NAVIGATING THE PATH WHEN YOU SUSPECT CHILDHOOD ADHD


By:
Medically Reviewed by: Syed M. Sayeed MD
When is it time to start paying attention to fidgeting, interruptions, a tendency to "blurt out" thoughts and a mile-a-minute, motor-like energy level? Attention deficit hyperactivity disorder (ADHD) is something that's on the minds of many parents today. The good news is that awareness regarding this condition is on the rise. That means that parents, educators, and doctors are having more conversations regarding how to provide resources and solutions for children living with ADHD than ever before. However, some confusion and misinformation regarding the condition still exist. Understanding ADHD is the first step to becoming empowered to help a child grow and thrive.

The first thing to know is that ADHD is a recognized disorder by the American Psychiatric Association (APA). A person must meet specific criteria to be diagnosed with ADHD. However, not every person with ADHD is going to display completely identical characteristics. Let's talk about the full spectrum of what ADHD encompasses.
The Definition of ADHD in Children
ADHD is not just a catch-all phrase to describe a child who disrupts the class or has trouble focusing. Yes, both of those things could point to a potential ADHD diagnosis. However, the criteria are far broader than that. ADHD is one of the most common neurodevelopmental disorders among children. ADHD is not a condition that is limited to children. Most people who live with the condition experience it throughout their entire lives. Childhood ADHD can be defined as a condition where a child has trouble paying attention and controlling impulses. A child with the condition may be overly active or unable to "think" through their actions.
There is sometimes confusion regarding the difference between ADHD and ADD. We aren't discussing two different conditions when we bring up ADHD and ADD. Attention deficit disorder (ADD) is simply the former label for ADHD. This is important to know if you're referencing literature that is a few years old because you may come across research or information that specifically discusses ADD. The truth is that researchers expanded the term as more information regarding the qualities of ADHD become known through study and observation. Researchers and doctors now know more than ever about the factors and mechanisms involved in this condition.
The Causes of ADHD in Children
It's important to say that the field of study regarding ADHD is still expanding. We simply may not have the full story regarding what contributes to the development of ADHD in children yet. However, we certainly do know quite a bit. What's more, ADHD may have different origins in different individuals. There is plenty of research to suggest that interactions between genes and environmental factors cause ADHD. Scientists also speculate that exposure to cigarettes, alcohol, and drugs during fetal development could contribute to the development of ADHD. Things like low birth weight and brain injury are also linked. Also, it is believed that exposure to environmental toxins that can include things like lead contribute to a higher likelihood of developing ADHD. It's also possible that some combination involving genetic and external factors could create the perfect "recipe" for ADHD to manifest.
The Symptoms of ADHD in Children
Diagnosing ADHD can be challenging. However, it should never be a frustrating experience for parents if they have the right resources at their fingertips. One of the things that can make solidifying a diagnosis particularly tricky is the fact that ADHD symptoms can vary by age. That means that a toddler with ADHD may not necessarily exhibit the same symptoms as a 10-year-old with ADHD. That doesn't mean that there won't be some degree of overlap. Making the diagnosis process even more complicated is the fact that every child presents ADHD symptoms slightly differently. The difference in the presentation of symptoms can be linked to anything from personal interests and hobbies to personality. What's more, there are three recognized varieties of ADHD. Here they are:
  • Hyperactive-impulsive
  • Inattentive
  • A combination of both

