Children With AD/HD Have Related Functional Disabilities

Results of the study were presented here last month at the annual meeting of the Society for Pediatric Research.

Using a standard developed at UB for use by the developmental and rehabilitation medicine community to assess a patient's needs for rehabilitation services, the researchers determined that most of the 43 children in their preliminary study were significantly less able to care for themselves, recognize appropriate social behavior and communicate than children of similar age who were not diagnosed with the disorder.

"When we applied this standard measure of disability to these children, we found that children who get referred for hyperactivity have high levels of documentable needs and require a lot more help than other children their age," said Thomas M. Lock, M.D., who presented the results. Lock is UB clinical assistant professor of pediatrics and associate medical director of the Robert Warner Rehabilitation Center at Children's Hospital of Buffalo.

Lock said the results could have significant impact now because, as of this month, children diagnosed with attention deficit disorder who routinely have been receiving federal Supplementary Security Income funds must demonstrate they are truly disabled.

Considerable controversy exists within the medical and education communities about whether AD/HD is a disability or a behavioral problem. Diagnosis of the disorder occurs most often in school-age children and usually is precipitated by disruptive classroom demeanor.

Lock and colleagues felt that if functional deficits of children with AD/HD could be documented outside of school, the results would support the hypothesis that the disorder is, in fact, a disability. To accomplish this, they used an assessment tool called the Wee-FIM.

The Functional Independence Measure, or FIM scale, was developed by the UB Department of Rehabilitation Medicine and has been adopted universally as a standard measure to characterize the level of adult disability and to direct treatment. The Wee-FIM has been standardized for children. It contains measures for self-care, bowel and bladder control, mobility, communication and social cognition.

The 43 children assessed were found to have lower than normal Wee-FIM scores overall, and to show significant deficits in self-care, social cognition and communication. There also was a correlation between inattention symptoms reported by parents and the self-care and social cognition deficits characterized by the Wee-FIM.

"These results confirm that young children with AD/HD have functional deficits in both self-care skills and social skills and that these deficits are related more closely to inattention than disruptive behaviors, age or IQ," Lock said. "The study should shed light on the public debate about whether these children are disabled or whether their families are playing the system for benefits."

If these functional deficits can be confirmed in a broader study, they should be the focus of treatments in children with AD/HD, Lock stated.

Other researchers involved in the study were Nadine L. Duchan, Sue E. Olexenko, and Michael E. Msall, of the UB Department of Pediatrics. The study was sponsored in part by the Children's Guild of Buffalo.