ADHD in Children – An Overview
Attention Deficit Hyperactivity Disorder, or ADHD, is a mental health disorder that is common among school-aged children. It results in higher than normal activity levels, difficulty controlling impulses, and poor attention spans. This causes difficulty in school, at home, and in interactions with peer groups. It often lasts into adulthood, though the symptoms may wane over time as children grow older. We will not discuss adult ADHD at this time.
Symptoms of ADHD
There are three distinct types of ADHD: Inattentive. Hyperactive, and Combined. Let’s look at each of these types.
Inattentive: Children with predominately inattentive ADHD have difficulty with organization and attention. They may be able to sit quietly in a chair but they are not focused on instruction in the classroom or what a parent may be saying. It is difficult for them to finish tasks because their minds are not able to focus and follow through. They are easily distracted mentally and often forget details.
Hyperactive: Children with predominately hyperactive ADHD are, as the name suggests, overly active. They have a very difficult time sitting still or keeping their bodies still. They move constantly, fidgeting, squirming, tapping, jumping. It is hard for them to be still long enough to complete tasks or finish a meal. These children are often very impulsive and will interrupt others, take things from others, or act in a dangerous way without thinking about the consequences.
Combined: Children with a combined ADHD demonstrate symptoms of both inattentive and hyperactive ADHD. These children may be more severely affected that those with only one type, but not always.
Diagnosis of ADHD
There is not a simple, one-step answer to determine if a child has ADHD. Symptoms must show a persistent pattern and interfere with functioning of daily life. They must be present in more than one environment – for children this is usually in school and at home. Symptoms must be present before 12 years of age and must not be able to be better explained by another mental disorder, such as depression, anxiety, or personality disorder.
There are screening tools used by physicians to determine objectively if a child qualifies for a diagnosis of ADHD. Usually, these evaluations are completed by a parent and a teacher, in order to obtain proof of difficulty in the two environments. Sometimes a more in-depth evaluation is completed by a behavioral specialist, psychologist, or neurodevelopmental pediatrician.
Causes of ADHD
Definitive causes and risk factors of ADHD are unknown but there is much research being done in these areas. We do know that genetics play a large role. Those children with family members diagnosed with ADHD have a higher risk of having it as well. Researchers are also looking into environmental exposures as risks as well, including brain injury (such as concussion or traumatic brain injury), prematurity, and prenatal exposures to alcohol, tobacco, and lead.
Research does NOT suggest that ADHD is caused by poor diets (excess sugar, in particular), increased screen time, or poor parenting techniques. These may worsen the symptoms of ADHD but do not actually cause the mental disorder to occur.
Therapies for ADHD
The initial therapy for children with ADHD of any type is behavioral modifications, both for parents and for children.
- Parents who learn different ways of interacting with their child and alternative methods of discipline can form stronger relationships and help curb problem behaviors.
- Children with ADHD tend to be very disorganized, and providing a structured environment with easily identified goals and schedules can be very helpful in keeping them on track.
- Keep a routine and use visual schedules, or dry-erase boards with tasks.
- Have specific folders for each subject in school, and specific locations for homework and completed work.
- Limit distractions during homework time.
- Use positive reinforcement as a discipline technique, allowing children to work towards goals and prizes. Restriction or loss of privileges such as screen time can also be a powerful motivator for these children.
- Provide an outlet for all of their energy, through sports activities, time playing outside, or family activities.
Sometimes these behavioral modifications are not enough. In these cases, medication is used to help manage the symptoms of ADHD. This decision is made jointly with parents and a child’s Pediatrician. There are several medications that are approved for treatment of ADHD in children and include both stimulants and non-stimulants. Children may respond to medications in different ways, and in the beginning it can take some time to figure out which medication works best and with the least amount of side effects.
Other Problems
Children with ADHD often deal with other disorders at the same time. These are called co-morbidities, and may include anxiety, depression, oppositional defiant disorder (ODD), and a myriad of learning disorders. Part of determining how best to help a child who is struggling is to determine if any of these co-morbidities are present. Sometimes children will seem to be very defiant and meet criteria for ODD, but in fact just lack impulse control and these symptoms improve through treatment of ADHD. This can be a long process, but determining what else may be affecting your child is worth the effort. One of the screening forms used for the diagnosis of ADHD, the Vanderbilt Rating Scales, also looks at criteria for ODD, anxiety, and depression, and can be a powerful tool in diagnosing these children. If true co-morbidities are found, a multi-step treatment approach – for instance, engaging with a therapist for anxiety and depression, or behavioral specialist for ODD – may be necessary to truly help the child.
Final thoughts
While ADHD is a common mental health issue among children, it is also one that is often misunderstood. Not all children with a lot of energy have ADHD – some are just being kids! Not all children who struggle in school have ADHD – they may have learning disabilities or other issues preventing them from doing well. Kids with ADHD are not “bad kids” – they are simply faced with challenges that affect their interactions with others and their ability to learn. Many children feel a huge sense of relief once their symptoms are under control and they can learn and act in the manner they know they should, but with far less effort and frustration.
If you have concerns about your child, talk with the teacher and the Pediatrician to start the process of evaluation and learn about behavioral modifications that may be helpful and promote learning and improved social skills.
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