Attention deficit hyperactivity disorder (ADHD) is a chronic and complex neurodevelopmental disorder that can have significant impact on a child’s success during school and beyond. Attention deficit hyperactivity disorder affects millions of children and for many will continue into adulthood. This condition s characterized by multiple persistent problems including difficulty sustaining attention, hyperactivity and impulsive behavior.
Many parents may look at the list of symptoms associated with Attention deficit hyperactivity disorder and wonder if their child may have this condition. Any child may experience some of the individual symptoms associated with attention deficit hyperactivity disorder at some point during their childhood. That said, a visit to your doctor is often required to determine if your child indeed has attention deficit hyperactivity disorder, or if their symptoms are merely a part of the maturing and growth process.
What Are Some of the Common Symptoms?
The primary and most common symptom of attention deficit hyperactivity disorder are inattention and impulsive behavior. Typically, symptoms of attention deficit hyperactivity disorder begin before a child reaches the age of twelve and in some children, they may be noticeable before the age of three. Symptoms of attention deficit hyperactivity disorder can be classified as mild, moderate or severe and as previously noted, may continue through the teen years and into adulthood. Also, attention deficit hyperactivity disorder tends to occur more commonly in males than females and often presents differently across genders.
Attention deficit hyperactivity disorder is divided into three different subtypes. These include:
- Predominately inattentive- children who have this subtype of attention deficit hyperactivity disorder will have most of their symptoms fall under inattention.
- Predominately hyperactive/impulsive- these children have more symptoms related to hyperactivity or impulsivity.
- Combined- these children present with a mixture of inattentive symptoms and hyperactive/impulsive symptoms.
To better understand what these symptoms mean, it may be helpful to briefly review each one.
A child who shows symptoms related to inattention may often do one of several of the following.
- Fail to pay close attention to detail or make careless mistakes in their schoolwork
- Have difficulties staying focused on tasks or at play
- Appear not to listen (even when spoken to directly)
- Have trouble organizing tasks and activities
- Avoid or express dislike for tasks that require focused mental effort
- Be easily distracted
- Lose items that are required for tasks and activities such as pencils or items related to school assignments
Hyperactivity and impulsivity
A child who shows symptoms more closely related to hyperactivity and impulsivity may often do one or several of the following.
- Fidget with or tap their hands or feet
- Consistently squirm in their seat
- Have difficulty staying seated when necessary
- Be constantly “on the go” or “in motion”
- Run around or move in situations where movement is inappropriate
- Talk too much or at inappropriate times
- Blurt out answers (frequently interrupting the person asking questions)
- Have difficulty waiting his or her turn
- Interrupt or intrude on others’ conversations, activities or games
These lists are by no means exhaustive and your child or teen may exhibit or experience symptoms that are not a part of the list above. The best way to determine if the symptoms your child is experiencing are attention deficit hyperactivity disorder or not is to seek advice from your medical provider.
Common Causes and Risk Factors
Despite a broad range of research into attention deficit hyperactivity disorder, the exact cause of the disorder remains unclear. There are a variety of factors that may lend to the development of attention deficit hyperactivity disorder which include genetics, the environment or problems with the child’s central nervous system at key moments in their developmental process. Below is a short list of possible risk factors commonly associated with the development of attention deficit hyperactivity disorder.
- Blood relatives (such as a parent or sibling) who have been diagnosed with attention deficit hyperactivity disorder or another mental health disorder
- Exposure to environmental toxins such as lead
- Maternal drug use, alcohol use or smoking during pregnancy
- Premature birth
Many people point to sugar intake as a popular link in the development of attention deficit hyperactivity disorder in children. To date, there is no reliable proof of this. While sugar (and a variety of other conditions or factors) may lead to difficulty sustaining attention for a time, this is not the same as a diagnosis of attention deficit hyperactivity disorder.
Is it ADHD or Typical Development (Immaturity)?
There have been several studies conducted in recent years that have found that children who are among the youngest in their class are diagnosed with attention deficit hyperactivity disorder at much higher rates than their older classmates. This may suggest a significant number of younger children could be misdiagnosed due to immaturity.
Most healthy young children are often inattentive, impulsive or hyperactive at one time or another. It is also typical for preschool aged children to have short attention spans and be unable to “stick to” one activity for an extended time. Also, the attention span of older children and teens is often directly related to their level of interest in an activity. The same is also true of hyperactivity in children and teens. Young children (especially of preschool and elementary school age) are often very energetic and their energy tends to far outlast that of their parents or much older siblings. Also, some children are simply more active and energetic than others. This does not mean they have attention deficit hyperactivity disorder or should be classified as having attention deficit hyperactivity disorder without seeking a medical opinion and considering any other symptoms they may or may not present with.
Children who have difficulties with focus or energy at school but do well at home (or vice versa) are likely struggling with something other than attention deficit hyperactivity disorder.
The overwhelming majority of attention deficit hyperactivity disorder diagnoses are the result of children who struggle to meet expectations for behavior and performance throughout the school day. As previously noted, virtually all young children will find it difficult to sit still, pay attention, wait their turn, avoid interrupting and finish their tasks in a timely manner.
