What Do You Need To Know About ADHD?
Hyperactivity is usually the first sign people notice when it comes to ADHD—children who have difficulty staying in their seats, trouble engaging in quiet activities, and who seem as if they are “driven by a motor,” meaning their activity is non-stop! Impulsive behavior, which is not thinking before acting, is often noticed early as well, since kids who are not following rules are frequently in trouble, resulting in notes and calls home from school.
Sometimes it can be challenging to tell the difference between what is typical for a child versus what is ADHD. The DSM5 lists criteria for an ADHD diagnosis, but many of the symptoms can be typical in some settings. For example, depending on age and the activity, it is perfectly normal for a child to have difficulty finishing some tasks, daydream, or have difficulty waiting their turn. The key is that, with ADHD, the symptoms must be a major problem and they must occur in at least two different settings, such as at home and at school.
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ADHD can sometimes be diagnosed in children as young as 3 or 4 in cases of extreme hyperactivity, but it is most commonly first diagnosed around age 5 or 6, when children start school. Part of diagnosing ADHD is determining whether it is a significant problem in more than one setting, so children who are only having difficulty at home might be showing behavioral difficulties for another reason. Whether ADHD is diagnosed or early signs of potential ADHD are recognized in early childhood, the first steps for young children are typically to help structure the child’s environment in a consistent way.
ADHD Diagnosis Challenges
ADHD symptoms in girls are usually less noticeable and ADHD is diagnosed later—in comparison to boys, who are often hyperactive and on their teacher’s radar from an early age, girl’s symptoms are often more on the inattentive side or apparent in social interactions with peers. For these reasons, teachers often do not notice their difficulties and they do not get help as early or as consistently.
For LBGTQ+ and children of color, getting the right diagnosis might be particularly challenging. Anxiety, depression, trauma, and any other factors that influence how a child interacts with others may lead to either over- or under-identification with the proper diagnosis. Practitioners need to be culturally competent to assess the cultural factors influencing a child’s mental health.
ADHD diagnoses are typically made by pediatricians and psychologists. With a strong history of attention problems, pediatricians will sometimes diagnose ADHD based on a short parent checklist and in-office interview. Psychologists typically do more testing to rule out other mental health concerns.
ADHD can be assessed by behavioral observations (often conducted when a child is in school and also while doing testing tasks during the evaluation), parent interviews about symptoms, and standardized checklists of behavior completed by parents and teachers, which compare a child’s behavior to that of peers.
ADHD Diagnosis and Symptom Changes
Psychologists use the information they obtain from observations, checklists, and assessments to determine whether a child is experiencing symptoms and if ADHD is the best fit for these symptoms, or whether another mental health condition may be responsible.
ADHD diagnoses fall into three categories: primarily hyperactive, primarily inattentive, and a combination. Children may change categories over time, and sometimes it goes away as children get older.
ADHD does not appear for the first time later in life if attention symptoms are developing in adults with no prior history of attention problems, it can sometimes be attributable to anxiety, trauma, a TBI, or other mental health conditions. It can sometimes be first diagnosed in adulthood, however; for a variety of reasons, some children have difficulties with attention but are never diagnosed with ADHD during childhood.
If there is a history of attention difficulties, even if they were not diagnosed during childhood, an adult ADHD diagnosis may be appropriate. Additionally, symptoms may change over time a child may have primarily hyperactive symptoms at first but then later experience more inattentive symptoms as they grow and mature.
ADHD symptoms in children can be very challenging for parents. Many of the behaviors, like impulsivity, constantly being on the go, and not following instructions can create friction at home. These behaviors can sometimes look like laziness or willfull bad behavior, which can be especially frustrating for parents. Working from home with a child with ADHD can be difficult to manage.
Set up clear expectations and structure so your child knows when it is okay to interrupt and when it is not. If there are two parents in the home, planning times when each parent is the point of contact for the children can be helpful, so each parent gets some uninterrupted work time.
Managing ADHD in Daily Life
ADHD symptoms can often be improved with small changes to an individual’s environment and learning strategies to manage executive functioning. Very young children are not able to manage these techniques on their own, so they depend on parents and teachers to adapt to the environment for them. As children mature, they can learn to incorporate these strategies and techniques into their work (i.e., making lists, scheduling tasks, choosing a helpful environment for work, etc.). People must first learn to self-monitor their attention before they can improve it, so the first step is often teaching individuals to notice if they are paying attention.
This has been a challenging year for all children and families with the transition to distance learning, hybrid learning, social distancing, and everything in between. While every child is different, parents should notice what is going well and try to do more of it. If particular methods of teaching or school activities are not going well, find ways to change or adapt it. Essentially, do more of what works, and also encourage kids to get away from their screens as much as possible.
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For a parent of a child diagnosed with ADHD, the first step is to share this information with the child’s pediatrician and school. While parents may or may not choose to pursue medical management of ADHD, the child’s doctor needs to have a full picture of the child’s health. By sharing the diagnosis with the school, the child will be eligible for a 504 plan, which will help support them academically and in other areas where they may need support.
Treatment Options for ADHD
If you are a parent facing a new diagnosis for your child or an adult learning about an ADHD diagnosis for the first time, know that many successful people have ADHD, and determining the correct diagnosis is half of the battle. There are many effective treatments for ADHD, and once you have a diagnosis, you can start looking for what treatments make the most sense for your child and your family.
Many children and adults benefit from ADHD medications, but they are not right for everyone. I often recommend that parents try behavioral and teaching strategies first. Some children will do great with these adaptations, but for some, it is not enough.
If children are significantly struggling in class, or their behavior or self-esteem is a significant problem due to their ADHD symptoms, I think medications are worth considering. Some parents worry about over-medicating their children, and it is important to note that the right ADHD medication should not turn your child into a zombie, but it may help them be much more successful, both academically and socially. Most doctors start children on very, very low doses to prevent this issue.
Sometimes it can take a few medication changes or dose changes to determine the best medication for a child. Some parents wonder about supplements to aid ADHD rather than prescription medications, and I usually share with parents that medications have far more research and safety regulations, and are much more likely to be effective than over-the-counter supplements.
Need an Autism Evaluation?
Dr. Jessica Myszak has over 10 years of experience performing psychological evaluations with children and adults. She offers both in-person and telehealth evaluations. In addition to seeing clients on the Chicago North Shore, she can work with families who reside in Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Illinois, Kansas, Kentucky, Maine, Maryland, Missouri, Nebraska, New Hampshire, New Jersey, Nevada, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Utah, Virginia, West Virginia, and Wisconsin! If you want to learn more about potentially working with her, you can contact her to start the process.