Is Your Child Experiencing Symptoms of ADHD?
The scenario is a familiar one. Parents bring their child to see me on the advice of a school official who is concerned about disruptive behavior, lack of cooperation regarding schoolwork and lack of attention. Often, they will talk about comments they have received such as:
“He’s so bright but he is failing because he won’t turn in homework or is constantly making mistakes because he works too quickly.”
“She would do better if she wasn’t constantly talking and disrupting the class.”
“When he gets involved in something, he tunes everything out and won’t listen.”
Sometimes the parents have noticed similar behaviors at home and will speak of their child as being too active, lazy, disorganized or easily distracted. Other parents may have considered these behaviors as simply “being a kid.”
Whatever the symptoms, they know their child is having a hard time in school and at home and they are frustrated and worried. Often, I recognize classic symptoms of Attention Deficit Hyperactivity Disorder (ADHD) from the start, but need a more detailed picture before I start treatment.
Talking with the Child
After getting the basic story of why this family has visited me, I like to talk with the child. This is often difficult, because I need to gain his trust. In many cases, this child has been yelled at a lot. He has been told he is lazy, dumb, or even “bad.” As a result, he does not easily trust that any adult can understand what he’s experiencing, feeling or thinking.
Many times I find I’m working with a child with very low self-esteem and trust issues. The words she has heard from her earliest years have become deeply ingrained in her developing mind. Every time she fails to meet real or perceived expectations, her self-esteem takes a hit. She feels like she has failed at home, at school and with her peers.
If I can get him to open up and put his frustration and confusion into words, I have a greater chance of gaining his trust, which means we then have a greater chance of successfully putting clear strategies into action. He needs to understand that ADHD does not make him bad or a failure. It simply means his mind works differently than the majority of those around him, and he can learn how to work with that difference. I often point out the many great minds in history that were thought to also have ADHD and show how they succeeded.
Once I’m sure the child has ADHD, I have to make a connection with her parents. They’ve had years of frustration and often feel they’ve been failing as parents. Sometimes one parent will mention they simply thought their child had inherited the absent-minded behavior of the other parent. That’s an indicator that both a parent and child may be living with this difference and I’ll explain that ADHD is inherited and some of my suggested strategies can benefit both parent and child. I reassure the parents it is nothing they have done incorrectly and they didn’t cause the difference, but as a family, they have the power to work with the thought differences and see success.
The first thing I want to make clear is that ADHD does not doom a child to a life of under-achievement. In fact, many of our greatest discoveries and inventions were made by people with ADHD, because they were able to see the world from a different perspective. Once you understand the differences, you can learn ways to make them work for you.
ADHD is easiest explained by viewing the brain as being made up of many wires that crisscross in many directions. In the majority of brains, a thought will start at Point A and move directly to Point B. When a person has ADHD, a thought starts out at Point A, but before it gets to Point B, something at Point C captures their attention, then Point D calls, and before they know what is going on, they’ve completely forgotten their goal of reaching Point B.
This detouring is often thought of as inability to pay attention, but that isn’t exactly the problem. What happens is that a child with ADHD pays attention to everything. While most of us are able to block out stimulus, the child with ADHD hears, sees and is interested in everything going on around them. Some develop the ability to go inside and focus on one extremely interesting subject. This, however, requires a complete blocking out of everything, which makes it appear that the child is ignoring parents or teachers.
This cross wiring causes issues in two main areas. The child with ADHD has trouble with executive functioning and self-regulation. Once these two things are under control, success starts to become noticeable.
Executive functioning is the ability to stay organized and follow a project from start to finish, among other things. This difficulty is what causes a child to forget her homework, or make mistakes that seem obvious in schoolwork. It makes it difficult to finish projects and tasks. Often, multi-step projects become so overwhelming the child simply doesn’t do anything because she has no idea where to start.
Self-regulation is the ability to manage impulsiveness. A child with ADHD has a tendency of acting without thinking of the consequences first. They fail to pick up on the behavior of those around them and behave in the same manner. Basically, if a thought enters their mind, they act upon it immediately, and then usually find themselves facing the anger of adults around them.
Once a child learns how to work with the executive functioning deficit and is able to practice better self-regulation, things begin to fall into place. Treatment is started.
There are three common approaches to treating ADHD: medication (a stimulant), diet changes, and behavior modification therapy. After much study, it has been found that combining medication and behavior modification works better than either alone. Not enough study has been done regarding diet’s role in connection with the other two, but early results are promising. Ideally, combining the three could have the best effect.
The First Three Visits
I spend the first three visits explaining that treatment consists of three parts: medication, learning to break down projects and self-regulation.
- Medication – Brain scans have shown that the electrical connections in a person with ADHD fire at a much greater speed than those without ADHD. This is a physical difference that creates the racing thoughts and the inability to ignore unessential stimuli. Prescribing a stimulant has the opposite effect on these children and helps slow down this over-active brain activity.
One of the main concerns parents have about medication is that their child will become addicted to it. I explain that not only does this not happen, but it can prevent addiction to drugs and alcohol in the future. Often a teen with ADHD who is not medicated will attempt to self-medicate by looking at drugs or alcohol to help quiet his mind. This need to quiet his mind, mixed with the lack of self-regulation, can result in addiction quickly. Normally by the fourth visit, parents will agree to at least try medication.
- Executive functioning – When working in this area, the main thing is to help reduce any feelings of being so overwhelmed that a kind of paralysis sets in. The first thing I teach is how to break projects down into manageable tasks. This is one area in which parents must play a strong role because children need time for their brains to develop fully. I can work with the child on learning how to take a project like homework and break it down into individual tasks, such as concentrating on the first five problems in math, then the next five, and so on. A school paper would consist of picking a topic, researching, writing the beginning, etc. Each task is a mini-success and as it’s completed, confidence increases.
Parents can help by providing lists of things like chores and breaking down the chores into individual steps. They can put into place a reminder system and initiate routines like seeing that clothing is put out the night before and homework is finished, placed in a bookbag and the bookbag placed near a door so it won’t be forgotten in the morning.
- Self-regulation – Medication plays a part in this, but it doesn’t solve the issue. I like to explain that medication settles the mind to make it easier to slow down and think, but it doesn’t make you think. Here we frequently work at role-playing. A child is often told what not to do, but adults forget to tell him what he can do instead. Working on role-playing and decision-making skills help the child learn what is acceptable to function within society.
School is the next hurdle we need to address. Parents need to meet with school officials and work out a program of individualized instruction that helps a child succeed. This may include placing him in a quieter environment, allowing more time for tests, writing detailed instructions for homework, and more. By setting a child up to experience success in school and at home, it helps increase self-confidence, which in turn makes the child want to continue succeeding.
The ultimate goal of my treatment is not simply to make school and home easier for everyone. My goal is to work with the family as a whole to help everyone see that having ADHD is not a bad thing. The different way the mind works in a child with ADHD comes with many advantages. These children are often remarkably smart. Their viewpoint allows them a sense of innovation and creativity that helps them use their innate intelligence to discover, create and thrive in the world. These children are often natural leaders and with the correct treatment, they will be the leaders, creators, artists and scientists of the future.