Mikey is a special needs child, part of a growing population in Humboldt County.

Jude Power is the principal of early start and itinerant preschool for the Humboldt County Office of Education. On Dec. 1, 2007, her office reported 129 preschoolers eligible for special education at various sites in the county, including College of the Redwoods.

“That’s the biggest we’ve ever had,” she said.

Over the past dozen years, she estimated, the size of the program has doubled.

Siddiq Kilkenny, director of Head Start, cannot comment specifically on Mikey’s case. But Kilkenny said his agency services 900 to 1,000 children from birth to age 5, about 35 percent of which are special needs children. Mikey will turn 3 in May.

Kilkenny said 25 percent of his special needs clients are on individual family services plans, and the vast majority of children have “speech and language deficits.” Mikey fits in that group.

He said the other 10 to 15 percent display conduct disorders that don’t qualify for special education, but grow out of troubled family histories that include positive drug toxicology at birth, homelessness or substance abuse. Mikey’s mom said she was clean during her pregnancy, but substance abuse runs in both sides of the family.

“The world has changed,” Kilkenny said. “It used to be one or two kids in a classroom that had some issues. In the last 25 years, sometimes you could have 80 to 90 percent in the classroom with significant issues. If you talk to anybody in elementary education, they will say the same thing.”

Today, at least one child in every class suffers from ADHD — attention deficit/hyperactivity disorder.

In someone like Mikey, Kilkenny and Power called ADHD a tough diagnosis. Different things can present as ADHD, and young children develop at rapid rates.

“The tools developed for diagnosing are really developed for teenagers and adults, not for children under 5,” Kilkenny said.

ADHD used to be known as attention deficit disorder. It was renamed in 1994 to better reflect the three patterns of behavior: predominantly hyperactive-impulsive; predominantly inattentive, which is still sometimes called ADD; and a combined type that displays all the characteristics.

The National Institute of Mental Health reports “little compelling evidence” tying ADHD to child-rearing and social factors. Biological issues and genetics seem more likely, but environmental factors such as cigarettes and alcohol in pregnancy and high levels of lead in preschoolers may influence the severity, NIMH stated.

Typically, NIMH reports, hyperactivity and impulsivity may precede the inability to focus on any one thing for a period of time. Children with ADHD may have no problem concentrating on a task they really enjoy — think video game — but Dr. Emily Dalton of Eureka Pediatrics said that’s missing the point.

“Most people have an ability to tend to things that aren’t intrinsically interesting and discipline ourselves to do homework or finish an article,” she said. “Kids with a short attention span lack the ability. The surrounding stimuli are overwhelming.”

The student who can’t sit still or acts impulsively is easily noticed; the inattentive daydreamer or sluggish student can be overlooked or tagged as unmotivated.

Kidshealth.org reports that boys are three times more likely than girls to suffer from ADHD.

There is no test to determine its presence and no cure for an illness whose prevalence increases with the child’s age.

As of 2003, the Centers for Disease Control and Prevention reported there were 4.4 million youths age 4-17 diagnosed with ADHD by health care professionals and 2.5 million receiving medication for the disorder. The numbers are based on parental reporting.

The CDC noted the prevalence of ADHD was significantly lower among children age 4-8 years than with children 9 or older. The greatest prevalence: 14.9 percent of 16-year-old males and 6.1 percent of 11-year-old females.

As for geography, California has almost half the prevalence as in parts of the Southeast.

“There are young children out there destined to meet the criteria for ADHD when they get older,” Dalton said. “It’s a very difficult diagnosis to make in preschool; most have very short attention spans and a lot are very active. Sometimes the diagnosis is made in a tentative way with the understanding as they develop and change, soft diagnosis like these can change.”

Dalton said it was extremely rare in her practice to make a diagnosis of ADHD in a child under the age of 4.

“Maybe 1 in 200 or 300 under the age of 4. We might suspect it, but we want more time to see what happens with time maturation.”

NIMH estimates 3 percent to 5 percent of children have ADHD, or approximately 2 million children in the U.S. It is a more conservative estimate than the numbers reported to the CDC by parents, but it still puts a child with ADHD in every class of 20 to 30 students.

“I have experienced parents wanting some help for terrible behavioral problems,” Dalton said. “Most parents are willing to consider whatever resources are available, including medications.”

Dalton and the NIMH said stimulants are the most commonly prescribed medication.

