There are 6.4 million children in the U.S. with diagnosed Attention-Deficit/Hyperactivity Disorder (ADHD). That means there are 6.4 million kids trying to play catch-up without an ability to focus, battling to stay in their seats to learn, or wondering why they can’t just be like their classmates.
Parents of these children often struggle on the sidelines, faced with the reality of their child’s difficulties. And it’s possible, despite all their love, attentiveness, and patience, that they are at their wits’ end, overstressed and tired of their child not listening.
From day one, parenthood brings an array of tough choices. For parents whose child faces challenges with inattention and hyperactivity, these choices get even harder. Professionals urge parents to choose proactivity over reactivity; hopefulness over helplessness; action over resignation. The good news is that ADHD is now a manageable disorder with the right education, counseling, and support.
If you believe your child is in the 11 percent of 4- to 17-year-olds suffering from ADHD, ignore the naysayers who blame iPads, junk food, and even bad parenting for the uptick in this disease. Research has demonstrated an increase from 7.8 percent in 2003, to 9.5 percent in 2007, to today’s current rates. This is a real, biologic, chronic problem that often persists into adulthood and coexists with other serious disorders and diseases. Here are straight answers and clear options from professionals who specialize in childhood behavior and ADHD.
What ADHD Is and Isn’t
If your child is struggling to pay attention in school or regularly displays hyper behaviors, this doesn’t necessarily mean he has ADHD, says Kathryn Lester, PsyD, ABPP, director of the neuropsychology program at Capital Health’s Capital Institute for Neurosciences. Part of the surge in diagnosis numbers—especially in certain demographics, such as high school-aged boys—may be due to comorbidities (two or more conditions occurring at once), ambiguous diagnostic criteria used by quick-to-decide generalists, or over-assessment of mild symptoms.
According to Dr. Lester, “We often hear parents say, ‘he’s not listening’ or ‘he can’t sit still,’ but a lot of these behavioral observations used to make a diagnosis are inadequate and tend to over-diagnose kids, which you can see in the context of more comprehensive work-ups,” she reports.
These comprehensive work-ups are an absolute imperative for tracking down behavior origins, patterns, and possible treatments for your child. Dr. Lester is trained to conduct neuropsychological evaluations, including clinical interviews, standardized testing administration, scoring, interpretation, and reporting for adolescent neurology patients, and has also performed psychoeducational evaluations to recommend specialized education programs in schools.
Dr. Lester notes that a high level of activity is not uncommon for certain age groups of healthy children, and that as maturation naturally occurs these behaviors typically decrease. Often times, unrealistic age-expectations cause suspicion of disease in otherwise healthy children. “While hyperactivity is a prominent feature of ADHD, it doesn’t make the diagnosis. There has to be evidence of other problematic behaviors.”
If your primary concern is your child’s inattention, Dr. Lester points out that attention is a non-specific symptom, meaning there are a number of medical and neurologic diseases or environmental issues that could create difficulties sustaining attention. She warns against assuming an ADHD diagnosis on a symptom without first ruling out other issues that could be contributing.
Seeking Outside Support
If you think your child may have ADHD, approaching the primary teacher is a great first step to confirm or deny any suspicions. Teachers see many kids in the same age group and are likely to notice atypical behaviors. If your child’s teacher agrees that an assessment may be warranted, visit your pediatrician for a recommendation, or go straight to a behavioral specialist or neuropsychologist for a thorough ADHD assessment.
Unfortunately, blood draws or brain scans can’t test your child for this disease, but behavioral questionnaires and screenings for other diseases, emotional issues, and environmental disruptions are available.
“We have the behavioral criteria to make the diagnosis in kids [as compared to typical children] but it can really manifest in different ways and the disease can affect their lives in different ways,” says Dr. Lester. “There’s no ‘cookie cutter’ solution; we must take a comprehensive approach to diagnosis, identify strengths and weaknesses, then go about creating recommendations for interventions with an understanding of that specific child.”
Olga Goldfarb, M.D., who treats children with ADHD at the Capital Institute for Neurosciences, says that once a child is diagnosed, she and the family discuss the right combination of interventions for each patient, which may include:
A child with ADHD has unique educational needs. Schools are usually helpful in providing accommodations to get him back on an even playing field with other kids, but they may vary depending on the degree of the problem, Dr. Goldfarb says. Specific to each child, examples of classroom alternatives include a smaller or less distracting environment, reward systems, or homework-focused strategies.
A child with ADHD may need to discuss challenges of the disease impacting different aspects of behavior, self-esteem, or organizational skills. Tips for battling “triggers” and combatting detail-rich tasks may be useful. Your child’s needs will vary greatly from another’s; that’s just how this disease works.
Parents need to work hard to understand the disease and how it can be managed. Strategies implemented at school should remain consistent at home. For example, try breaking tasks into smaller segments and be consistent offering both praise and discipline to your son or daughter. Parents also must understand the importance of a strict schedule with expectations for routine activities like homework, healthy mealtime, and adequate sleep.
The importance of interaction with children cannot be overstated, says Dr. Lester, who encourages frequent conversation, game playing, and other family activities for optimal communication. While screen time should be limited, research has not found that ADHD is caused by too much television or exposure to electronics.
Between 85 to 90 percent of kids with combined-type ADHD will respond to one of the available stimulant medications: amphetamines (Adderall) and methylphenidate (Ritalin and Concerta). “When we compare the avenues of treatment individually, medications are the most effective way to treat the symptoms of ADHD, which is a biologic disease,” says Dr. Goldfarb, who explains these medications work on neurotransmitters in the frontal portion of the brain.
Even with their overwhelming success in treating the symptoms of ADHD, stimulants to children should be given with caution. Decreased appetite/weight loss, irritability, moodiness, tearfulness, headaches, and other systemic effects are not uncommon, warns Dr. Goldfarb.
Parents are aware and concerned about these side effects, as they should be. “We’re not giving this lightly. Many times, it is most effective, but we still don’t always start with this treatment; we prefer to start with other strategies if possible, especially in a young child,” she says. “We must monitor the child very closely, making sure the mood, growth, and cardiovascular system are all in check. Of course we want to be making sure the medication is helpful.”
Dr. Goldfarb is quick to remind parents that while medication is the most effective single method, the ideal treatment includes all aspects of care involving the child, the family, academic supports, and psychological help.
This ADHD journey may be a new one for you and your child, but it’s not one that you’ll need to walk alone.