Children are usually diagnosed with attention-deficit/hyperactivity disorder, or ADHD, when they go to school. Problems with concentration tend to be most problematic then. They are inattentive or disruptive in the classroom.
When we ask parents about whether this occurs in other settings, such as the home, they usually say yes. But they often have tolerated it. (Don't forget, a lot of ADHD children have ADHD parents and their behavior seems more normal.) If we put up with it before, they say, can we put up with it now that school's out?
Many kids, of course, don't stop their academics in the summer. Moreover, many kids do outdoor or athletic activities that require more concentration. I was a Little League baseball coach, and I saw what lack of concentration could do. Tae kwon do, tennis, gymnastics, soccer and dance are just a few of the activities that children likely do better when taking their medications.
But most important, children who need ADHD medicine are safer on their medications. According to a 2002 study in ADHD Report, children with ADHD have a 15.6% chance of having at least four significant injuries - meaning they need stitches, break a bone or need hospitalization. They are more likely to get burns. They are more likely to get accidental poisonings.
I used to work in the emergency room at Children's Hospital of Wisconsin, and at about this time of year we started to see more major and minor trauma. Usually accidents are related to impulsivity. A typical situation is street crossing. Cognitively, most kids by age 7 know all they need in order to cross the street by themselves. Yet, in real life they don't do it right. They get caught up in distractions and impulse. By age 10, they're old enough for a safe street crossing.
Add ADHD to the equation and it is just worse. Study after study has shown that children and adults with ADHD have more accidents than people who don't have the disorder.
But while it can be an annoyance to have kids in the ER more often for stitches, it is an entirely different situation when people get behind the wheel. Driving collisions account for an average of 15 teenage deaths a day. According to the National Highway Traffic Safety Administration, motor vehicle crashes cause 36% of all deaths in people 15 to 20 years old.
A person with ADHD, who is not on medication, has an 88% chance of having an accident. I think this is at least equal to the risk of driving while using a cell phone. Of greater importance are the studies looking at teenagers who are driving on and off medications. Two studies have looked at this, each with a different stimulant (but ones we commonly use). Both showed significant improvement for teens on the medications.
Most often, ADHD comes to our attention when kids go to school. But it doesn't stop when the school day or academic year ends. We seldom think about the burden of the "accident-prone" child.
I think that using ADHD medications leads to a safer summer. For most kids in competitive sports or who are doing activities that require concentration, they are happier and have more fun. And with driving teenagers, it saves lives.
(5/11/08)
