[Healthy 100-Year Life] Early Treatment of Pediatric and Adolescent ADHD Is Essential

Professor Tae-Yeop Lee, Department of Child and Adolescent Psychiatry, Asan Medical Center, Seoul

Recently, a parent and child came to the clinic. The child has difficulty sitting still during classes at school that do not interest him and is constantly chatting with the friend next to him, leading to frequent reprimands. When talking with friends, he does not listen attentively and suddenly interrupts with off-topic remarks or touches his friends' belongings without permission. As a result, conflicts arise with teachers and friends, making it difficult to adapt to school life. There are various reasons for struggling to adapt to school, but Attention Deficit Hyperactivity Disorder, or ADHD, is one of the common causes.

It is estimated that about 5-10% of children and 4-8% of adolescents in Korea have ADHD. This prevalence rate is relatively consistent regardless of the country. However, the proportion of children receiving treatment in Korea is lower compared to advanced countries such as the United States. The parents of the child I met in the clinic said that it took longer to come to the hospital because of comments from others like, "Boys are all like that. It's just a phase and will get better as they grow."

Does ADHD improve with age? This is partly true and partly false. It is believed that in cases of ADHD, the function of the frontal lobe, the front part of the brain, is weak. As one grows older, the frontal lobe develops and matures, and symptoms such as inattention, hyperactivity, and impulsivity tend to improve. Since the frontal lobe is the last part of the brain to fully develop, these changes can continue into early adulthood. Nevertheless, many still have symptoms, with about 70% of ADHD cases in childhood continuing into adolescence and about 50% persisting into adulthood.

When medication is needed to treat ADHD symptoms, parents often find it difficult to make a decision. This is completely understandable. Since symptoms can naturally improve as the brain develops, it makes the decision even more challenging. It is important to try to see the world from the child's perspective. Children with ADHD usually lack self-regulation skills. This leads to problems not only at school but also at home. The child has many things more interesting than studying, but he may be nagged more than ten times to sit at the desk to do homework and may have a battle with his mother every morning before going to school. Eventually, the father ends up yelling.

When such incidents repeat at school and home, the child begins to think that there is nothing he is good at. Low self-esteem greatly affects daily life and can later lead to depression. Taking medication does not solve all problems, but it significantly reduces these conflicts. One child said with a smile after starting medication, "Teacher, it feels like my ears have opened. I can hear other people’s words well, and I like it very much." If you have concerns about medication, please remember that the wounds the child has received due to ADHD symptoms do not disappear.

Some children show great improvement with medication alone. However, some children have other difficulties along with ADHD symptoms. Some have high anxiety, some have tic symptoms, some have difficulties in peer relationships, and some have difficulties in relationships with their parents. These children need treatments other than medication. Cognitive-behavioral therapy, social skills group therapy, and parent education help alleviate ADHD symptoms and other difficulties.

Lee Taeyeop, Professor, Department of Child and Adolescent Psychiatry, Seoul Asan Medical Center