A Familiar Scene in Hong Kong
It’s 7:20am in the morning in a small apartment. A mother is trying to get her son to put on his uniform in order to catch the school bus, while at the same time juggling her work emails and breakfast prep. Her child is bouncing around from one room to the next, having a hard time focusing even to put on his shoes. He’s a loving, caring and bright child, but also easily distracted and emotional. This is an all-too-familiar scenario for families in Hong Kong given that ADHD is one of the most common neurodevelopmental conditions in children. While it may be overwhelming and exhausting, we want to give a basic framework on diagnosis, treatment, side effects and alternative options.
Diagnosis
The earliest age a child can usually be diagnosed with ADHD is 6. If you suspect your child to be overly inattentive, hyperactive and/or impulsive, they might be suffering from ADHD. A diagnosis can be made from a clinical interview to gather information about the child’s symptoms, medical history, developmental history, social interactions and school performance. Further standardized assessments could aid in making the diagnosis.
Medication: The Cornerstone of ADHD Treatment
Stimulant medication such as methylphenidate is the first line treatment for children with ADHD. According to our clinical experience, up to 70-80% of children taking it experience improvements in attention, hyperactivity, and impulsivity. While there are side effects such as reduced appetite and slower physical growth, they are mild and largely manageable with regular monitoring. Medications are taken long term as ADHD is a neurodevelopmental condition. However, the symptoms do change over time, and get less noticeable into adolescence and early adulthood. A small proportion of adolescents continue to take medication into adulthood.
Side Effects: Appetite and Growth
Many parents worry whether stimulants would affect their child’s growth and eating habits. It is a valid concern and we’re here to address it. Yes, stimulants can affect appetite, especially at lunch, but children usually make up for it during dinner. There may be slower growth at first, but long terms studies have shown no significant effect on adult height. We recommend that parents give their children a highly nutritious breakfast, high-calorie snacks, and employ “medication holidays.”
Mineral Deficiencies and Myths
Some parents have expressed concern that magnesium, iron and zinc deficiencies could be causes of their child’s ADHD, and have resorted to use supplements to “cure” it. While some studies have shown lower levels of these minerals in children with ADHD, the evidence is simply not strong enough to recommend supplements as a standalone treatment. It’s best to consult our psychiatrists before considering oral supplements for your child.
Beyond Medication: What Else Helps?
Non-pharmacological interventions are helpful and most effective when combined with medication, and not used in isolation. Some families benefit from parent training, academic organization skills remediation, or social skills groups.
As part of lifestyle modifications, we often recommend regular exercise which could increase levels of dopamine, noradrenaline and endorphins – all of which help with regulating attention and mood. Sometimes physical exercise can be a child’s outlet for excessive energy, in turn helping with symptom reduction. The decision whether to exercise before or after homework is a personal one, and dependent on your child’s personality.
A balanced and regular diet is also helpful. Your child should be eating regular meals and snacks which help maintain blood sugar levels, and in turn help with attention. Some children with ADHD can be picky eaters, and meal time becomes a chore which is often stressful to the parent! Try to make it fun, and even involve them in meal preps. Those little wins can boost up dopamine levels and regulate your child’s energy. There are a lot of urban myths about the relationship between excessive sugar intake and ADHD symptoms. While there is no direct scientific evidence to suggest this, we do know that excessive sugar intake can lead to spikes in blood sugar. These fluctuations could impact attention.
Children with ADHD could have trouble falling asleep at night. It could be due to hyperactivity or excessive energy. Some ADHD medication could affect sleep and it’s important to discuss these sleep-related issues with your psychiatrist. Establishing a good sleep hygiene is important – follow a regular sleep routine, and restrict screen time 1-2 hours before bedtime to prevent the interference with natural melatonin production.
Final Thoughts
We know it’s easy for parents to feel overwhelmed, but know that you’re not alone as there are other parents navigating similar paths. It’s especially difficult in a fast-paced city like Hong Kong. We look forward to connecting you with one of our psychiatrists for a thorough assessment in order to come up with a plan that best fits your child.
