Dr. Angela Hanford
Sarah is a 10-year-old girl who is often caught daydreaming. She tries to pay attention in class, but her mind simply wonders off to what she would like to do later in the day or to developing a fun game for her friends to play at recess. She becomes frustrated and anxious because she then does not understand how to do her school work and forgets to write down homework assignments.
Her struggles continue at home. For example, she has every intention of working hard and staying focused on her math homework. However, once she sits down she realizes that her pencil needs sharpening, so she looks for her sharpener. But wait, her desk drawer is a mess and really needs to be cleaned.
Sarah begins cleaning the desk, only to discover a small toy that she played with when she was little. Sarah starts remembering all the fun she had playing with this toy. Forty minutes later, her mom comes into the room and finds Sarah sitting on the floor and staring at her toy with a smile on her face.
Her mom is not so amused! In fact, her mother is frustrated because Sarah takes hours to finish her homework. Sarah also forgets to do her chores, loses objects that she needs, and has an overall tendency to lack focus. Nothing seems to motivate Sarah to stay on task.
Charlie is an 8-year-old boy who always seems to be on the move. He tries to sit still, but he feels jittery. He is always getting into trouble for getting out of his seat at school or at church or talking to his friends when he is supposed to be listening to his teacher.
His energy seems unlimited. People also tend to become frustrated because Charlie is constantly interrupting conversations. His teacher has constantly been working on helping him to remember to not simply blurt out the answer during class, but to raise his had and wait to be called on.
Charlie feels guilty and like he is “bad” because something inside of him makes it almost impossible for him to control his reactions. He has every intention of following the rules and really wants to please others. This leads to him beating himself up for getting into trouble yet again.
Do either of these scenarios sound familiar? Both of these children have different types of Attention-Deficit/Hyperactivity Disorder (ADHD). According to Visser et al. (2014), 11% of school-age children are affected by ADHD. The American Psychiatric Association (2013) reported that 5% of children are diagnosed with ADHD. Regardless of the exact prevalence rate, ADHD affects many children.
Symptoms of ADHD in Children
There are three primary types of ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) (American Psychiatric Association, 2013). These three forms of ADHD include: ADHD predominately inattentive presentation (previously known as ADD), ADHD predominately hyperactive/impulsive presentation, and ADHD combined presentation (i.e., both inattentive and hyperactive/impulsive symptoms).
The specific symptoms of ADHD in children associated with each type include (American Psychiatric Association, 2013):
- Lacks attention to details and/or tends to make careless mistakes (e.g., misses details in homework)
- Has difficulty sustaining attention on tasks (e.g., during lectures or conversations, reading long books)
- Does not seem to listen to when directly addressed (not defiant in nature, but the child’s mind seems to be elsewhere)
- Lacks follow through (e.g., does not finish chores, is easily sidetracked on tasks, may go from one task to another without completing anything)
- Difficulty with organization (e.g., has difficulty keeping papers organized or struggles with organizing the sequence in a report, time management problems)
- When a task requires sustained cognitive effort, the child tends to avoid the task, dislikes the task, or reluctantly engages in the task (e.g., homework)
- Forgetful of daily tasks (e.g., chores, appointments, turning in homework)
- Loses needed objects (e.g., phone, pencils, school books)
- Easily distracted by irrelevant stimuli (also includes distraction by unrelated thoughts)
- Leaves seat when remaining in seat is expected (e.g., during school or at church)
- Runs/climbs excessively at inappropriate times (Note: In teens and adults this can be a feeling of restlessness.)
- Fidgets frequently
- Has difficulty with doing things quietly (e.g., play)
- Seems to be “on the go” or “driven by a motor” (e.g., unable to sit still comfortably in a restaurant)
- Talks Excessively
- Blurts out answers before the question is completed
- Has difficulty waiting their turn
- Interrupts and/or intrudes on others (e.g., interrupts conversations, taking over a game)
In order for someone to be diagnosed with ADHD, he or she must have enough symptoms (i.e., six or more) and the symptoms must interfere with functioning (e.g., academic problems) or quality of life. Furthermore, some symptoms must have been present prior to age 12 and in at least two settings for a diagnosis to be given.
The prevalence and presentation of ADHD varies between genders. More boys than girls are diagnosed with ADHD (American Psychiatric Association, 2013). According to Quinn and Madhoo (2014), in a review of articles on ADHD, girls tend to be diagnosed more with an inattentive presentation than hyperactive-impulsive presentation. The authors also noted that, because of a prominence of inattentive symptoms, that girls are more likely to be overlooked for a diagnosis of ADHD.
For example, a boy who is constantly leaving his seat and annoying his classmates has more obvious symptoms than a girl who daydreams. Furthermore, the authors postulated that females may have developed better coping skills for dealing with their ADHD symptoms, which may then mask that they have ADHD.
Another reason that the authors believe that girls are often misdiagnosed as not having ADHD is that their aggression tends to be more relational and therefore more covert than the overt or physically aggressive behavior of boys.
Children with ADHD may also have another specific disorder, such as a mood disorder, an anxiety disorder, or other behavioral disorder (e.g., Oppositional Defiant Disorder). Further complicating matters, symptoms can overlap between ADHD and other diagnoses, making it more difficult to diagnose. Therefore, it is important to have a thorough evaluation completed in order to accurately diagnose and treat the symptoms.For example, someone who constantly worries also typically experiences difficulty concentrating in class because of the anxiety. The clinician must then determine if the concentration problems are due to ADHD, anxiety, or a combination of the two conditions.
