The mother of a 12 year-old boy I recently evaluated, called weeks after he was diagnosed with ADHD. She stated, “He’s finally stopped beating himself up for not being able to focus in class, follow directions, or remember to bring home books for homework. He told me he felt great relief knowing that he is special and his brain works differently than other children. He’s so happy to know he now has tools and resources to help him a overcome his challenges. I already see an improvement in his grades and teachers are finally sending home positive reports.” I thanked her for the update, and was reminded about the usefulness of a diagnosis and how this can lead to a better understanding of one's challenges and developing a roadmap for success.
Have you noticed that your child has difficulty paying attention or focusing on one thing at a time? Or perhaps as you observe your child play with friends, you notice they have a hard time waiting their turn in games and often interrupt others while they are talking. Maybe you think back to your last few outings and wonder why your child can’t seem to sit still and acts if they are driven by a motor and goes for hours. You’ve probably wondered if your child has Attention-Deficit/Hyperactivity-Disorder (ADHD)?
Have you asked yourself this question, but then wondered, “If my child has ADHD then how come they can sit for hours uninterrupted and play video games?” “Why is it that when they do something of interest, they can focus for hours and not get distracted, but getting them to sit for fifteen minutes of homework feels like torture?”
ADHD is a Neurodevelopmental Disorder, or in other words a disability related to the brain, commonly diagnosed during childhood. A hallmark of ADHD is that the brain is under stimulated, therefore, when engaged in repetitive or seemingly arduous tasks, the brain is highly distractible and easily bored. However, when the brain is stimulated and engaged, such as watching television or playing video games, the brain is attentive and focused.
According to the Center for Disease Control (CDC), from 2013 to 2015, 10.4% of children ages 5 to 17 years were diagnosed with ADHD. Boys are approximately twice as likely to get diagnosed with ADHD than girls. The National Survey of Children’s Health (NSCH) estimate that the average age of onset for children with ADHD was 6 years of age; however, the diagnosis can be made in children as young as 4 years of age, especially when the presentation and symptoms are more severe.
ADHD symptoms may affect children at home, school, or in social situations. Often, teachers may be the first to point out concerns, as school is the primary setting where children are expected to remain seated for extended periods of time, stay quiet, use time management, and listen closely to teachers and follow directions.
While there has been a steady increase in the diagnosis of ADHD, this may be in part due to access to better measurement tools, enhanced knowledge and awareness about symptoms, and the way this disorder is diagnosed has changed over time.
The three core symptoms of ADHD includeinattention, hyperactivity, and impulsivity.The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) characterizes ADHD as a pattern of behaviors, that must be present in multiple settings (e.g., school and home), and symptoms lead to performance issues in social, academic, or occupational functioning.
According to the DMS-5, symptoms of Inattention include:
- Often makes careless mistakes and lacks attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g. overlooks or misses details, work is inaccurate)
- Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy readings)
- Often does not seem to not listen when spoken to directly (e.g., mind seems elsewhere, even in the absence of obvious distraction)
- Often does not follow through on instruction, and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked)
- Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks, difficulty keeping materials and belongings in order, messy, disorganized work; poor time management, fails to meet deadlines)
- Often avoids, dislikes, or is reluctant to participate in tasks requiring sustained mental effort (e.g., schoolwork or homework; for older adolescents or adults, preparing reports, completing forms, reviewing lengthy papers)
- Often loses things necessary for tasks and activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile phones)
- Is often easily distracted by extraneous stimuli (e.g., for older adolescents and adults, this may include unrelated thoughts)
- Is often forgetful in daily activities (e.g., doing chores, running errands; for older adolescents and adults, returning phone calls, paying bills, keeping appointments)
According to the DSM-5, symptoms of Hyperactive/Impulsivity include:
- Often fidgets with or taps hands and feet or squirms in seat
- Often leaves seat when remaining seated is expected (e.g., leaves their place in the classroom or in other situations that require remaining seated)
- Often runs or climbs where it is inappropriate or feels restless (e.g., In adolescents and adults, may be limited to feeling restless)
- Often unable to play or engage in leisurely activities quietly
- Is often "on the go," acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for an extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with)
- Often talks excessively
- Often blurts out an answer before a question has been completed (e.g., completes people’s sentences, cannot wait for next turn in conversation)
- Often has difficulty waiting his or her turn (e.g., while waiting in line)
- Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for older adolescents or adults, may intrude into or take over what others are doing)
The diagnosis of ADHD has three types including predominantly inattentive presentation, predominantly hyperactive/impulsivity presentation, or combined presentation if criteria for both sets of symptoms are met.
As a parent, you are the expert in your child’s life and if you’ve been concerned about their behavior, this is the time to trust yourself and take action. There are some steps you can take to help your loved one.
