We’ll continue with our ‘How We treat’ series, this time targeting ADHD. In this post, I’ll describe the nature of ADHD, how it’s diagnosed, and how it’s treated.
What is ADHD?
ADHD is considered to be of disorder of the pre-frontal cortex, which is the most advanced part of our brain, and a subsequent deficiency in the executive functions. In that respect, the pre-frontal cortex of the brain is responsible for vital tasks including attention, emotional control, working memory, organizing, planning, shifting attention and mental flexibility, impulse control, and time management. I’ve written a prior post describing, in more detail, the aspects of these executive functions: ADHD: What’s Executive Functioning Got To Do With It?
And more about the connection between the executive function of ‘emotional control’ and ADHD:
ADHD & Executive Functions: Emotional Control!
It is hypothesized that in those with ADHD, areas of the pre-frontal cortex are not working to their fullest potential, and the subsequent executive functions tend to be lacking.
What Is The Cause Of ADHD?
It is recognized that people are born with ADHD and the cause is primarily genetic. In that respect, ADHD tends to run in families. However, there are other potential causes including head/brain injury, exposure to drugs/toxins/heavy metals (including and especially in-utero), premature delivery, and low birth weight.
What Are The Types And Signs Of ADHD?
There are three different types of ADHD and each is rather self-explanatory: Hyperactive/Impulsive Type, Inattentive Type, and Combined Type. Here are the diagnostic criteria:
Signs of Inattention Type ADHD:
Six or more:
- failing to pay close attention to details or making careless mistakes
- problems sustaining attention in tasks or play activities
- often not appearing to listen
- having trouble following through with directives or fails to finish tasks
- being less than well-organized and poor time management
- reluctant to engage in tasks requiring sustained mental effort
- losing things
- being easily distracted by extraneous stimuli
Signs of Hyperactivity and Impulsivity Type ADHD:
Six or more:
- being fidgety or taps hands, squirmy
- often leaves their seat when remaining seated is expected
- often runs or climbs when not appropriate to do so
- Unable to play quietly
- moving around excessively and always being ‘on the go’
- talking excessively
- blurts out answers
- having problems waiting for turns
- having a tendency to interrupt and intrude at times
These signs need to be seen before 12 years of age and notably impact a person’s life.
How Do We Assess For ADHD?
The evaluation process is comprehensive; I’ve explained the specifics in prior posts:
The process includes assessing for the signs and symptoms that have been observed over a long period, in multiple settings, that the condition is getting in the way of the child’s life, and the signs are not better explained by another ailment. We also look for genetic predisposition.
Is There a ‘Test’ For ADHD?
There is no blood test or medical work-up, except to rule out a medical cause. There are diagnostic tests that include various tasks that measure the extent of attention, concentration, impulsivity, hyper-reactivity, and delay in response. These tests are vulnerable to a false negative when the individual performs well on the assessment, but are quite helpful in providing additional evidence for ADHD when the assessment results suggest there is a problem.
Okay, So Let’s Get To The Primary Focus Of This Post: How Do We Treat ADHD?
Step One: Structure!
I’ve written a lot about structure, including the following post: What is “Structure” and What Does it Look Like?
It’s clear that structure is vital in helping your child with ADHD function to their fullest potential. Of course, our goal is to decrease the amount of structure necessary over time and increase your child’s ability to accomplish tasks on their own. That is a slow-but-steady process but key to helping your child independently accomplish daily tasks.
Step Two: Improve Coping Skills
It’s important to teach your child coping skills so they can self-monitor and adjust their behavior based on their circumstances. Children can learn to use visual reminders, lists, and timers. A consistent schedule and daily routine are important aspects of structure, and routine can become habitual and therefore be internalized and function as a coping strategy. Your kiddo can also come to recognize times and situations when they are more vulnerable to distractibility, such as an especially boring class, or when they are tired or hungry, and learn how to find the drive, and use effective strategies, to work-through those situations.
Step Three: Medication
There may be some hesitancy to consider medication, with parents being concerned whether the medication will have negative side effects, or be effective. Well, in terms of the latter, I’ve written quite a bit, and here is a relevant post in that respect: Is ADHD Treatment Effective?
Yes, there may be side effects, such as loss of appetite, and such can be closely monitored by the prescribing physician with adjustments made, as necessary, to the dose and type of medication being prescribed. Most children tolerate the medication quite well.
Step Four: Parent Education
A primary aspect of any therapy is talking with parents about structure and, in that respect, those situations when it’s better to lovingly stay in close proximity and guide the child through any given task, and when to set limits and use consequences. Parents often feel bad about punishing their child for something that is not in their control; making that distinction is an important part of effectively managing a child with ADHD. Sometimes it’s a gut feeling that your child is simply ignoring you rather than being genuinely distracted, but we try to make informed decisions based on experience, the current situation, the complexity of the task, and your child’s mood and disposition at the time.
Take Care Of Yourself
Parents often blame themselves for their child’s behavioral difficulties. You may do the same and lament that, if you were properly parenting, your child would not have these difficulties. However, it’s important to understand that, in these circumstances, you have your hands full; the situation is genuinely challenging and the traditional behavior management approaches often don’t work so well. If they did work, you wouldn’t be seeking help. So, take a deep breath, don’t be so hard on yourself, and realize that your job, at this point, is to delve into the learning process on how to effectively parent your child with ADHD. It’s a trial-and-error approach, far more hands-on, and such can be stressful.
Managing Your Own Expectations
Note that frustration is based on expectations; if you have the proper expectations - you won’t get as frustrated. I don’t want you to lower your expectations, just make them more realistic for the current situation. If you expect that your 8-year-old child will independently follow your first directive that involves stopping a favored activity, walking across the room, cleaning up a big mess that involves putting a bin full of toys away, then taking some clothes to his room, and then coming to dinner, you likely will get frustrated when that does not transpire.
We may start a bit less ambitiously and break down the task into smaller chunks. Stay in closer proximity, praise along the way, maybe step in and help when you see your child losing focus, and keep prompting along the way. The expectation is that, over time, you’ll be able to back off but, in the meantime, oversight likely will be necessary.
It’s not so bad; someday your child will be grown and leave the home – and you’ll miss him; here’s your chance to spend time with him and build that relationship. It’s important to take a few deep breaths, remind yourself of these aspects cited above, and maybe even recite some Scripture that, for many, is a vital source of peace and strength. Verses such as Philippians, 4:13, “I can do all things through Him who gives me strength” can literally be a God-send.
That’s A Wrap!
Okay, that provides an overview of the ways we effectively treat ADHD. I hope you found the information helpful – don’t hesitate to reach out at DrCarosso@aol.com with any questions. In the meantime, happy parenting!