What is going on with your child?
Almost all children are inattentive, hyperactive or impulsive at some point. When this behavior is constant to the degree that it interferes with their ability to do well at school, affects their capability to maintain friendships or they exhibit the behaviors while at home, it can have a significant impact. What is the difference between typical childhood distraction and activity level and that of a child with ADHD? What is the treatment?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a combination of problems, difficulty maintaining attention, hyperactivity and impulsive behavior, that are continually displayed by the person who has it. It affects millions of children (typically boys more than girls), usually starts before the age of 12 and is classified as mild, moderate or severe. The exact cause is unknown but thought to be related to a combination of genetic, environmental and developmental factors. The three types are predominately inattentive, predominately hyperactive-impulsive and combined (most common). In order to be diagnosed with ADHD, the symptoms must be present for at least six months with multiple symptoms that are negatively impacting school, home life and/or relationships with friends.
The two main symptoms are inattention and hyperactivity/impulsivity. Inattention can be qualified as making careless mistakes in schoolwork, trouble staying focus on tasks/play, unable to follow instructions causing them to fail to finish schoolwork or chores and dislike/avoiding tasks that require focused mental effort (homework). They appear not to listen, forget to do daily activities, are unable to organize tasks and are easily distracted. Hyperactivity/impulsivity is when the child is constantly in motion, such as fidgeting, tapping hands or feet or squirming in their seat. It also means that they have difficulty staying seated, so they often run around or climb in situations when it’s not appropriate, have trouble doing an activity quietly, talk too much and have a hard time waiting for their turn. This causes them to interrupt a questioner (teacher) by blurting out answers or interrupting others’ conversations or activities. While all children display these behaviors intermittently, for children with ADHD these behaviors never go away. If a child demonstrates this behaviors in one setting, such as school, but not others, at home or interacting with friends, it is likely that they are having difficulty with something other than ADHD (same holds true if they are having challenges at home or with friends but not with school).
The behaviors associated with ADHD can lead to a variety of issues. Due to their challenges in school settings, it can lead to academic failure and judgment by other children and adults. This causes them to have difficulty interacting with and being accepted by peers and adults, which can trigger low self-esteem and depression. Children with ADHD are more likely to have accidents and injuries than other children. Also, they are at increased risk for alcohol/drug abuse and other reckless behaviors. While ADHD doesn’t cause additional psychological or developmental disorders, children with it are often found to have coexisting conditions, such as learning disabilities, anxiety disorders, mood disorders, conduct disorders and depression to name a few.
There are several components to treating ADHD. The first is medication because it has been found that in individuals with ADHD there is a decrease in of certain chemicals in the brain (neurotransmitters). Stimulant (or psychostimulant) medications help to boost and provide a balance of these neurotransmitters. The two groups are amphetamines (Dexedrine, Adderall, Vyvanse) or methylphenidates (Concerta, Metadate, Ritalin, Focalin). Both come in long or short-acting forms because the right dose varies significantly for each person. Since stimulants can cause unwanted side effects for some people, some other medications (Straltera, Wellbutrin, Intuniv, Tenex, Catapres, Kapvay) are non-stimulant and have proven affective at treating ADHD.
The second major component is various types of therapy. For younger children, behavior therapy is aimed at behavior-changing strategies that helps them cope with difficult situations. For older children, psychotherapy is helpful in encouraging them to talk about issues that are bothering them, explore negative behavioral patterns and learning ways to deal with their symptoms. For children who have a hard time interacting with other children, social skills training can be beneficial. Parenting skills training is valuable in helping parents learn how to interact with and support their child. Family therapy sessions can be useful in having all members of the family to talk about the situation and to gain a better understanding of each other and what they can do.
The third component is strategies that parents can implement to help their child thrive. By being consistent and having a regular schedule with clear expectations, your child will learn a routine and be less likely to forget to do something that is expected of them. An important part of the schedule is that your child gets enough sleep so they are well rested. Set limits that have clear consequences for your child’s behavior and use timeouts or appropriate discipline as necessary. Work with your child to develop organization skills and use simple worded directions that you demonstrate the steps when instructing your child what to do. Be sure to make eye contact when speaking to your child and avoid multitasking yourself when doing so. Identify potentially difficult situations and find ways to help your child improve their self-esteem and sense of discipline. Talk with your child’s teacher to identify any problems early and ask about programs through school that could be helpful. Through it all, be sure to enjoy time with your child and give them lots of affection. It is helpful to remain calm, be patient, keep things in perspective and to take breaks yourself.
Since the exact cause of ADHD is unknown, it is hard to pinpoint one thing that would prevent it. One of the biggest recommendations is to avoid anything that could harm fetal development during pregnancy. Another is to protect children from environmental toxins, such as lead exposure. Something that is being researched is the effect screen time has on the development of ADHD. Currently, it is recommended that screen time is limited during all of childhood, but especially during the first five years of life.
Attention-Deficit/Hyperactivity Disorder is challenging for both parent and child. With early intervention, the effects can be limited. If you have any questions or concerns about it, please speak with your child’s doctor. If you would like more information, please visit the Center for Disease Control’s ADHD page at https://www.cdc.gov/ncbddd/adhd/index.html