ADHD

Does your school-aged child love to move, seem to be “always on the go,” or have trouble sitting still? Or does she seem to forget the three things you asked her to do, even before she gets upstairs? Does he struggle socially or in school because of these traits?

All of those things can happen occasionally for any child, but if they’re true most of the time, then it’s possible that your child may have Attention-Deficit/Hyperactivity Disorder.

Which does, of course, bring a few questions to mind right away: What does that mean? Isn’t ADHD over-diagnosed, and aren’t medications over-used? What can you do to help your child?

What ADHD Means

Attention-deficit/hyperactivity disorder, or ADHD, is a common neurological condition, occurring in about three to five percent of the population worldwide. There is a strong genetic component to the disorder, although environmental factors and early life experiences (things such as prematurity and very low birth weight, prenatal alcohol or drug exposure, lead toxicity, malnutrition, abuse or neglect — to name a few) can also significantly impact a child’s risks for ADHD.

ADHD is divided into three sub-types:

1. Those with primarily hyperactivity and impulsivity;

2. Those who are not hyperactive but have difficulty maintaining their attention and focus;

3. Those who have both sets of difficulties.

Children who are hyperactive and have difficulty with impulse control are often diagnosed at a younger age, since their behavior prompts diagnostic evaluations. Children who have the primarily inattentive subtype are often not diagnosed until they’re older, when they struggle to follow directions, complete schoolwork on-time, or keep track of things past the age where most children are able to do so.

That said, not all children who are active, impulsive, or distracted have ADHD. These can be normal reactions to stress, particularly big changes at home or school, or major stressful events in the family. Kids can also have symptoms that mimic ADHD if they are not sleeping well — either not getting enough sleep, or not getting high quality sleep because of things like illness or obstructive sleep apnea. Learning disabilities may also present with ADHD-like symptoms, when children become bored, frustrated, or try to compensate for academic struggles by becoming the class clown or bully. Learning disabilities also frequently travel together with ADHD, which we cover in a separate Doctor’s Note.

ADHD can be diagnosed by a pediatrician, family doctor, psychologist, or psychiatrist. All should use a careful history and either standardized rating scales or more in-depth psychological testing. If a psychologist is evaluating the child, then a physical examination by a physician is also warranted, to address the possible medical causes noted above. By definition, the symptoms must be present for more than 6 months, start before age 7 years (although they may not be recognized as such until later), and must impact the child’s ability to function in an age-appropriate way in multiple settings (for example, both at home and at school).

Primary care doctors will typically use one of several common standardized rating scales (the Vanderbilt and Conner’s scales are two of the most commonly used). These standardized rating scales may also suggest the possibility of other disorders such as learning disabilities, anxiety, depression, or oppositional-defiant disorder, in which case further evaluation would be warranted. Children being seen by a psychologist or psychiatrist may be evaluated for these possibilities at the same time as the initial ADHD assessment.

How to Help

Once a child has been diagnosed with ADHD, what can we do to help? To start, the diagnosis itself helps the child, parents, and teachers to know that the problems are not the child’s fault.  It’s not willful misbehavior or laziness, but rather a neurological disorder that causes the child’s struggles. Structure and consistency at home and at school also really help, so parents may need to communicate with teachers regularly to ensure that expectations, rewards, and consequences are applied consistently between home and school. Daily communication logs and checklists for often-repeated tasks can help children to keep track of assignments and complete their work.  Children who have ADHD and learning disabilities will need learning supports and accommodations that include these strategies, as well as specialized curricula to address specific learning differences.

Although there is no evidence that supports “special” diets for successfully treating ADHD, it’s clear that an overall healthy diet, free from excess “junk” foods, as well as plenty of exercise and sleep, do help all children to do their best. There’s also some evidence that diets rich in Omega-3 fatty acids, iron, and zinc help to support brain development.

Participating in activities where the child has a chance to excel is also important. Children with ADHD work very hard to accomplish things that are easier for many of their peers, and that hard work is stressful. Non-academic pursuits can offer a respite from that hard work, and should not be taken away as consequences for academic or home struggles. For children who are interested, martial arts classes (karate, tae kwon do, etc.) and yoga can be very helpful, with lots of mind-body control work being integral to the practice of each.

Medication?

Even with all of these supports, however, many children with ADHD still struggle, and the question of medication inevitably arises. While very few parents are eager to try medication, it’s often the missing link in the pathway to success for a child with ADHD. The fundamental neurobiologic difference in ADHD is an imbalance of neurotransmitters (the chemicals that brain cells use to talk to each other) in a part of the brain that helps a person to focus on a task, but remain aware enough of her surroundings to be able to drop the task and respond to an emergency. These same brain cell pathways also allow a person to stop and consider the consequences before performing an action.

Using medication to help this part of the brain to do its job better is much like using glasses to help eyes to see better. As a parent, if the eye doctor told you that your child didn’t see well, then what would you do? You’d get him glasses, right? You wouldn’t say, “Yes, I understand that he can’t see, but I don’t believe in glasses, so we’re not going to use them?” You’d get him the glasses, because the glasses are a tool to help his eyes do their job better. And that, in turn, helps him to do everything else more easily. Medication for ADHD is much like glasses for your child’s brain — a tool to help the malfunctioning part to do its job better. Once a child’s brain is able to focus and control impulsivity, then the rest of what he or she is good at, both at home and at school, gets a chance to shine.

Medication should only be used after ADHD has been properly diagnosed, and must be monitored carefully. Many children can take “medication holidays” on breaks from school, using the medication only on school days and other days when they need to have their best focus. Because it’s a genetically-based, neurobiological difference in the brain, ADHD is not something that children “grow out of,” and many adults who were diagnosed as children now find that they continue to function better when using medication — just as do many adults who began wearing glasses as children. Some teens and young adults with mild ADHD do, however, learn strategies to manage their focusing and impulse control, and can do well without medication.  It’s important that any decision to stop using ADHD medications be made carefully with medical consultation, particularly for teenagers who are driving, since a lack of focus or impulse control behind the wheel could have obvious and severe consequences.

Some Final Thoughts & Resources

With proper diagnosis, treatment, and support, children with ADHD can live very successful and productive lives. It’s our job, as the adults who care about them, to make sure that that happens. To learn more, see these excellent resources:

If you think your child might have ADHD, schedule an appointment to talk with one of our doctors. We look forward to working together with you and your child.

Dr. Sarah Springer, a Shareholder in the practice, is the Medical Director of Adoption Health Services of Western Pennsylvania.