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    Understanding ADHD

    Pam Pepper, MSN Clinical Nurse Specialist with Deaconess Cross Pointe 08/13/2014
    ADHD is a common condition, but is often misunderstood. Currently, it’s believed 9% of children ages 3-17 and 2-4% of adults have ADHD. ADHD is an acronym for Attention Deficit Hyperactivity Disorder.  ADHD is a neurodevelopmental disorder, which means that the part of the brain that controls attention and prioritizing what a person pays attention to doesn’t develop like others’.

    ADHD can involve symptoms of inattentiveness, impulsivity and/or hyperactivity. Some people may have one or two symptoms, while others may have all.  Years ago, there was a term called ADD.  That diagnosis actually was ended in 1992 and replaced with ADHD – inattentive, ADHD – hyperactive, or ADHD combined.

    There is not a specific test that diagnoses ADHD.  It is diagnosed after observing a persistent pattern of behavior in all environments.  For example, a child diagnosed with ADHD must be having similar issues at home, play and school.  ADHD always begins in childhood.  Adults can have it, and sometimes people aren’t even diagnosed until they are adults, but it always begins before the age of 12. This is important to note, because sometimes similar symptoms that present themselves in adolescence or adulthood may look like ADHD, but if they weren’t there when the person was a child, it’s not ADHD.

    Although testing isn’t required for the ADHD diagnosis, it can be done. It is important to match the information in the test to what is being seen in real life. Symptoms behavioral checklists that are done by different people such as a teacher, a parent, a coach or scout leader gives information about how someone is functioning. That may be  more valuable than a specific test.  Sometimes there is a question on what someone’s IQ is. It is difficult to be attentive to something when the information is beyond one’s level to comprehend. If testing shows IQ deficits or learning disabilities then addressing these issues may be what is needed rather than treatment for ADHD. 

    I diagnose ADHD and also help treat the condition.  In my role at Deaconess Cross Pointe, I specialize in the care of children and adolescents with psychiatric and mental health needs.  So, I see a lot of kids with ADHD.

    Kids with ADHD that are coming to a professional for assessment are probably having trouble with school work, struggling with social skills (making/keeping friends), or may be having some behavioral issues causing them to get in trouble because “they aren’t paying attention.”  They also may seem more immature than their peers.

    Once the diagnosis of ADHD has been made based on the many factors listed above, medication is the gold-standard for treatment. Medications that treat ADHD are stimulants.  Many people are surprised by this, because they’re thinking, “Wait, this kid’s hyperactive, and we’re going to stimulate him?”   Stimulating the brain makes the poorly working area of decision-making more active and enables the child to think through consequences and resist impulsive behavior.

    Some people worry that these stimulants are addictive.  Stimulants CAN be addictive, particularly if they are misused.  Medication taken as ordered by physician or other care provider is not the same as if someone were to grind up a pill and inhale it.  The key, as with any medication, is to take as directed.

    Something that may be surprising is that if a person who needs medication for ADHD takes their medicine, they are actually less likely to become a drug abuser.  Why?  Because the medication they take helps them improve their decision-making.  They’re less impulsive, and can think through the consequences of their decisions better. 

    Let’s give an example:  Say a teenager with ADHD is at a friend’s house after school, and the friend offers him some pot.  If he hasn’t taken his ADHD medication, he’s more likely to be impulsive and say, “Sure!”  But if he’s taken his medicine, he may be more likely to think, “I’d like to, but I might get caught and not be allowed to go to prom this weekend.” 

    Q: I hear a lot of people saying that kids today are getting labeled ADHD. Some think that it is getting over used. Do you think there is a difference in kids today compared to 20 or more years ago? Or is it that there just wasn't a term for what kids might have been experiencing many years ago?
    A: Twenty years ago, there were probably as many people with ADHD as there are now.  But in the past 20 (and certainly 40) years, there has been a major change in the level of attentiveness required in daily life.  In pre-computer/technology life, individuals could make a living without having to pay close attention during their education and in adulthood.  What I mean is that a person could get a job that was more labor-oriented, and could make enough to take care of their family.  Those jobs are fewer now, and schools must focus on preparing students for the technology driven world we live in.
    Conditions that can appear like ADHD
    • Sleep Disorder A child may have a sleep disorder that is causing them to not be well-rested every day, resulting in them being inattentive and even becoming hyperactive in an attempt to stay awake.
    • Behavioral Issues Depression, anxiety or other mental illness can cause inattentiveness and “acting out.”  This can sometimes be the result of serious problems at home, or some emotional trauma such as a major loss, or abuse.
    • Boredom The child may be bored in class because the coursework is either too hard or too easy. 

    Types of ADHD Intervention
    For kids who have ADHD, there are three types of interventions that can be considered along with medication.

    1. Family-focused efforts:
    • Educating the family about ADHD so they understand how the child is struggling.
    • Stress management techniques.  ADHD is a chronic illness, and many families find that the forgetfulness or the need to repeat instructions and steps many times can wear thin.  Helping families cope with and understand this is important.
    • Behavioral modification techniques.  These are deliberate and planned ways to help the child gradually learn better structure and behaviors.  An example may be a sticker chart used to reinforce brushing teeth, bringing home homework, putting clothes in the hamper, etc.—whatever behavior you’re working on. Or if your child consistently forgets the same steps over and over—like leaving their shoes in the middle of the hall—you have a plan to deal with it.  You don’t pick up the shoes—you have the child come and get their shoes and put them where they belong.
    2. School interventions
    • Modifying the classroom or work in some way.  If you have a child who is easily distracted, move them to the front of the room so all they’re seeing is the teacher and not all the other kids.  
    • A smaller classroom fewer students in the class.
    • Organizational help.  This may mean that a child with ADHD has their teacher review and sign off on their planner before they go home, and then the parent does the same in the evenings.
    • An IEP—an individual educational plan—is something that many ADHD kids can qualify for. This could include having a timed test broken into smaller chunks so they don’t have to focus for such long spans.  They still take the test, but in a way that helps them.  (This is only an example of one way an IEP may be used.  An IEP is something that a student must qualify for.  If you have questions about that, your school counselor may be able to help.)
    3. Child-Focused Interventions
    • Kids with ADHD are often immature, and they need help with social skills, such as waiting their turn to play or talk.  Parents may recognize these lapses and can help address it. Other adult leaders, such as a coach, Scout leader, etc. can be helpful. There are even social skills classes that can be found.
    • Working on a child’s self-esteem may be needed.  The child may recognize that they’re “not getting it, and it can make them feel insecure. Help a child identify what they do well, and build on that. 
    • Don’t use the illness as an excuse.  Instead, the illness is simply a reason that some things are more difficult, and we have to address that illness.  It doesn’t mean the child is bad—it means that the illness is causing problems.
    • Anger management skills may also be needed.  Impulsivity is a symptom of ADHD, and can result in words being said that shouldn’t be (a “filtering” problem), or even fists being thrown.  A child may need help regulating this.
    Q: Does technology (watching lots of TV, playing video games, etc.) cause ADHD or make it worse?
    A: Video games are engrossing by nature—they have a way of “sucking you in.”  For people with ADHD, who have difficulty focusing or prioritizing their attention, video games can be even more distracting.

    There are studies that show too much screen time (TV, video games, computer) can interfere with normal brain development and can cause a child to have trouble paying attention in “every day life,” such as to a teacher in a classroom.  Limiting screen time is a good idea. This also creates time for more physical activity.  Physical activity has been shown to sometimes help with ADHD symptoms.

    This blog was updated 10/19/16
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