Consider this condition in a new light.Is Attention Deficit Hyperactivity Disorder (ADHD) really a lack of attention that causes problems in the classroom?
In my practice I spend time explaining that many of the children with this condition actually have an inability to focus because they are paying attention to everything around them. The Centers for Disease Control and Prevention (CDC) reports that nearly 11 percent of children between the ages of 4 and 17 meet the criteria for ADHD.
Parents ask why this condition is more frequently diagnosed now than in previous years. Classroom settings have changed and no longer allow for flexibility in learning styles. Classes are large and teachers lack resources and time to manage even mild cases, so more children are sent for evaluations.
Health care providers are also much better trained to read the signs of this condition, and we know that there are implications to the child’s mental health if the condition goes unaddressed.
Strengths-Based Approach to ADHD
So why is it important to see ADHD in a new light? Children are told that they have a deficit and a disorder, and often grow to feel defective. It’s crucial that they understand that their ability to have multiple attentions can be a gift that just has to be managed. This disorder is inherited in about 75 percent of the cases. By approaching diagnosis and treatment from a strengths-based position, children are more receptive. They learn that they can use this gift later in life, but first must learn new skills and, in many cases, treat this condition to promote their ability, access education and preserve self-esteem.
ADHD is diagnosed in three categories: predominantly inattentive, predominantly hyperactive or combined. No matter which type, left untreated, ADHD has significant implications. They include obvious school issues and significantly higher dropout rate, discipline problems, family stress, accidental injury due to impulsivity, drug and alcohol use, employment problems, driving accidents, higher teen pregnancy rates, elevated criminal and arrest rates and significantly elevated depression and anxiety related to self-esteem problems.
Proper diagnosis is essential and can be done as early as age three, but often does not happen until children enter kindergarten. Other peak times of diagnosis are entry to middle school and high school when the complexity of work becomes high enough that inattention symptoms can no longer be compensated for by children on their own. Girls often internalize symptoms and demonstrate more anxiety than boys. It’s important to recognize that anxiety may be masking ADHD symptoms.
Complicating an ADHD Diagnosis
ADHD is easily the dumping ground for symptoms that cause distraction and inattention. However, there are many conditions that mimic the symptoms of ADHD, and a full evaluation is imperative.
Anxiety is the most common condition that can cause attention symptoms just like ADHD. Anxiety and its many forms — including obsessive compulsive disorder — often demonstrate symptoms of inattention as it’s difficult to focus when you are distracted by anxiety or obsessive behaviors. Depression features can often appear to be inattentive as well. Often auditory processing disorder and other learning disorder issues are overlooked, but can appear to be a lack of attention and may even lead to acting out or behavioral problems or oppositional behavior as the child becomes frustrated. Sometimes a full psycho-educational evaluation is needed to understand the full diagnostic picture.
If Your Child Has ADHD Symptoms
Many parents are initially opposed to medication, but it’s important to understand the neurobiology of ADHD. Most ADHD patients have a deficit of the neurotransmitter dopamine, which affects their ability to process information and impacts executive functioning. This has implications on their ability to process information, pay attention when not prompted, think of consequences before actions and avoid distractions. The most common treatment for ADHD is the use of stimulant medications that elevate dopamine levels for a period of time. Some are short-acting and some are long-acting. In most cases, it’s most effective to use long-acting medications. It’s important that parents understand that the brain is still learning on the weekend. Weekend treatment preserves the family environment and the child’s self-esteem.
Recommendations for Parents
* Know your rights, and ask the school if your child is struggling. ADHD is a medical condition that often qualifies children for an accommodation plan such as a 504 plan, but can qualify them for an IEP if grades are below level.
* Establish a study environment that is quiet and free from distraction as much as possible. If your child is on medication, encourage that homework be done as soon as your child comes home from school. If your child is not on medication, a little playtime is helpful to increase dopamine naturally before homework time. Just set limits and be firm.
* Most children with ADHD respond much better to reward systems than they do to negative discipline. Of course, there is always cause and effect when discipline is needed but it should be as non-emotional as possible, and follow-through with consequences is essential.
* Use a token system as a reward method. Do not reward with money. When your child does things that you want to see happen again, reward with a poker chip. Set goals for your child. Start with five tokens first, and eventually move up to reach goals.
* Electronics are a problem for most children, but are highly problematic for children who hyper-focus on them due to ADHD. Establish rules and limits and be very consistent.
* It is imperative that all children with ADHD get adequate sleep. Sleep hygiene means that all electronics are off at least one hour before bedtime. Have a regular, predictable bedtime routine.
There are non-stimulant approaches to treatment of ADHD, but the gold standard recommended by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry is to treat patients with long-acting stimulant medications. Based on research, this gives children the most effective management of their symptoms.
Kimberly R. Lawrence, CPNP, PMHS, is an NP working exclusively in a psychiatric practice offering a strengths-based approach to treatment.