Does my child have ADHD or is he just rambunctious?
Checkup on Health
Imagine a first-grade classroom. Caleb is in constant motion, wiggling in his seat and fiddling with papers.
Every few minutes, he jumps up from his desk to talk with a friend across the room, to check for something in his cubby, or to run to the window when someone passes by. When the teacher asks the class a question, Caleb is the first to shout out an answer, never remembering to raise his hand.
Is this typical 6-year-old behavior? Or is Caleb hyperactive, a label that gets tossed around with increasing frequency these days?
What is generally referred to as “hyperactive” is known medically as attention deficit hyperactivity disorder (ADHD), a very real neurodevelopmental condition recognized in about one in 20 children in the U.S. The diagnosis usually includes features of inattention, distractibility and impulsiveness as well as a high level of activity.
Like ice cream, ADHD can come in different flavors, with some children displaying more inattentive symptoms and other displaying more hyperactive and impulsive challenges. Additionally, it is important to note that ADHD occurs in both boys and girls. However, rates of referral for treatment are consistently higher for boys.
We know that such characteristics are present to some degree in almost all children and are closely related to their developmental level. Then how can we determine which children actually meet criteria for ADHD?
The answer is not always clear cut. However, the American Academy of Pediatrics, the Academy of Child and Adolescent Psychiatry and the American Psychological Association all offer guidelines for appropriate decision making. In considering a diagnosis of ADHD, one must look at a number of factors:
- How extreme is the behavior?
- How much impairment does it cause?
- How far outside of typical development does it fall?
- How much do the behaviors affect learning?
- How much do the behaviors affect relationships with family and peers?
- Are the behaviors limited to just certain settings, or do they occur pervasively?
- Are the behaviors present most of the time?
The UC Davis MIND Institute ADHD Clinic offers evaluation and short-term treatments for children, adolescents, and adults with ADHD.
The diagnosis of ADHD requires a team approach, which should include your child’s pediatrician or family practice physician, a school or child psychologist, your child’s teacher or day-care provider and yourself. Typically the diagnostic process includes the following:
- Complete medical and family history
- Physical examination
- Interviews with parents and child
- Behavior rating scales completed by parents and teachers
- Observation of the child
- Psychological assessment if there are concerns about learning (however, psychological testing is not required to make a diagnosis of ADHD)
Brain imaging techniques are used in research to understand the disorder, but they are not currently used as a part of standard assessment However, this is an area that holds promise for the future.
Treatment for ADHD usually involves the use of a stimulant or similar medication. Stimulants include medications such as methlyphenidate (Ritalin) or dextroamphetamine (Adderall and Dexedrine).
There are also nonstimulant medications available to treat ADHD that may be considered if your child experiences side effects from stimulants, has other symptoms that contradict the use of stimulants or has other symptoms that are not adequately addressed by the stimulants.
At present there is a lack for rigorous and convincing scientific evidence to support the use of herbal combinations, special diets and megavitamin therapies. If you are considering trying such interventions, discuss it with your child’s physician. Some may be harmful.
Parents can learn techniques that work well with ADHD children, such as developing a reward program and learning how to give instructions effectively.
In addition to medication, counseling and behavioral treatment is also beneficial. While medications can help reduce impulsiveness and distractibility, effective counseling or therapy may help the child deal with the features sometimes associated with ADHD such as depression or anxiety.
Parents, too, can benefit from a good therapist who has experience with ADHD. Parents can learn techniques that work well with ADHD children, such as developing a reward program, learning how to give instructions effectively, keeping a regular schedule, limiting over-stimulating activities, and using timers or other organizational strategies to help the child stay on task.
Most experts recommend avoiding physical punishment such as spanking, and instead recommend making clear rules with specific consequences (such as time-out or the elimination of a privilege) for misbehavior.
It is important to always start with a positive reward program and then later adapt it with taking away privileges or points for misbehavior. Equally important is to daily give plenty of encouragement and clear positive feedback to help the child develop a positive self-image.
Rewards given soon after positive behavior occurs is likely to be most effective particularly for children with ADHD for whom delayed rewards are less effective. For instance, it is better to give a child with ADHD a reward for doing homework every night, rather than waiting for a good grade on a report card.
Opportunity for success
Recognizing the disorder and providing treatment early on may help reduce the negative associated outcomes of ADHD, such as poor academic functioning or failure to graduate from high school on time.
The good news about ADHD is that many children with it have the potential to achieve success, given the right opportunities and drive. We now know that ADHD will persist into adulthood for about 75 percent of people diagnosed as children. With appropriate intervention many have the potential to make positive use of their enthusiasm and “thinking outside the box” skills.
Recognizing the disorder and providing treatment early on may help reduce the negative associated outcomes of ADHD, such as poor academic functioning or failure to graduate from high school on time. It is our task as parents and health-care professionals to ensure that they are given positive reinforcement for their successes, opportunities that match their strengths, and the encouragement and treatment they need to reach their full potential.