by Nicholas Levy, MD
Scripps Coastal Medical Center pediatrician and Attention Deficit Hyperactivity Disorder expert Nicholas Levy, MD, offers insights into raising a child with ADHD.
Children (and adults) with ADHD tend to have problems with impulsivity, inattention and with hyperactivity. Children may talk out of turn, move around when asked to stay still, forget to follow instructions and lose their possessions.
Adults with ADHD tend to become impatient when waiting in line, drive too fast and may engage in risk taking behaviors. As patients get older their hyperactivity often subsides. While it is true that that everyone is inattentive or impulsive from time to time, the difference is that in the ADHD population it is pervasive and also significantly impacts them both at home and at school.
Underlying all of this is the unifying problem of not suppressing impulses well. Thoughts, feelings and ideas that arise have to be acted on which may lead to increased movement or impulsive blurting out or may lead to the child simply following a new train of thought (day dreaming). That is why the inattentive subtype (previously known as ADD) is very much part of the same disorder.
One of the most damaging misconceptions is the idea that if you punish students enough they will learn to pay attention and that kids may use it as an excuse for being lazy.
Children all like to do well. They will tend to quickly tire of activities that they are not good at and when they find something they excel in they will tend to spend more time doing it. For ADHD kids who have tried very hard to do well in school and continually fall short of the mark, it is understandable that they will stop trying.
After all, it’s much easier emotionally if you fail at something when you didn’t put the effort in. These kids often end up feeling “stupid” and they suffer significantly from low self-esteem.
The other misconception is that ADHD is more common in the U.S. than in the rest of the world. The frequency of this disorder is the same in all countries and in all cultures. It is true, however, that it will have less of an impact in some cultures while other cultures are much less forgiving of certain behaviors.
In the U.S., there tends to be a great deal of emphasis on time management and organization and these are far more difficult for children with ADHD than for their peers.
Another misconception is that people outgrow ADHD. While about 20 percent of patients will truly outgrow their ADHD symptoms, for most patients it is a lifelong condition.
What will change, though, is that the hyperactivity will diminish or become much more subtle (leg shaking, finger twitching, etc.). Many adult ADHD patients have developed tools to help them stay organized and manage their time.
There are many conditions that might look like ADHD. If children are not seeing or hearing well they often appear inattentive. Today all school children are screened for vision and hearing but more subtle issues like learning disabilities and auditory processing disorders may be missed. Emotional problems can also make children inattentive.
If there is conflict between their parents or if they are being bullied at school the anxiety this produces will prevent them from paying attention to schoolwork. Mental disorders like bipolar disorder, high functioning autism, anxiety and depression may all create states that may appear like inattention.
Children who have been exposed to lead or who have deficiency in iron or magnesium may have problems in school and seem inattentive.
For this reason I believe it is important to have a screening evaluation, including ADHD testing, that looks at all of those areas.
The most important component of treatment is creating structure for the child and understanding their limitations. There needs to be ongoing supervision and help with organization and planning.
Medications can be extremely valuable for ADHD patients and should allow them to feel more integrated and in control of their emotions and their thought processes. The mainstay of medication managements is with stimulants (methylphenidate and amphetamine) which improve the amount of neuro-transmitter in the pathways of the brain that allow us to suppress impulses.
Parents need to educate themselves and learn how children with ADHD tend to respond. They need to create as much (kind) structure as possible and not set these children up for failure by demanding behaviors that they are not capable of producing.
They should also make sure that there is not excessive screen time (an average of one hour a day maximum is the goal), that the child is exercising regularly and that the diet is nutritious and does not contain preservatives, corn syrup solids and food dyes wherever possible.
It may also be helpful to find an activity that the child is naturally gifted in, which can provide an opportunity for them to excel at something and improve their self-esteem.
If the parents of a child with ADHD have a strong channel of communication with the child’s teacher, they can work together to keep the child on task.
For example, if parents know about long term projects right when they are given (rather than the night before when the child falls to pieces) they can help the child break the work up into manageable sections and work on the project a little at a time.
Teachers can also help by double-checking that homework assignments are written down and that homework is being turned in when it’s due. It is really best if this can be achieved without singling out the child in front of the rest of the class.
This Scripps Health and Wellness information was provided by Nicholas Levy, MD, a pediatrics specialist on medical staff at Scripps Coastal Medical Center Encinitas.