Schedule an evaluation to find out if your child has ADHD. The first and most important step is to schedule an appointment with a psychologist to have your child formally evaluated. An expert psychologist trained in conducting psychological evaluations are qualified to make this diagnosis. This can be a lengthy process, but it is recommended because the symptoms of ADHD may mimic many other mental health disorders. For example, a child who appears to daydream in class and struggle with attention and concentration may suggest ADHD, anxiety, or even depression. A child who appears fidgety and restless may suggest ADHD or anxiety. Or perhaps symptoms of boredom could suggest ADHD or giftedness. Furthermore, autism spectrum disorder may present with symptoms of ADHD and vice versa, therefore, it is important to thoroughly assess a child to ensure getting a treatment plan that will help your child achieve success. At Bayview Therapeutic Services, Dr. Heather Kuhl specializes in conducting comprehensive evaluations with children and adolescents. Call her today to start the process at (954) 391-5305 ext. 4.
Engage in therapy. Research shows that parent involvement through parent training sessions or groups, along with individual therapy and teaching skills to your child can significantly reduce the deficits experienced as a result of ADHD.
Create a structure for your child. Children with ADHD exhibit difficulties with executive function such as planning, organizing, resisting impulses, monitoring behavior, and completing tasks. Therefore, creating a structure and sticking to the schedule will be crucial. Some ideas include developing a morning and evening routing; using clocks, alarms, and apps to help your child be more aware of when it’s time to start or end a task; simplify your child’s schedule to allow a balance between school, after school activities, and down time; and make it easy for your child to stay organized (e.g., labeled bins, color coded notebooks, etc.).
Set clear expectations and rules in the home. Children with ADHD benefit when they have consistent rules to follow. It will be important to review them together as a family and post them in a place where your child can read them. Make your life easier by keeping rules, simple, short, and clear. It will be your job to monitor and enforce the rules and hold your child accountable if they deviate. Using a reward system has also been shown to be very effective for children with ADHD. Have clearly spelled out rewards for compliance and good behavior and consequences for noncompliance and misbehavior.
Keep your child active. Because many children with ADHD have ample energy, having them involved in sports or physical activities can help them release the energy in a productive way. It can be helpful to have your child participate in extracurricular activities of interest to enhance self-esteem, self-confidence, and provide opportunities for social interactions. However, as mentioned previously, it will be important to provide time to wind down and have playtime at home.
Incorporate Mindfulness. Teaching mindfulness can help your child learn to respond rather than react and improve attention. Consider incorporating mindful breathing, mindful meditation, or even yoga for kids to create healthy habits early and provide your kid a leg up on learning ways to manage their behavior.
Maintain good sleep hygiene. Adequate sleep is important for all children, but for children with ADHD, tiredness can lead to inattentiveness and distractibility. Not to mention, hyperactivity can lead to problems falling asleep. Regardless, developing a consistent, early bedtime with ample time to wind down and prepare for sleep is recommended.
Teach your child how to make friends. One associated feature ADHD is difficulty with social interactions. Many children with ADHD experience low frustration tolerance, irritability, mood liability, and difficulties with emotional regulation which can interfere with making and keeping friends. Providing your child with education about social skills and social rules can be helpful to ensure they have success on the playground. Working with a psychologist or therapist to guide you and/or your child may be beneficial. In addition, you may seek out a social skill group in your area where children can learn in the moment with other children through guiding and coaching from a trained expert.
For parents, manage your own stress and practice good self-care. Parenting a child with ADHD can test your patience. This is more of a reason to manage your frustrations and disappointment. Children with ADHD need a firm, but fair and reasonable parent. Consistently is important, but parenting with patience, compassion, support, and respect is critical. Do your best to keep a positive attitude, pick your battles and be willing to compromise, and practice good self-care to prevent burnout. Remember, you are the model for your child so practice what you preach. Eat well, exercise consistently, get regular sleep, and manage your stress. You may notice, but your child is always watching and learning from you.
Educate yourself. There are endless resources for parents, and the best parent is an informed one. Therefore, take time to educate yourself about what to expect and utilize resources to remind you that you are not alone and there is always support available. Helpful resources may be found at Children and Adults with Attention/Hyperactivity Disorder, www.chadd.org. You may also find the following book helpful - Taking Charge of ADHD (3rd Edition): The Complete Authoritative Guide for Parents by Russell Barkley PhD., ABPP
Explore other supportive therapies. While therapy with or without medication is an effective treatment for ADHD, other supportive therapies such as Cogmed, an evidenced-based, computerized training program designed to improve attention by increasing working memory, and neurofeedback, which is training in self-regulation, may be helpful.
Consider medication. Not all children with ADHD need medication. However, if the above recommendations do not work substantially to improve your child’s behavior at home and/or school, it may be helpful to take your child to a psychiatrist specializing in child and adolescent mental health for a medication consult.
If you have questions about your child and want to talk to an expert about how to take the next step, call Dr. Heather Kuhl at (954) 391-5305 ext. 4 for a complimentary consultation.