Someone who has a processing disorder (e.g., auditory or visual) or learning disability may fall behind in school and, therefore, feel anxious and be plagued by self-doubt. This child could appear to have symptoms consistent with ADHD since the child is struggling in school and likely has focusing problems that relate the anxiety and self-doubt. Further complicating the picture is that medical conditions may mimic ADHD, such as thyroid conditions.
These are only three ways in which ADHD and other conditions overlap. However, these examples highlight the need for a thorough evaluation by a skilled professional.
Evaluation for ADHD
So what does an ADHD evaluation consist of? If the evaluation is thorough, there will be a variety of components. For example, behavioral checklists are typically completed by the parents and/or guardians, teacher(s), and child (depending on the age). A continuous performance task (e.g., IVA-2, TOVA), which is a computer-administered measure of ADHD symptoms, may also be administered.
Other standardized tests may be included, such as portions of intelligence tests. The clinician will also screen for other disorders, such as depression and anxiety. Depending on your child’s presentation, the clinician may recommend ruling out a processing disorder and/or learning disability.
A medical evaluation, that also includes hearing and vision tests, will also likely be recommended to rule out any medical contributors to symptoms. As you can see, this will not be a short office visit. However, a comprehensive evaluation is needed in order to accurately diagnose.
Treatment for ADHD
When ADHD is left untreated, the consequences can be great. Untreated ADHD can lead to academic problems, low self-esteem, social problems, substance abuse, emotional difficulties, and affect work functioning. This is why finding the appropriate treatment is vitally important.
Often, you will be given a referral to a psychiatrist in order for them to determine if medication would be helpful. However, there are also psychological interventions that can be helpful for children. Types of therapies that may be recommended include behavioral interventions, cognitive behavioral therapy (especially for co-occurring depression and anxiety), or neurofeedback.
Strategies for Helping Children With ADHD
1. Develop structure in your household, such as consistent chores and routines.
2. Set clear boundaries so that your child knows the rules and consequences. Ambiguity is not helpful for children with ADHD!
3. Help your child to create a space to do homework that is quiet and free from distractions.
4. Help your child develop organizational systems and reminders.
5. Develop good self-care for yourself! It is difficult to care for a child who is struggling and you will be most effective if you care for yourself!
6. Teach your child good self-care, such as nutrition, obtaining enough sleep, and engaging in physical activities.
7. Help your child develop strategies for soothing emotions when he or she becomes overstimulated. For example, your child could have a kit that includes soothing objects that tap into the senses (e.g., a soothing song for sound). Learning deep breathing can also be effective.
8. Engage in mindfulness activities to help your child learn to develop control over his or her thoughts.
9. Limit video game/technology exposure. This one is not popular, but research is showing that unlimited gaming is not helpful for ADHD (Miller, 2018)
10. Help your child learn how to interact effectively in social situations.
11. Maintain contact with your child’s teacher.
1. Provide your student with opportunities to move about the classroom, such as being in charge of passing out papers.
2. Make sure that your student does not skip recess, as this will only exacerbate the problem for both of you.
3. Seat student near to the teacher or in the front row.
4. Repeat directions several times.
5. Break down instructions into small, simple steps.
6. Call on student often in order to keep engagement higher.
7. Prearrange a signal to redirect student’s attention back to task.
8. Praise the student for positive behaviors, since low self-esteem often accompanies ADHD.
9. Try not to point out negative behaviors in front of the entire class, again, to avoid increasing shame.
10. If overstimulation is contributing to behaviors, you may need to dim the classroom lights or have the students become silent for a few minutes.
11. Know your student’s triggers.
12. For younger students, daily behavioral report cards may be helpful
It can feel overwhelming when you have a child with ADHD. Thankfully there is help! If you believe that your child is struggling with ADHD it is important to seek direction from someone who is trained in the assessment and treatment of ADHD. We are here to help you and your child on your journey!
ADDitude Magazine – additudemag.com
Attention Deficit Disorder Association – add.org
Children and Adults with Attention-Deficit/Hyperactivity Disorder – chadd.org
Driven to Distraction (1994) – Edward M. Hallowell & John J. Ratey
Taking Charge of ADHD, Third Edition: The Complete, Authoritative Guide for Parents (2013) – Russell A. Barkley
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Miller, C. (2018). Do video games cause ADHD: Why kids with attention problems are so focused-even fixated on the screen. https://childmind.org/article/do-video-games-cause-adhd/. Retrieved on 8/28/18.
Quinn, P.O., & Madhoo, M. (2014). A review of attention-deficit/hyperactivity disorder in woman and girls: Uncovering this hidden diagnosis. Prim—— Care Companion CNS Disorder—-, 16(3)
Visser, S.N., Danielson, M.L., Bitsko, R.H., et al. (2014). Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD disorder: the United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53(1):34–46.
“Busy”, Courtesy of Pan Xiaozhen, Unsplash.com, CC0 License; “Taking Notes”, Courtesy of Thought Catalog, Unsplash.com, CC0 License; “Fairy Bonsai”, Courtesy of Faye Cornish, Unsplash.com, CC0 License; “Surf and Turf”, Courtesy of Daniel Gaffey, Unsplash.com, CC0 License