A Parent’s Guide to ADHD in Children
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What is Attention-Deficit with Hyperactivity Disorder (ADHD)
Problems with attention are often hard to distinguish from normative childhood behaviors. This places children at high risk for a misdiagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Although evaluations are sought to confirm a diagnosis of ADHD, some may not be comprehensive enough to systematically assess for the presence of other disorders that can mimic or coexist with ADHD, such as neurodevelopment (IQ, specific learning disorder, Autism), neurological (epilepsy, movement disorders), and psychiatric disorders (anxiety, depression), which can thwart necessary treatments. Therefore, a thorough and complete assessment is integral in securing a person’s health, education, and future well-being.
Some symptoms of Attention Deficit Hyperactivity Disorder (ADHD) can include:
- Daydreaming
- Trouble sustaining attention in activities/tasks
- Forgetful in daily activities
- Losing/misplacing items
- Fidgety
- Talkative
- Making careless mistakes
- Blurts out answers/often interrupts others
- Trouble taking/waiting turns
- Having difficulty getting along with others
Although these symptoms are common in ADHD, they also present in other conditions. There are other disorders that mimic or coexist with ADHD, such as neurodevelopment (Intellectual Disability, Specific Learning Disorder, Autism Spectrum Disorder), neurological (Epilepsy, movement disorders), and psychiatric disorders (Anxiety, Depression). Therefore, a thorough and complete assessment is integral in understanding the presence of any other underlying issues that may present as attention issues.
Is there a difference between ADHD and ADD?
Although ADD is often used to characterize problems with attention, ADD is not a diagnosis that currently exists. On the other hand, ADHD is a recognized medical diagnosis that is currently used to identify the inattentive and hyperactive/impulsivity behaviors that encompass the disorder.
What is the difference between ADHD and normal attention problems or typical development in children and adolescents?
Young children and adolescents may not know how to regulate their emotions and behaviors on their own yet, which is expected because their prefrontal cortex is not yet fully developed.They are still working on perfecting their ability to regulate their emotions and coordinate their movements. While this is typical, problems with short attention span, excessive motor activity, and difficulties managing their behaviors and emotions, etc. become problematic when they begin to interfere with daily activities (e.g., classroom participation, academic achievement, following rules, making friends). This may prompt individuals and caregivers to think about a possible diagnosis of ADHD. (LINK to our services)
Common questions about ADHD:
1. Are all children with ADHD hyperactive?
ADHD is characterized by both symptoms of inattentive and/or hyperactive and impulsive behavior. Therefore, not all children with ADHD are hyperactive. Rather, some children who appear to be lost in thought, distracted, and have difficulty organizing their thoughts and behaviors may also be diagnosed with ADHD.
2. If my child is diagnosed with ADHD, will they ever be able to pay attention?
Children and adolescents with ADHD may not know how to regulate their sensory and motor processing systems, which can contribute to their inattentive, impulsive, and hyperactive tendencies. Children with ADHD benefit from consistency, support, and supervision when learning new tasks. Over time, when routines and behaviors become more consistent and automatic, they will learn to manage and focus their attention much better with these supports.
3. At what age is ADHD diagnosed?
Symptoms of ADHD become more prominent once children enter school and there is more emphasis on structure and school routines. Therefore, it is more commonly diagnosed in the preschool to school age years. Although development varies for many children, it can also be diagnosed prior to entering school if symptoms cause a significant amount of impairment.
Adults who present with ADHD symptoms much later must demonstrate that symptoms were present before 12 years of age. Additional information from people familiar with the individual may be necessary to support the timeline of symptoms.
4. Can children with ADHD control their behaviors?
Children with ADHD have difficulties with self-regulation, and may have difficulties managing their behaviors on their own. They may be prone to act out or withdraw when over or under stimulated. Because of this, they will need assistance in managing their behaviors at first. This might look like regular reinforcement and modeling of what is expected and acceptable behavior, which in time, will hopefully become automatic and will allow them to manage their behaviors on their own.
5. What causes ADHD?
Specific causes leading to the development of ADHD is largely unknown. However, studies have shown that genes may play a role. Although no specific gene has been identified yet, family studies have shown that when one family member is affected, other family members may also have the diagnosis.
Additionally, ADHD has been associated with anatomical differences in the brain. Studies comparing individuals without ADHD and without ADHD have demonstrated differences in the prefrontal cortex (attention, executive functioning, regulate behaviors and emotions), caudate nucleus (regulate motor responses), corpus callosum (communication pathway), and cerebellar vermis (emotions), which affects connectivity and function (Tripp & Wickens, 2009).
Furthermore, research has shown that ADHD is associated with an imbalance in neurotransmitters in the brain, including:
- Reduced dopamine (implicated in rewards and reinforcement)
- Reduced noradrenaline
Disruptions in these pathways have demonstrated impaired activity in the prefrontal cortex, limbic system, basal ganglia, and other relaying systems, seen in ADHD.
