It seems like every parent is familiar with the term Attention-Deficit/Hyperactivity Disorder, or ADHD. No one wants their child to have the diagnosis; nonetheless it can often come as a relief to explain a child’s constant movement, hyperactivity, staring off into space, impulsivity, and what can appear to be disregard for social norms and other people. The Diagnostic and Statistical Manual for Mental Disorders, 5thEdition (DSM-5) estimates that 5% of children and 2.5% of adults suffer from ADHD. However, the CDC approximates that 9.4% of children 2-17 years of age (6.1 million) had been diagnosed with ADHD, according to parent report in 2016.
This specific diagnosis creates great debate among parents and health professionals in regards to over diagnosis and medication. Because determining if a child has ADHD is largely subjective, it should be based on multiple factors including parent and teacher report, interview of key people in the child’s life, and clinical observation in multiple settings if feasible. One common opinion is that the diagnosis is given too often as a means to justify medicating a child with challenging behaviors. Other experts feel that the disorder is largely under diagnosed. Whether it is under or over diagnosed; parents, caregivers, teachers and anyone who works closely with children can be aware of the signs and seek appropriate medical and mental health care when concerned.
What are the symptoms of ADHD?
ADHD no longer refers to just hyperactivity. It is now an umbrella term for both predominantly inattentive presentation (formerly known as ADD) and also predominantly hyperactive/impulsive presentation. Simple things to look for in regards to inattention include:
● Failure to pay close attention to details or making careless mistakes in schoolwork
● Difficulty sustaining attention
● Appearing not to listen, staring off into space, or being “dazed”
● Trouble following through with tasks
● Lack of organization with tasks and/or activities
● Avoidance of tasks that require sustained attention
● Losing necessary items needed for tasks or activities
● Becoming distracted easily
Likewise, signs of hyperactivity/impulsivity include:
● Frequent fidgeting and squirming
● Inability to stay seated when remaining seated is expected
● Running or climbing when inappropriate
● Being unable to play or engage in leisure activities quietly
● Often “on the go” or “always moving”
● Talking excessively or speaking fast
● Having trouble controlling themselves such as being unable to wait turns in conversations, blurting out answers before the question is complete, or often interrupting others
It’s important to note that these symptoms must be present in two or more settings and interfere with or reduce the quality of social, academic, or occupational functioning. To be diagnosed with ADHD, someone must have six or more of the symptoms from one or both categories. What does this mean? It means that a child who is simply “high energy” and “very active” but is able to concentrate on tasks, sit calmly when expected, complete school work, and control impulses does not meet the criteria for a diagnosis of ADHD.
How is ADHD treated?
Research shows that a combination of medication and behavior therapy is the most effective way to treat ADHD. Behavior therapy consists of defining clear goals for the behaviors that you want to change and utilizing the parents and therapist to help the child succeed at achieving those goals. In behavior therapy, the therapist trains the parents on the best methods to help the child. Parents can also communicate strategies with the child’s teacher and other significant people in their life. Why does this work? It works because parents and other caregivers in a child’s life spend much more time with the child than a therapist. The people closest to the child are the ones who are with them in multiple settings and can implement techniques discussed in therapy sessions throughout the week in the daily routine. When the caregivers and therapist work together, they can discuss the methods that worked and did not work throughout the week (or weeks) in between sessions and then modify the plan to best fit the child and family’s needs.
As far as medication, there are a few to choose from and if a parent chooses to go that route, they should meet with the child’s doctor or psychiatrist to determine the best treatment. The child should remain closely monitored by a medical professional while taking medication for ADHD. It’s important for parents to communicate what medications their child takes to both healthcare providers and the child’s therapist.
One more thing:
A child can be diagnosed with ADHD, even if they do not meet the criteria for both inattention and hyperactivity. I share a story (one of many) of an intelligent little girl from a middle-class family with two professional and involved parents in a blue-ribbon school district who struggled to learn to read. No one could figure out why. In 3rdand 4thgrades, she was tested for Dyslexia and a multitude of learning disorders all for which she did not meet the criteria. She continued to struggle as no one wanted to mention the possibility of the dreaded “ADHD” even though her 5thgrade teachers noticed increasing inattention, staring off into space, lack of organization, frequent distractions, not attending to details and forgetfulness. Her parents noticed avoidance of schoolwork and trouble following through with tasks. Her grades were dropping and her parents continued to search for answers. It was a tutor who suggested that she be tested for ADHD and while the only sign of hyperactivity she displayed was fidgeting, they went ahead with the testing. She began treatment with medication and while working alongside a therapist, her parents adjusted things at home, adding more structure and checkpoints into the evening routine. Not only did her grades increase by approximately 10 points in each subject, she gained confidence and her reading level jumped up 2 grade levels in a matter of months.
Bottom line is this: If your child is struggling with a number of the items listed above in either the attention or hyperactivity categories, go to your doctor, see a therapist, consult with their teachers and get them the help they need. Don’t let your own bias about medication, mental health, or other people’s stigmas interfere with your child’s ability to function in the most optimal way possible.
Carrie Cravens, LCSW
Licensed Clinical Social Worker
Early intervention Specialist/SST with ECI of Lifepath Systems
Photo by Charles Deluvio 🇵🇭🇨🇦 on Unsplash