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"Boys will be boys" attitude can delay help for attention deficit disorder Donna Greenstein knew something was wrong with her son, but no one believed her. The mother of four first had two daughters and went through the usual pediatric milestones with them. Then her son was born and began to grow up. "He would have tantrums that would last for hours and went above and beyond the normal realm of the terrible twos," said Greenstein, a nurse. "He would rip wallpaper off walls, urinate on walls and throw feces at his sisters." Preschool and kindergarten teachers kept saying, "Boys will be boys. It's nothing. He's immature, he'll catch up; this is typical boy behavior." When he started first grade, she received a call from his teacher, who told her, "'We need to have a meeting; something is wrong.' Finally someone was listening to me. Before, everyone told me I was crazy," she recalled. Her son was tested and diagnosed with attention deficit hyperactive disorder (ADHD), obsessive-compulsive disorder and bipolar disorder. Now 16, he is active in school and sports and is preparing for college. Without intervention, therapy and medication, his story would have had a different outcome. ADHD is a chronic condition that affects millions of children in this country, and it affects boys four times more often than girls. There are three types of the disorder: inattentive, hyperactive-impulsive and combined ADHD, the most common, which involves all symptoms. With the inattention type, a child has difficulty paying attention to details, is easily distracted, procrastinates and fails to complete homework or chores. These symptoms are often missed until a child faces the challenge of a structured classroom. Hyperactivity symptoms present themselves in very young preschoolers. They include talking excessively, always being on the go, fidgeting, running or climbing excessively. Impulsivity symptoms involve inappropriate behavior, conversations, blurting out answers before questions are asked, interrupting others in social situations, knocking over objects or banging into people. Dr. Lenard Adler, professor of psychiatry and child and adolescent psychiatry at NYU Langone Medical Center, said, "Girls are less likely to be diagnosed in childhood because they carry a higher load of the inattentive symptoms. So in a classroom, if you are daydreaming and not paying attention and distracted, you may be seen as underperforming, as compared to a boy, let's say, who is behaviorally disruptive, in and out of his chair, interrupting his teacher. "That doesn't mean that girls don't have any hyperactive impulses and boys don't have any inattentive. But the balance is different," he explained. The causes of the disorder remain a mystery. " We think the lion's share of the transmission of ADHD-probably about 80 percent-is familiar," said Adler. "It's a disorder that tends to run in families. "That being said, we also look for environmental causes that might be contributing; certainly it has been shown that maternal smoking during pregnancy may raise the risk for ADHD," he said. "Another environmental factor that has been shown has been maternal abandonment." Other possible causes linked to the disorder are lead exposure, certain food additives and, possibly, gluten. Children with ADHD without proper intervention often struggle in the classroom, tend to have more accidents and injuries, are more likely to have trouble interacting with peers and adults and are at increased risk for alcohol, drug abuse and delinquent behavior. Making the diagnosis of ADHD is not always easy, since there is no one specific test such as a blood test or CAT scan that can make the definitive diagnosis. Instead, it is usually made by gathering the child's history, first with the parents and later from the observations of teachers, before the child is brought in for evaluation. Standard treatments for ADHD include medications and counseling. Often, children can go on to lead productive lives. Typical medications include stimulants such as Ritalin, Adderall and Dexedrine, but there is no one perfect medicine, and it is often a trial to see which one or combination of them will be the most effective. The stimulants help boost and balance the neurotransmitters, or brain chemicals, that help improve inattention, impulsivity and hyperactivity. There are side effects to all meds; some may include decreased appetite, weight loss, insomnia and irritability. It may take several rounds of fine-tuning to find the perfect combination. Nonstimulant medications, along with antidepressants and clonidine, have also been used successfully. Greenstein advises parents like her to seek treatment early. "A lot of parents, I have found, are afraid of medications, so they allow their children to suffer for so many years because 'I don't want to put my son or daughter on medication,'" she said. "I think they do more harm than good, because the child's self-esteem takes a major blow when they are not able to function in a classroom with other children. "Once you medicate them and get them under control, their self-esteem starts to blossom, they learn, they start to feel better about themselves." Her son had difficulty maintaining friendships his first years in school. Now as a teenager, he has friends, is active and is looking forward to college. "I have him burn off energy so he does mixed martial arts and track," Greenstein said. "You have to keep all of that energy focused in a positive direction."

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