Attention-deficit hyperactivity disorder and its cousin attention-deficit disorder seem to be everywhere, right? If you have a kid in early elementary school, you probably are experiencing fellow parents sharing that their kids were diagnosed or you might be looking at your own kid and wonder, is that what this is or is it just Johnny being an active boy or Suzie being a daydreamer?
A January story published in the Journal of American Medical Association Pediatrics cited research that the diagnosis has increased 30 percent in the past 20 years. Is that because we are quicker to identify kids with attention deficits? Or could there be more going on?
The article suggested that perhaps instead of one (or two) disorders, ADD and ADHD should be considered more of a spectrum, like autism. Many kids might fall on that spectrum and benefit from some tailored learning situations, some therapies to help them with organization or accommodations to help improve their abilities to concentrate. The article also points out that the executive function of the brain — that frontal lobe that helps you make good decisions, not be impulsive, have self control, etc. — doesn’t fully develop in girls until age 22 and in boys until age 25.
Are we now asking for kids to do more tasks that are just not physiologically possible for many kids their age? When we ask kids to sit at a desk for many hours a day at school or do more fill-in-the-bubble testing, is it realistic that they could do that without losing focus?
The JAMA Pediatrics story also called for more research in the way the use of smartphones, tablets and computers and the increase in television viewing might be altering the way our kids’ brains work.
Dr. Leonard Sax, who wrote the book “The Collapse of Parenting: How We Hurt our Kids when We Treat them Like Grown-Ups,” also wonders with a diagnosis like ADHD and other mental illnesses, if what we might be seeing is actually kids who are sleep-deprived. He also believes that the increased use of electronics is rewiring kids’ brains and not for the better. The result might be something that looks like ADHD.
Child and adolescent psychiatrist Sonia Krishna of the Seton Mind Institute agrees that not enough sleep or another psychiatric disorder might cause kids to be labeled with ADHD, when really something else is going on.
A learning disability also can look as if a kid isn’t paying attention, when really, it’s that he just doesn’t understand or cannot process the information.
An ADHD diagnosis might be masking a physical problem such as the lingering effects of a concussion.
ADHD or ADD also isn’t something that comes on suddenly. If the symptoms do, then Krishna will look at what else is going on: bullying? stress? change in family dynamic?
It might be the go-to diagnosis, but there might be more to it.
Typically, ADHD gets diagnosed by having parents fill out a survey and teachers fill out a survey. Doctors are looking for a child to demonstrate 6 out of 9 specific behaviors and demonstrate those both at home and at another setting like at school before the diagnosis is made. Those can be subjective, although teachers usually can pick out the kids who seem to be stand out for a lack of attention from the rest of the class.
To rule out everything else and to get a clearer picture, Krishna likes to do a full range of neurological tests that take about six hours and cost hundreds of dollars. Often insurance doesn’t cover those tests. Other newer testing such as an ADHD test that tracks eye movement or brain imaging also might not be covered by insurance.
Krishna also looks at family history. ADHD and ADD have a strong genetic link, stronger than hair and eye color, she says. “Usually there is someone in the family,” she says. “What used to happen is they would be pulled out of school and have to go to work. Now we don’t just send kids to work or pull them out to be on the ranch. Now that the policy is to stay in school, we’re seeing a lot more of it.”
It’s still only about 5 percent of kids.
Often, though Krishna says, that by the time patients gets to her from the pediatrician, the diagnosis is pretty clear. They’ve had multiple problems in school and at home.
Sometimes parents are afraid to medicate, though, or afraid of the diagnosis. The good thing about the ADHD medication, Krishna says, is that it becomes obvious if a child has ADHD. The medication is a stimulant, which has the reverse effect on a child with ADHD. That child will be calmer and more focused. The child who doesn’t have ADHD or ADD and gets the medication, will be revved up and will be able to concentrate less than before the medication. The medication also works quickly and is out of a child’s system quickly, too. “That’s why I feel like a trial of medication is not as daunting as it may seem,” Krishna says. “We don’t have to try it for very long to know if it is working.”
Medication is not the only recommendation. Last year a study recommended that kids, especially younger kids, try ADHD therapy first before medications. Some of the therapy is just different ways of making schedules, organizing their stuff, making charts to stay on top of things. Krishna recommends kids with ADHD get assignments written out, be able to use computers instead of hand writing assignments, sit at the front of the classroom, limit the repetition in homework and receive one-on-one tutoring.
“A lot of children don’t need anything if a teacher is mindful and a parent is really involved,” Krishna says.
But for kids who do need medication, you don’t want to ignore it. Kids with ADHD who aren’t treated, might have difficulty making friends, have trouble becoming employed or holding a job as an adult, or self-medicate with drugs or alcohol. ADHD might not be forever. About half of kids diagnosed are able to develop strategies or benefit from the developed frontal lobe to not need medication as adults.
For more information, read our overall guide to ADHD.