The usual scenario that unfolds is that you have been called in to see the teacher yet again. Your child is not concentrating, causing havoc and not progressing with basic concepts in the class. These are not easy words to hear and I have had distressed parents in my rooms asking roughly the same questions… “What did we do wrong? Will my child ever pass the year? What’s is going to become of them if they can’t learn?” Lets talk about ADHD.
First of all… ADHD is real. It is a proven chemical imbalance of neurotransmitters (too much of some, and not enough of others) in the brain.
ADHD is an acronym for Attention Deficit Hyperactivity Disorder.
The three commonest symptoms are:
• Inattention
• Impulsivity
• Hyperactivity
There are 3 subtypes of ADHD, depending on which of these three symptoms are mostly displayed by the child i.e. mostly hyperactive and impulsive, mostly inattentive and then the combined type that can have symptoms of both groups.
Lets look at the three symptoms and see how the kids can present.
1. Inattention can often be described by the following: daydreaming, in his own world, forgetful, inability to follow a short list of instructions at home or in school (getting dressed, brushing teeth and getting out the door on school mornings becomes a nightmare). The little ones who fall in this subgroup are often missed until they are much older, as they fly under the radar. They are usually quieter, and unlike their hyperactive counterparts do not get into mischief and compromising situations as often when they are younger. Their symptoms present later as the demands of school increases and they are expected to sit still and independently complete assignments and worksheets in a certain time frame.
2. Impulsivity- Someone once explained ADHD as having a Ferrari racing-car engine for a brain; a Ferrari that is amazingly powerful with an engine that can do incredible things… but an engine that only has bicycle brakes. Brakes that are not strong enough to control that amazing brain. Children who mostly have these symptoms lack impulse control. The thought to climb onto the roof will enter their minds, but someone else without ADHD might think in a split second about the dangers and consequences of such an action and abandon that thought. In the child with ADHD there’s no pause and think… they push through and act before thinking about possible repercussions of their actions. In other words, they lack the ability to determine if an upcoming action is safe and appropriate for a specific situation, time or place.
3. Hyperactivity is the symptom most people will notice about children with ADHD. They are busy, very busy… something has to move at all times. They really have significant struggles to stay seated, staying still when seated, they often fidget incessantly by either tapping on the desk, swinging a foot to and fro, bouncing up and down in their seats, interrupts and shouts out of turn and they usually talk a lot. The symptoms are often noticed by the age of 4 years, and gets progressively more obvious towards 7 years of age.
How do we diagnose ADHD?
There is no one specific test to diagnose this condition. It can usually be diagnosed by Paediatricians, Educational Psychologists and Paediatric Psychiatrists and some councilors trained in the presentation of children with ADHD.
We use various modalities to diagnose this condition; parental and teacher histories and reports, certain screening scales and questionnaires (Vanderbilt and Connor’s). I usually ask parents to bring some of the workbooks from school, and their are a few telltale signs that can help to diagnose this condition.
It is also important to rule out and/or diagnose conditions that may mimic and occur together with ADHD. Conditions like anxiety, depression, sensory processing disorders, tics, epilepsy and certain behavioral disorders needs to be ruled out, or then addressed, should they be present.
There are also very specific criteria that have to be met to make this diagnosis and this criteria is only applicable to children over the age of 4 years.
• Symptoms have to be present in more than one environment or situation (school and home). If problems occur only in one place, it is more possible that the child has adjustment issues with the structures that are in place in that specific environment.
• Symptoms have to be present for more than 6 months.
• The symptoms have to be present before the age of 7. Many adolescents and even adults are becoming aware that they might have ADHD, but confirming that they had symptoms by the age 7 is sometimes difficult.
• Symptoms must impair function. The most common reason why I see children with these complaints, is that they are doing poorly at school and not progressing appropriately. They also get into trouble because of impulsivity and have difficulty following the household rules.
How do we manage ADHD?
Contrary to popular belief, medicating children with ADHD is not our first option. Please know that there is no quick fix here!
• Structure and a consistent behavioral plan is vitally important. This must be applied by all caregivers; parents, grandparents, teachers and any other significant people in their lives need to all be on the same page; deciding what is acceptable behaviour, and what not. Sometimes parental, or parent-child therapy and behavioral interventions can be very useful, especially in the younger child where medicating is not indicated. Behavioral therapy, focusing on coping mechanisms, organizational skills and self-regulation techniques even has benefits in the older child in addition to medication.
• Help them make schedules, charts and checklists for homework time, daily chores, and self care (brushing teeth, shower etc). The ADHD child is often a visual, concrete learner and if there is a list, there is structure, and where there is structure, there is organisation.
• Establish a good communication channel between parent and teacher. So that any changes in behaviour or problems in either the home or school environment can be addressed immediately.
• Set small, attainable target goals. It could be academic (remembering to hand in homework or assignments), improved relationships with parents, peers and siblings, or improved rule following (less interruption and talking back at teachers, peers or parents).
• Positive reinforcement of good behaviour. A simple phrase such as “good job” encourages the child to act appropriately. Be specific in your praise and define what they did well.
• An appropriate bedtime and sleep routine is so very important. The last thing a brain that is usually over-firing needs, is to be over tired as well. It makes everything worse.
• Exercise and channeling that abundance of energy is very useful. This is applicable to all children, and not just those diagnosed with ADHD. Exercise increases natural feel good hormones called Endorphins, as well as elevates Dopamine and Serotonin which in turn improves attention and focus.
• Limit screen time during the week. The AAP (American Academy of Pediatrics) recommend an hour or less of screen time a day for children between the ages of 2 and 5.
• Try to limit intake of sugar, colourants and preservatives. Elimination diets (dairy, gluten and wheat), have not been shown to be of any benefit.
• Supplementing Omega-3 fat acids can not cure ADHD, but is not harmful in any way.
• Complimentary and Alternative medicine (CAM) have been shown to be used in as many as 64% of ADHD patients. Please discuss these with your Paediatrician as certain therapies like chelation therapy and megavitamins may have serious side effects.
• The different medication options, mode of action, and possible side effects for the treatment of ADHD warrants a post on its own. The decision to medicate or not is an intricate and sensitive one that should be debated and discussed by the parents, the doctor and the child, if they are old enough to do so. There are different options, for different children, but the most important factor is that it should improve the impairment of function and poor academic progress that certain individuals suffer because of ADHD. The goal of treatment with or without medication is always to help them navigate life and an academic career, to hone and develop their natural abilities and talents, so that that amazing Ferrari brain of theirs can work for them and not against them.
Xoxo Dr Christa
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