Background​

Dr. Susan Chung is a child and adolescent psychiatrist. Born and raised in South Korea, trained first in internal medicine, then psychiatry at Albert Einstein, adult psychiatry at Tulane, and two years of fellowship in child and adolescent psychiatry. She served four and a half years in the US Army as an army psych physician, then worked 35+ years at Kaiser Permanente in Los Angeles, and continues to see Asian patients as a volunteer.​

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Historical Context and Brain Basics

Earlier terms included MBD (minimum brain dysfunction). DSM3 used ADHD and ADD; DSM4 (1994) defined ADHD with three subgroups: inattentive, hyperactive impulsive, and combined type. A post–World War II “Japanese bee encephilitis” observation led to interest in attention and fidgeting behaviors. The “decades of the brain” (1990s) expanded MRI and neurotransmitter knowledge. 

 

A simple brain walk-through: brain stem (blood pressure, heart rate, respiration, temperature), limbic system (emotional brain; fight or flight), and prefrontal lobe (attention, memory, judgment, planning, controlling emotions from the limbic system). Neurotransmitters include dopamine, norepinephrine, serotonin, endorphin, GABA. When dopamine/norepinephrine are not secreted enough for the prefrontal lobe, paying attention, memorizing, good judgment, and behavior control are hard. ADHD often shows when bored: not enough dopamine to do study, homework, or boring work, impairing academic, social, and occupational function.​

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Diagnostic Framework

ADHD subtypes:

• Inattentive type: mistakes in detail, easily distracted, not obviously hyperactive.

• Hyperactive impulsive type: runs, climbs, driven, impulsive (blurts answers, interrupts, intrudes, hard time waiting turns). “Like cars with a broken brake.”

• Combined type: both sets of symptoms.

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Diagnosis requires symptoms in more than one setting such as home and school and lasting at least six months. Single-setting problems suggest other issues such as learning problems, environment, or home dysfunction. Behaviors can mimic other conditions, for example a boy misread as ADHD actually had depression after his father was deported.

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Referrals, Culture, and Privacy

Referrals often come from teachers who compare same-age peers or from teenagers themselves asking for evaluation. Many Asian parents feel ashamed, fear discrimination, or move schools; some worry records will harm college or jobs. HIPPA protects privacy; information cannot be shared without consent from parents for minors or from patients over 18. Trust with schools and doctors is encouraged.

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Evaluation Steps

History from parents, teachers, and child; questionnaires such as Vanderbilt, Conners, and SWAN from parents, teachers, and others such as siblings, tennis coaches, and tutors. Note cultural response patterns; some Asian parents under-endorse problems while teens endorse them, and the opposite is true with many Caucasian families. Developmental milestones include pregnancy, delivery, sleep and eating, sitting, walking, toilet training, and speech; also consider injuries and poisonings, report cards, family history including substance use, conduct, and criminal behaviors if ADHD is untreated, and medical, surgical, and trauma history. Fathers’ participation helps; children learn from parental actions.

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In office, some children look “perfect” because novelty raises dopamine. Observation during parent interview often reveals inattention or impulsivity. Diagnostic criteria: at least 6 of 9 behavioral points in a cluster, ≥6 months, in more than two sites, with developmental, family, and past history considered.

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Telling Children and Reducing Stigma

Children should hear the diagnosis. Knowing “it is the brain condition, brain disease” relieves guilt for child and parents and creates hope.

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Treatment Overview

Many Asian parents prefer herb/oriental medicine and worry about western medicine. Dr. Chung explains with a brain model: prefrontal lobe, limbic system, stress reactions, and how stimulants/non-stimulants help the prefrontal lobe function (attention, memory, plans, judgment).

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Stimulants:

• Methylphenidate (short acting “ritual” 3–4 hours; start very low, watch side effects like low appetite, stomach upset, nausea, headache, fast heartbeat, rare mood change/crying). Drug holidays on weekends. Dosing can go by weight (about 1–1.5 mg/kg), titrated slowly.

• Concerta (long acting release 10–12 hours; small amount on surface then pumped out gradually).

• Adderall/amphetamine (IR 4–6 hours; Adderall XR extended release). Long acting meds lower teen motor-vehicle accidents.

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Avoid stimulants in heart problems or epilepsy.

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Non-stimulants:

• Atomoxetine (Strattera); start low and increase (children 10/18/25 mg, adults 40–100 mg). In her experience, autistic kids with attention deficits may respond well to non-stimulants.

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School Supports and Legal Protections

ADHD is a disabling condition affecting schoolwork, social function, and friendships. Schools can help with letters documenting diagnosis/treatment. IEP (individual education plan) or 504 plan (federal law from the 1970s) provide supports: longer time on exams, quiet rooms, seating in front to reduce distractions. Parents should allow schools to know about medications for safety (nurse evaluation if side effects). Trusting the school is emphasized.

 

Parenting, Praise, and Home Practices

Parents’ happiness, peaceful marital relationship, and behavior such as not screaming and not drinking affect children. Praise raises dopamine and attention; praise behavior and effort right away, close by, with eye contact. For example, say “I’m very proud you didn’t fight with your brother after he broke your toy.” Then give the next instruction. Intelligence in ADHD follows the usual bell curve; the issue is regulation, especially with hormonal changes at ages 10 to 12. Many ADHD kids are two to three years behind peers in maturation but eventually catch up around ages 25 to 30. Keep hopeful feelings.

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Sensitivity and routines: Transitions, including nightly sleep, create anxiety. Use rituals such as brushing teeth, reading, or praying, and maintain consistent sleep and wake times, including on weekends. Teach children to set their own alarm clocks; use stars or stickers to build self-esteem that carries into adulthood. Avoid repeated wake-ups that create a sense of failure.

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Pandemic note: Teen anxiety/depression increased; late night gaming/social media hurt functioning.

 

East–West Values and Communication 

Asian families often value group identity, interdependence, and keeping problems at home; western settings encourage individual voice and independence. Children navigate both. “Ghost in the nursery” (three generations of child-raising beliefs) influences help-seeking. Fathers’ involvement in evaluation/treatment is especially helpful.

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Recap

Historical background to DSM5 naming, brain, limbic system, prefrontal lobe and neurotransmitters, diagnostic criteria across settings and time, culture and privacy including HIPPA, evaluation through questionnaires, developmental and family history, and teacher reports, medication options such as methylphenidate, Concerta, Adderall XR, and atomoxetine also known as Strattera, school supports including IEP and 504, praise and effort focus, sleep routines, maturation pace, and the importance of trusting schools and collaborating for early detection and treatment.