By the time many children enter school they have developed the skills necessary to manage these tasks, but it is important to keep in mind not all children enter school at the same age. In a typical classroom, the range of students can span an entire year which means the developmental differences between the youngest student and the oldest student in the classroom can be significant. For this reason, when evaluating a child for attention deficit hyperactivity disorder, their behavior and symptoms should be compared against students their own age in the classroom as opposed to all other children in their class. There are significant differences in the developmental progress of a five-year-old and a six-year-old. This needs to be taken into consideration when evaluating whether a child may have attention deficit hyperactivity disorder.
Other “best practices” to follow when evaluating for attention deficit hyperactivity disorder to avoid the potential for misdiagnosis include:
Looking at a variety of sources
A diagnosis of attention deficit hyperactivity disorder should not be used based solely on observations conducted at school. A clinician should evaluate the child and collect information from several sources and adults including teachers, parents and others who spend time with the child.
Not just at school
As we mentioned above, if the child is struggling at school not at home or elsewhere, it is likely they are struggling with something other than attention deficit hyperactivity disorder. For a child to be properly diagnosed with attention deficit hyperactivity disorder the signs and symptoms associated with the disorder – inattention, impulsivity and hyperactivity – have to be present in more than one setting.
Scales filled out by teachers and parents should be used to collect specific information about the frequency and severity of behaviors associated with attention deficit hyperactivity disorder. These scales should then be used to compare the child’s behavior with other children who are the same age as opposed to relying on general impressions or statements of “I’ve seen this a million times.”
A thorough history
To obtain a complete and thorough history of the child’s behavior, a clinician needs to examine how the behavior has developed over time. How did the child act at age three or four as compared to now? Did these issues only arise after they child started school or were, they asked to leave preschool due to their behavior? Comparing then to now is an essential step in the diagnosis process. .
Level of impairment
The most significant difference between children with attention deficit hyperactivity disorder and those who are just immature or at a different developmental stage is likely to be how much their behavior impacts their lives. Do they get excluded from playdates with (same age) friends due to their behavior? Are they experiencing the same negative issues at home? Are their parents extremely frustrated with their behavior?
If a child is struggling due to immaturity, things could (and likely will) get better over time as they adjust to the new expectations of school and life in the classroom setting. Kindergarten may be the firs time the child has been in a setting with so many other kids where they are expected to take direction from an adult other than mom or dad. Giving kids time to adjust to this new stage in life is essential to avoid misdiagnosis and unnecessary treatment.
ADHD Treatment Options
Stimulant and nonstimulant medications are often used in the treatment of attention deficit hyperactivity disorder. Although medication is often an important part of treatment for a child with a diagnosis of attention deficit hyperactivity disorder, the use of medication can be a difficult decision for parents to make. To ensure you make the best choice, you and your child’s doctor should work together to decide if medication (either alone or in conjunction with other forms of treatment) is a good option.
There are two primary types of medication used to treat attention deficit hyperactivity disorder. They include stimulants and nonstimulants.
Central nervous system stimulants
Central nervous system stimulants are the most commonly prescribed class of drugs used to treat attention deficit hyperactivity disorder. These drugs work by increasing the amounts of dopamine and norepinephrine in the brain. The goal of this increase is to improve your child’s ability to concentrate and focus.
When stimulants have not worked or the side effects have proven to difficult to handle, your medical provider may consider nonstimulant medications. Certain nonstimulant medications work by increasing the norepinephrine levels in your child’s brain in an effort to help with attention and memory. Other nonstimulant medications can also help with attention deficit hyperactivity disorder however, their exact function is not entirely understood.
Stimulant and nonstimulant medications while sometimes helpful in symptom mitigation, are not without side effects. The more common side effects of both can include headache, difficulty sleeping, gastric upset, nervousness, irritability, weight change and dry mouth. For stimulant medications there are some (rarer) more serious potential side effects which can include hallucinations, elevated blood pressure, allergic reaction and suicidal thoughts or actions. Serious side effects for nonstimulant medications can include seizures and suicidal thoughts or actions.
Several therapy options can help your child if they have been diagnosed with attention deficit hyperactivity disorder. If you and your child’s doctor have decided therapy may be an option, contact us here at Hillcrest. We would be happy to teach you about all of the possible therapy options available here and how each may be able to help your child and your family.
Psychotherapy– Psychotherapy can be helpful in getting your child or teen to open up about their feelings of coping with attention deficit hyperactivity disorder and its symptoms. Psychotherapy can help your child better handle relationships with peers and authority figures.
Behavior therapy- The goal of behavior therapy is to teach your child or teen how to monitor their behaviors and then change them appropriately for the situation.
Social skills training- Social skills training can sometimes be useful if a child shows serious issues dealing with social environments. Similar to behavior therapy, social skills training is designed to teach the child new and more appropriate behaviors such as waiting their turn, sharing toys and asking for help.
Support groups-Support groups are an excellent way for parents of children with attention deficit hyperactivity disorder to connect with others who share similar experiences and concerns.
Parenting skills training– Parenting skills training is designed to help parents develop the tools and techniques for understanding and managing their child’s behaviors.
If your child is struggling with attention deficit hyperactivity disorder and their behavior is affecting their success in school (and out) it may be time to start thinking about the next steps. Attention deficit hyperactivity disorder is treatable and there is a wealth of different California teen treatment options available. If your child or teen has been diagnosed with attention deficit hyperactivity disorder, contact us at Hillcrest today.