Other factors, such as low birth weight, premature birth, exposure to toxins (alcohol, smoking, lead, etc.) during pregnancy, have also been implicated in the development of ADHD. Click here to learn more about our services.
Does ADHD occur in adulthood?
Although ADHD can resolve in adulthood, it may shift and present differently. For example, it may present more as executive dysfunction in adulthood.
It is important to note that various medical conditions may also present as ADHD. Therefore, a full evaluation will be necessary to determine if symptoms are related to unresolved ADHD or signs of other neurological issues. Click here to learn more about how we can help.
Do ADHD symptoms change at different ages?
The first signs of ADHD usually include hyperactivity and impulsivity in young children. As they transition into school age years, more problems with inattention may manifest. While some children can learn to develop strategies to overcome these difficulties, problems with ADHD may become more apparent for some people in adulthood when task demands increase. This can look like difficulty managing schedules, juggling multiple tasks at one time, distractibility, having to read things over and over again, misplacing items, and forgetting appointments. As such, some people may be diagnosed with ADHD later in life.
Is anxiety a symptom of ADHD?
Anxiety is characterized by excessive and unrealistic worries that affect attention and concentration. It can also be accompanied by somatic symptoms such as restlessness (e.g., fidgeting) and hypervigilance, which can mimic symptoms of ADHD. Therefore, a comprehensive assessment will be important to identify whether issues of anxiety may be contributing to attention problems reported.
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Individual Therapy
Individual therapy is used to address behaviors and/ or improving attention/ executive functioning skills. A Cognitive Behavioral approach to increasing education, building awareness, and implementing executive functioning strategies will be most helpful.
Medication Management
Medication may be helpful in addressing chemical imbalances associated with ADHD. Therefore, it will be important to consult with your physician and/or psychiatrist to determine if medications may help to manage symptoms.
Neurofeedback
Other options include Neurofeedback Assisted Cognitive Remediation Therapy (N.A.C.R.T.). Neurofeedback to train individuals to become more aware of their somatic symptoms. Neurofeedback provides real time feedback of brain activity to raise awareness of physical symptoms that will then trigger application of intervention strategies..
Cognitive Remediation Therapy
Participation in cognitive remediation therapy to train and strengthen cognitive skills may also strengthen attention skills.
Visual Therapy
Visual therapy may also assist in improving attention by targeting the visual system. Vision assessment in ADHD is an essential step in determining a patient’s ailment.
Tips for parents whose children have ADHD
Children with ADHD benefit from consistency. At home, it will be important to establish consistent routines, schedules, rules and expectations. Help children with developing skills for structuring their day by planning out schedules, creating behavioral plans, and developing a rewards system together. By ensuring they are part of the planning process, you are increasing the likelihood that they will participate and follow through with the limits and routines set. Repeat and model the skills you are wanting to see.
Recommendations for parents whose children have ADHD
In-Person feedback session with parents to review test findings, provide psychoeducation and explore treatment options for their child. This session will consist of the following:
– Provide the parents a full summary of the test findings and discuss the strengths/weaknesses of the child with respect to cognitive, academic, emotional and social functioning.
– Based on the child’s needs, as identified on the multidisciplinary assessment, treatment recommendations will be discussed, and the clinician will explain in detail our customized treatment program. This discussion will include a description of our computerized cognitive remediation program. The benefits of neurofeedback and cognitive therapy will be addressed, along with other treatment options (based on need) including vision therapy (computerized), along with mental and physical relaxation techniques. Our multidisciplinary treatment program includes the following: Neurology, Neuropsychology, Neuro-Optometry, Psychology.
– Collaborate with educational personnel and school psychologists with regards to implementing appropriate academic accommodations (IEP, etc.) within the child’s academic curriculum.
Tips for teachers whose students have ADHD
It will be important to work with parents to ensure consistency between home and school. Make sure routines are consistent, provide extra supports and accommodations when necessary. Collaboration with the family will be important to ensure that you are supporting the child excel in all areas.
Recommendations for the School System to Care for Students with ADHD
Phone consultation/in person meeting with the child’s teacher to address strengths and weaknesses with respect to cognitive/academic functioning. Determine what arrangements within the classroom setting can be made to optimize learning and academic achievement.
Phone consultation/in person meeting with educational administrators to explain test results and appropriate academic accommodations to be instituted within the child’s academic curriculum. Collaborate with educational staff/school psychologists to implement the appropriate (agreed upon) academic accommodations (IEP, etc.). If recommended, supportive counseling/behavioral services will also be discussed with the school psychologist.
Take the next step for your child
In order to confirm a diagnosis of ADHD, a full comprehensive ADHD in children assessment process evaluation may be necessary. Although behavioral rating scales and questionnaires are more beneficial in identifying specific and/ or ruling out areas that may be contributing to the individual’s attention difficulties.