS have a normal life span and do not have serious medical problems.  Five percent of girls and fifteen percent of boys affected by FXS develop seizures, that are most often are controlled through medication.  The risk for chronic inner ear infections is increased in children with FXS and may increase the need to have tubes placed in their ears.

 A child with FXS may have mitral valve prolapsed, a heart condition, that causes heart murmurs.  In most cases this is not life-threatening and does not require treatment.

While there is no cure for FXS there are treatment services that help with learning skills such as learning to walk, talk and interact with others.  Medicine can be used to control behavior problems.  Early intervention services (birth to age three) may help improve a child’s development.  Through the local Children’s Developmental Services Agency a child can be evaluated and receive treatment.  A treatment plan that involves parents, child, teachers, and health care providers allows everyone to work together to help guide the success of the child with FXS.

For more information on FXS contact your physician.  Additional information is available online at the National Fragile X Foundation.

Wilkes Community Partnership for Children is a Smart Start and United Way Funded Agency.