“Kids with ADHD have a paradoxical reaction to a stimulant,” Dalton said. “They don’t get more stimulated and active, which would be a disaster. They get calmed down and focused in.”

Dalton said she tries not to treat with medication at the preschool age unless there are “very significant, life-threatening issues — 3- and 4-year-olds running into traffic, jumping out windows, climbing on roofs. Every parent knows you can’t monitor them 100 percent of the time.”

For children under 3, that’s a challenge. The stimulants listed by the NIMH for treatment of ADHD include three stimulants appropriate for age 3 and older and eight for age 6 and older.

In Mikey’s case, taking a medication that has been approved by the FDA for use in adults and older children is going “off label.” The medications haven’t been systematically studied for safety and efficacy. As a result, they may not be covered by insurance.

Dalton called Medi-Cal’s list of medications “restrictive” and “continually changing,” but said Eureka Pediatrics hasn’t had a problem with availability of psychotropic medications.

Kilkenny feels differently.

“There’s a child I’m aware of given a certain drug because that’s the only drug Medi-Cal covered,” Kilkenny said. “The proper drug was always the proper drug, but Medi-Cal wouldn’t cover it.”

Kilkenny said the difficulty in finding physicians, poor reimbursement and parents improperly medicating children to keep them in a child care facility are problems that may be faced by special needs children.

In the most intensive study ever done to evaluate treatment of ADHD, the NIMH studied elementary school boys and girls in four groups: medication management, behavioral treatment, a combination of both, and routine community care that consisted of seeing a physician twice a year.

The study indicated that long-term combination treatment and the medication-management-alone models were superior to intensive behavioral treatment and routine community treatment.

“The way education looks at problem behaviors today, it looks at the child’s environment and function: What is the child getting from this behavior; what is motivating the behavior?” Power said.

She said by determining the function of the behavior — avoidance, energy release or a way of dealing with emotion — teachers attempt to meet those needs in more constructive ways and try to modify the environment to minimize the behaviors.

“You need a lot of tools and a lot of support,” Power said.

An ongoing study by NIMH to evaluate the effect of medication on children ages 3 to 5 with severe and persistent symptoms of ADHD is under way at six universities, including UCLA and the University of California at Irvine.

Compounding the problems parents and children face are the disorders that sometimes accompany ADHD. The NIMH reports:

+ A small proportion display the nervous tics or repetitive mannerisms of Tourette’s syndrome.

+ 20 to 40 percent may develop a serious pattern of antisocial behavior that includes lying, bullying, stealing or fighting and puts them at greater risk for substance abuse and, later, dependence and abuse.

+ 33 to 50 percent, mostly boys, have oppositional defiant disorder. They are often belligerent, stubborn or defiant. They argue with adults and refuse to obey.

+ Some suffer from anxiety and depression or bipolar disorder.

+ 20 to 30 percent also have a learning disability that includes difficulty in self-expression with words.

“He just learned to talk five months ago,” Mikey’s mother said. “He’s in speech therapy four times a month. The county Office of Education works on building his motor skills once a week. He has an occupational therapist twice a month who also works on his motor skills and speech skills.

“His doctor said in the 30 years he’s been a pediatrician, it’s been one of the toughest ADHD cases that he’s seen.”

Mikey and his family will face a host of challenges in the years ahead. He will be part of the Head Start program at Alice Birney next fall. His mother is getting behavioral therapy training to build a toolbox of parental tricks to deal with him. He still head butts, earning himself a trip to the emergency room last week after a losing encounter with the floor, and he’s about to get another mediction change.

“Counseling and behavior change is a process,” Dalton said. “It takes work, time and resources.”

Even so, Mikey will face other risks. Youths with ADHD, in their first two to five years of driving, have nearly four times as many automobile accidents, are more likely to cause bodily injury in accidents, and have three times as many citations for speeding as young drivers without ADHD.

“Walk in my shoes for a day,” said Anthony Curo, Mikey’s grandfather. He has seen a different side of Mikey, one that responds to a male voice and does what he asks.

Curo and his wife, Ruth, were the primary caregivers for part of Mikey’s life. They still care for him five to six hours a day and relish the times when Mikey seems to respond to a male voice and respect the boundaries Curo said he sets.

“He has big blue eyes that melt your heart,” Curo said. “But I look at him sometimes and see that medicated look in his eye. It tears my heart out.”