Jumping and squealing! Shouts and laughter! There is beauty in the exuberant energy of children – even if it leaves us older folks breathless in our efforts to keep up. Although high energy and youthfulness may sound like a natural descriptive pairing, an increasing number of cases demonstrate that hyperactivity is a disruptive issue for many of today’s youth. The importance of proper diagnosis and appropriate treatment highlights an area that may benefit from technology.

Indeed, as the need for therapeutic and diagnostic tools rises, the growing industry of wearable technology including activity tracking monitors provides a potential solution. Current diagnosis relies heavily on information provided by parents, teachers, and other figures in patients’ lives (Batstra, 2014). As crucial as this information may be to a clinician’s ADHD diagnosis, there are uncertainties attached to reported observations. On the one hand, the doctor is receiving insight from individuals who daily and directly interact with the children in question. On the other hand, collected behavioral reports from parents and teachers are subjective.  How can clinicians ensure a proper diagnosis, so children can grow to be as healthy and productive as possible? Perhaps the growing field of health technology provides the answer to this question. 

During the past decade, the diagnosis of Attention-Deficit-Hyperactivity Disorder (ADHD) in children has been on a steady rise; it’s now the most common childhood neurobehavioral disorder (Batstra, 2014; Groenewald, 2009). Hyperactivity is one characteristic, along with inattention and impulsivity. If levels are extreme, these traits can impair appropriate child development (Davis, 2011).

Treatment options vary depending on the child and include but are not limited to behavioral therapy, organization treatment, and medication treatment. The latter option is a controversial approach when considering the young ages at which children are diagnosed with ADHD today. Centers for Disease Control and Prevention (CDC) principal deputy director Ileana Arias has stated, “Because behavioral therapy is the safest ADHD treatment for children under the age of 6, it should be used first, before ADHD medication for those children.”

While behavioral therapy has been identified as the safest ADHD treatment for children under age six, a national survey conducted by the CDC shows that in 2009 about half of preschoolers (ages four to five years) diagnosed with ADHD were taking medication; one-quarter of those were treated with mediation alone (Campbell, 2000). In addition to the unknown long-term effects of ADHD medication on young children, the diagnosis has associated negative stigmas (Campbell, 2000; Walker, 2008; Ben-Zeev, 2010). Thus, fears of misdiagnosis are commonplace, but it is also important to detect and treat cases to avoid the dangers of under-diagnosis—another concern for some subpopulations of children (Groenewald, 2009). There is great pressure on the clinician to delineate whether reported observations are truly rooted in a case of ADHD or simply products of a child’s environment or personality. Clinically relevant tools able to collect more objective data from children can provide physicians with an additional clue to the puzzle.

As activity monitors continue to grow in sophistication, the potential for their use in the objective monitoring of childhood hyperactivity increases as well. Measuring ADHD symptoms with actigraphy is not a new concept; however, there is definite room for growth in using this data for the accurate quantification of a child’s activity in clinical settings (Teicher, 1996). In addition to ensuring that this data properly represents a child’s movement, efforts need to be made to present this data in a clear and useful manner to clinicians.

With improvements in both activity monitors and clinician/user interfaces, clinicians may be able to better gauge a child’s activity levels in comparison to his or her peers in order to confirm subjective reports from parents, teachers, and other caregivers. With that said, it is important to acknowledge that hyperactivity is just one characteristic of ADHD. To avoid under-diagnosis, it is important to treat this source of data as simply another tool in the clinician’s tool belt for accurate ADHD diagnosis.

References


1.    Batstra, L., Nieweg, E., Hadders-Algra, M. (2014, Jul). Exploring five common assumptions on Attention Deficit Hyperactivity Disorder. Acta Paediatr, 103(7), 696-700.
2.    Ben-Zeev, D., Young, M., Corrigan, P. (2010). DSM-V and the stigma of mental illness. Journal of Mental Health, 19(4), 318-327. 
3.    Campbell, S. (2000). Attention-Deficit/Hyperactivity Disorder. New York, NY. Kluwer Academic/Plenum Publishers.
4.    Davis, D., Williams, P. (2011, Feb). Attention deficit/hyperactivity disorder in preschool-age children: issue and concerns. Clin Pediatr, 50(2), 144-152.
5.    French, W. (2015, Apr). Assessment and treatment of attention-deficit/hyperactivity disorder: part 2. Pediatr Ann, 44(4): 160-168. 
6.    Groenewald, C., Emond, A., Sayal, K. (2009, Nov). Recognition and referral of girls with Attention Deficit Hyperactivity disorder: case vignette study. Child Care Health Dev, 35(6), 767-772.
7.    Teicher, M., Ito, Y., Glod, C., Barber, N. (1996). Objective measurement of hyperactivity and attentional problems in ADHD. J Am Acad Child Adolesc Psychiatry, 35(3), 334-342. 
8.    Walker, J., Coleman, D., Lee, J., Squire, P., Friesen, B. (2008, Aug). Children’s stigmatization of childhood depression and ADHD: magnitude and demographic variation in a national sample. J Am Acad Child Adolesc Psychiatry, 47(8), 912-920.

 

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