In 2013, the National Health Interview Survey determines that 9.5 percent of children ages 4 to 17 in the United States had been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). This number has climbed steadily since 2003, when around 7.8 percent of kids in the U.S. were diagnosed with ADHD. A common question is whether more children have ADHD now or if healthcare providers are starting to recognize it more. Either way the impact of ADHD on life and learning can be significant.
The diagnosis of ADHD is made using research-based rating scales, one for parents and one for a child’s teacher(s). Parents and teachers are asked to rate a child’s symptoms compared to other kids of the same age and sex. Children are rated on symptoms in two categories: inattention and hyperactivity.
Symptoms of ADHD
Some symptoms of inattention include forgetfulness in daily activities without reminders (such as brushing teeth), losing things, being distracted easily, having trouble finishing tasks or following through with more than one direction at a time.
Some of the hyperactive symptoms include more wiggling than expected when seated, talking too much, having trouble waiting his turn and being constantly in motion. Parents and teachers are asked to check off whether a symptom occurs “not at all,” “just a little,” “pretty much” or “very much.” Symptoms rated as pretty much or very much are added up to decide if the child meets the diagnosis of ADHD.
Both parents and teachers need to agree that the symptoms are causing problems in order for the diagnosis to be made. Some kids have only inattentive symptoms of ADHD, while others have only hyperactivity symptoms. Most school-age children have a combined presentation with both hyperactivity and inattention.
Steps Following Diagnosis
Once a child receives a diagnosis, a decision needs to be made about what to do next. Many younger children with hyperactive symptoms respond very well to behavior-management strategies. Keeping a daily routine can be helpful. Children with ADHD learn best when things are repeated and become part of their daily schedule. Some parents use a white board listing what a child needs to do. Others use pictures of people getting dressed or brushing their teeth to remind a child about what to do. Some families put the reminder list or picture on the bathroom mirror or tape it to a child’s dresser.
When giving instructions, make eye contact with your child and ask him to something using a short sentence, such as “Pick up your clothes.” Have your child repeat what you asked and then send him off to complete the task.
Once that task is done, your child can return for the next instruction. Teachers can use this breakdown strategy in school as well. Giving your child a huge task, such as cleaning her room, can be too difficult to tackle. Small steps, such as asking your child to clean off the top of her desk first, can lead to better results.
In the classroom, teachers should allow a child with ADHD to sit toward the front and middle of the class. Windows and doors are distracting for kids with ADHD. Children who wiggle and fidget may benefit from a wiggle seat that allows them to move without annoying their classmates, or a weighted vest that can help them remain calmer.
Placing a large rubber band around the chair legs allows a student to move his feet, and a strip of Velcro under a desk can be rubbed to release energy during class. Fidget toys can be helpful, as long as a child uses them respectfully. Fidget spinners tend to be more distracting than helpful to kids with ADHD. Teachers can remind a student with ADHD when something important is being said or they can ask him to repeat instructions to the class. Directions may need to be repeated to a child a few times for follow-through.
Medications and Side Effects
Most kids with ADHD benefit from medication to aid in helping them focus and remain calm. The goal of medicine in school is to help a child learn and retain the same information that the rest of the class is being taught. Medicine can also help socially, as children with ADHD don’t always respect body space or pick up on facial expressions or body language. People need to remain focused no matter what they are doing: riding a bike, learning math or engaging in a sport.
There are two different kinds of ADHD medications: stimulants and nonstimulants. Stimulants are divided into methylphenidate and amphetamine products. They are the most effective type of medicine for ADHD. About 80 percent of those with ADHD will have better focus and calmer behavior on a stimulant once the dose is right. Nonstimulant medications are about 60-percent effective for ADHD symptoms.
All ADHD medicines have side effects. Stimulant medications may cause loss of appetite, stomachache, dry mouth and trouble falling asleep, especially if taken later in the day. They last anywhere from 4 to 13 hours, depending on whether the medicine is long-or short-acting.
Side effects will only occur when the medicine is working. Once it has worn off, a child’s behavior and attention difficulties will begin again. Healthcare providers will decide which medication to use based on your child’s needs. If your child participates in sports after school and then comes home to do homework, he might need a 12-or 13-hour medicine. If he has a loss of appetite, a shorter-acting medicine may be used.
Nonstimulant medications also have side effects. Atomoxetine can cause a loss of appetite, as well as increased pulse and blood pressure. It takes up to six weeks to work, so everyone needs to be patient. Clonidine and guanfacine lower blood pressure, which can cause dizziness, although this is not a common side effect in children. They can also increase thirst and appetite, cause sleepiness and headache, especially if a child does not drink enough when on the medicine. They are more effective for hyperactive symptoms and are sometimes combined with a stimulant medication for increased symptom management and to balance side effects. Nonstimulant medicines need to be taken daily to work, and will work around the clock once they kick in.
The goal of ADHD medications is to allow a child with ADHD to keep up with classmates when learning and to develop organizational strategies to come off medicine in the future. Middle and high school students need to balance many subjects in school and sports or work schedules, which can be difficult with ADHD. Medication aids in assisting with other strategies to remain on top of expectations.
Other disorders — such as learning disabilities or anxiety — can be mistaken for ADHD. If you suspect that your child has ADHD, discuss your concerns with his provider, who can help you figure out the next steps. Medical providers and schools are familiar with strategies to handle ADHD symptoms, and they can be your team members to help your child feel more successful in school, leading to better grades and better self-esteem.
Amy Vierhile, DNP, RN, PPCNP-BC, is a PNP in the Division of Child Neurology at the University of Rochester Medical Center. She is the director of the ADHD Clinic where she sees children with ADHD, and has worked on numerous clinic trials in the area of ADHD. She has presented nationally and internationally on the topic of ADHD.