ADHD - Hyperactive-Impulsive Type
How can you determine which type is present in a child? The hyperactive-impulsive subtype must have at least six out of nine specific symptoms to meet diagnosis criteria. Here they are:
  • Fidgeting
  • Squirming
  • Frequently getting up when seated
  • Running or climbing at inappropriate times
  • Difficulty with playing quietly
  • Talking more than seems "appropriate"
  • Talking out of turn/blurting words out
  • Interrupting
  • An on-the-go demeanor
ADHD - Inattentive Type
An inattentive type will also display particular symptoms. It's necessary to show at least six out of the nine signs used in an inattentive diagnosis. Here they are:
  • Inability to pay attention to detail
  • A propensity for careless mistakes
  • Failing to pay attention/stay on task
  • Not listening
  • Being unable to follow or understand instructions
  • Avoiding tasks that involve effort
  • Being distracted
  • Forgetfulness
  • A habit of losing things that are needed to complete tasks
How Is ADHD Different in Younger Children?
In little kids, ADHD might look like an inability to sit still. Many parents of toddlers first get an inkling of suspicion that something is different about their children when they observe them being unable to even sit through bedtime stories. Toddlers with ADHD also typically run, jump, and climb far more than other kids their age. They may give off the appearance of merely being "full of energy" at all times. It can be challenging to get an ADHD diagnosis at such an early age. However, it is essential to "track" the signs of ADHD that are being observed with the help of a professional to ensure that no potential gaps in progress are left unfilled.
ADHD in elementary school children looks a bit different than what's seen in younger kids. This is the period where many parents begin to feel very strongly that "something" is going on. Some children with ADHD are hyperactive. However, this is not universal among all children with ADHD. Social and learning environments can often make ADHD symptoms more evident to both parents and instructors. For instance, a child with ADHD may have trouble with the reciprocity that goes on during a conversation. Here's a rundown of the main outward characteristics that can usually be observed in school-aged children with ADHD:
  • Self-focused behavior that makes it appear that a child is having difficulty relating to others
  • Interrupting others
  • Fidgeting
  • An appearance of a lack of focus
  • Trouble with sharing
  • Difficulty taking turns
  • Not finishing homework
  • Failing to complete chores
  • Trouble with keeping track of things needed to complete work or projects
Unfortunately, the social and academic "repercussions" of ADHD can hit a child hard once they get deep into the school-age years. This can be very troubling and heartbreaking for a parent to watch. Unfortunately, some of the behaviors that are displayed due to ADHD may make it difficult for a child to "fit in" in school or create meaningful relationships. Peers may mistake some of the symptoms of ADHD for uncaring behavior, aggression, or a lack of empathy. Teachers may mistake the signs for "laziness" or disobedience.
Many parents of children with ADHD find that their children can be highly emotional when they become frustrated. Unfortunately, the fact that ADHD children are often misunderstood or excluded can lead to an emotionally charged sense of frustration. As a result, many parents feel caught in a vicious cycle. There is also the issue that kids with ADHD can sometimes be prone to accidents or injuries because they have difficulty with "thinking actions through" ahead of time before acting. This can cause those around them to perceive them as being careless or accident-prone individuals.
How to Diagnose ADHD in Children
Yes, many parents very correctly suspect that their children have ADHD. However, an official diagnosis is always necessary. The main reason for seeking an ADHD diagnosis is that it opens a door for access to significant resources. Many schools offer special programs, support, and accommodations for learners who have been formally diagnosed with ADHD. Parents can also seek assistance from physicians and professionals specializing in ADHD treatment independently. Let's discuss exactly how an ADHD diagnosis is formulated.
There isn't a single ADHD "test." Doctors instead rely on comprehensive evaluations to establish a diagnosis. One of the primary tasks during the diagnostic process is to rule out other causes of hyperactive, inattentive, and impulsive behaviors. Also, doctors are trained to determine the roles or any potential coexisting conditions. Several other factors are looked at when an in-person evaluation is made. For instance, an assessment that looks at details regarding a child's academic life, social life, and emotional development helps to paint a complete picture. Parents often play essential roles in the process of reaching an ADHD diagnosis as professionals move through checklists that rate symptoms. Screening guidelines also recommend that both parents and teachers are utilized as resources for detailing behavior patterns in different settings.
Generally, an ADHD screening will involve a full physical exam. Physicians often include vision and hearing screenings in ADHD evaluations to make sure that "communication" issues related to physical limitations are not at the source of some or all ADHD symptoms. It's also essential to look for signs of thyroid issues, anxiety, situational anxiety, sleep issues, toxicity, and other conditions that could either mimic, cause, or exacerbate ADHD symptoms. It can take time to cultivate a diagnosis due to the many moving parts involved. Also, the goal of a professional is never to simply reach a hasty conclusion by skipping important indicators.
Treatment Options for Children With ADHD
There are several different treatment paths to take when addressing ADHD in children. The specific treatment path chosen will take into account the specific symptoms and objectives involved. Responses to various treatments can differ greatly between children. This is precisely why an open, problem-solving approach to creating a treatment path is so essential for helping children with ADHD see the best results.
Treatment is often a highly collaborative process that a child, parents, teachers, and doctors work on together. The two main treatments available are behavior therapy and medication. However, recommendations for treatment vary by patient age. Here are some general treatment options.
Parent Skills Training
Parent training in behavior management is recommended as the first line of treatment in children under the age of six. Parent training, in addition to behavior management, is recommended in all cases where a diagnosis is made up to age 12. Expanded behavior therapy is recommended for patients over the age of 12.
Behavioral Therapy
The recommended treatment path for children over the age of six includes a combination of behavior therapy and medication. The underlying goals of behavior therapy for childhood ADHD are to foster positive behaviors and eliminate unwanted behaviors.
Classroom Interventions
Children with ADHD have unique needs in the classroom. Behavioral issues associated with ADHD can often be disruptive at school. Therefore, the AAP generally recommends adding behavioral classroom intervention and school support in all ADHD cases. Here are some classroom interventions that are used for ADHD:
  • Feedback on behaviors
  • Providing clear instructions
  • Limiting distractions
  • Consistent expectations and consequences
  • Assistance with organizational skills
  • Using graphs and pictures along with other teaching methods
Medications
There are a variety of medications that can help with ADHD. Medications are usually used, along with behavioral and other therapies. Here are a few of the medications that are available for ADHD:
Stimulant Medications
Stimulant medications work by increasing the levels of dopamine, a neurotransmitter in the brain. These medications have been used for more than 50 years to treat this condition. They help manage hyperactivity, short attention span, and impulsive behavior. The most common stimulants used to treat ADHD include Adderall, Ritalin, Concerta, and Focalin. Stimulants are available in both long and short-acting forms.
Antidepressants
Sometimes antidepressants are used to treat ADHD. These drugs are not as effective as stimulants for ADHD, but they can be useful for kids and teens who also have depression. Antidepressants include Wellbutrin, Effexor, and Pamelor.
Non-stimulant Medications for ADHD
Strattera is a non-stimulant medication that is FDA approved for ADHD. However, it is often prescribed only in cases where stimulants can't be used, as it is not as effective for ADHD.
The Bottom Line
The bottom line on ADHD in children is that diagnosis and management are essential. The good news is that the medical community, schools, and society, in general, are really driven to serve the best interests of children living with ADHD. There has never been so much groundbreaking information regarding what the ADHD experience is like for children. Many parents find that linking up with the right care providers can make a world of difference for getting a proper diagnosis, obtaining the right resources, and making a plan to thrive!
Where should parents start? The first step to getting an ADHD diagnosis is simply information gathering! This means getting in touch with the right care provider to begin preparing for the evaluation process. There's a world of progress and potential waiting for ADHD children on the other side of that first visit with the right professional!

Posted on 06/14/2020


Disclaimer: No content on this site should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
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