By Michael T. Smith, Ph.D.
Most children will occasionally forget to do their homework, act without thinking, daydream during school or fidget when they shouldn’t but hyperactivity, impulsivity, and inattention are also signs of Attention Deficit /Hyperactivity Disorder (ADHD). ADHD can affect your child’s ability to learn and get along with others which can lead to problems at school and home. The first step to diagnosis and getting the help your child needs is recognizing the symptoms and signs of ADHD. October is ADHD Awareness Month and Family Psychology Associates would like to offer some answers to the most frequently asked questions from concerned parents.
ADHD is more prevalent than ever, but not all children who have ADHD are receiving the help that they need. According to a 2011 survey conducted by the Centers for Disease Control and Prevention, Attention Deficit/Hyperactivity Disorder is the most common Neurodevelopmental Disorder in America, affecting 11 percent of children between the ages of 4 and 17. Unfortunately, 17.5% of children who were diagnosed were not receiving medication or counseling. This is why ADHD Awareness Month is so important for diagnosis and treatment of those that are affected.
A diagnosis of ADHD requires much more than an interview with the child and parents. According to the American Academy of Pediatrics, a thorough evaluation of ADHD should not only determine if the child meets the criteria for ADHD, but they should also determine if there are coexisting problems with anxiety, depression or learning disabilities. Therefore, at Family Psychology Associates, our evaluation includes a detailed childhood history, behavioral ratings from home and school, an IQ measure to determine the child’s ability, measures of executive functions, a computerized measure of attention and impulse control, and an academic screening. The results of the academic screening may indicate the need for more educational testing to rule out a learning disability, which can occur in 20-30% of students diagnosed with ADHD. In addition to the above factors, we also inquire about a history of seizure disorders and a family history of thyroid problems, two of the most common physiological conditions that mimic ADHD. Furthermore, we explore the child’s sleep history, nutrition, exercise and amount of time spent on electronics. A diagnosis of ADHD is a complicated process that includes many factors which is why ADHD Awareness Month is so important.
Approximately 85% of children that are diagnosed with ADHD benefit from the use of medication as part of an overall treatment program. Of those who respond favorably to medication, the majority are on stimulant medications. Many children can have their medication effectively managed by their pediatrician, but a child psychiatrist, a developmental pediatrician or a pediatric neurologist are specialists to whom parents may also turn when considering medication.
Medication is only part of the solution. Counseling may explore sleep, nutrition and exercise as the foundation upon which a child develops. Treatment begins by encouraging better sleep, as sleep disorders are more common in children with ADHD. In fact, some children who have been diagnosed with ADHD may actually have a sleep disorder that mimics the symptoms of ADHD. Furthermore, if a child is on medication, it may affect their sleep patterns. Diet and exercise are also important areas to investigate. Many children with ADHD are picky eaters who prefer carbs and junk food. They may also spend too much time on screens. Not only does this reduce their cardiovascular fitness, which is important in improving stress tolerance, but too much screen time can reduce frustration tolerance and empathy.
We also provide family counseling to create a healthier daily routine. The three most common stress points in the day are getting ready for school (especially if the medication has not yet taken effect), homework and the evening wind down. Parents may have to be completely ready for the day ahead in order to provide arm’s length supervision of their child who is trying to get ready for school on time. Homework needs to be targeted to when medication effects are optimal. The evening meal may be delayed to boost the child’s appetite. Screens should be off one hour before bedtime to promote compliance with bathing and the development of sleep hygiene. Reading and relaxation exercises should be a part of the evening routine. One could say that “the day begins the night before.”
ADHD affects social information processing. As children get older, they may become less hyperactive or impulsive, but their information processing problems continue into adulthood. Emotion coaching with children and their parents focuses on modeling calm communication. The first step in emotion coaching is to teach the children a full vocabulary for their feelings. Rather than getting angry, children need to learn to calmly express their frustration, fear, sadness or disappointment. If a child is able to calmly express their feelings, the parent is likely to be more understanding. This can promote effective collaboration and problem solving. Children with ADHD tend to be egocentric. They have to be taught how to see their actions from the perspective of others. Once they realize that there may be more than one point of view, they can learn empathy or how to feel what someone else may be feeling. A successful treatment outcome is a child who has age appropriate self-help skills, a healthy balance of sleep, nutrition and exercise, and a student who contributes to their learning community at a level that is commensurate with his or her ability. Many young adults with ADHD are much more successful in the world of work than they were in school because they may find the type of work environment that fits their kind of mind.
Healing ADD. Daniel Amen. The 7 subtypes of ADHD.
Taking Charge of ADHD. Russell Barkley. A parent’s guide to managing the behavior of children with ADHD.
Smart But Scattered. Peg Dawson and Richard Guare. Help for parents of children with disorganization, emotional dysregulation and other executive function disorders.
The Misunderstood Child. Larry Silver. How to diagnose and treat ADHD and Learning Disabilities.