Notes on Parenting

Insights for parenting babies, toddlers, teens, and young adults.

Wednesday, May 28, 2014

I Think My Child Has AD/HD, What Now?

On a regular basis I get calls from frantic parents asking this very question. It is a very direct question, but the answer is much more complicated than can be explained in a quick phone call or passing in the halls of school. With recent news stories about the mass medication of toddlers for AD/HD, and even some doctors doubting the diagnosis altogether, I understand the confusion and concern. So, what should a parent do if they think their child has AD/HD? For starters they should seek a qualified mental health professional, who has experience working with and diagnosing the disorder in order to get an evaluation. For the most part, pediatricians, teachers, and even school counselors only see the child in certain environments that may bias the evaluation. The gold standard in AD/HD evaluations would include:

  • Multiple self report measures (questionnaires that the parent(s) and teacher(s) fills out),
  • Some sort of intelligence testing (to rule out any other cognitive or psychiatric disorder),
  • A development history interview (where the evaluator asks certain questions about the child's developmental history),
  • A structured interview with the child (where the evaluator interacts with the child for a period of time),
  • An off site observation (where the evaluator observes the child in an environment where the child has trouble focusing, and where the child is seemingly able to focus - usually at the school). 
An evaluation like that is expensive and time consuming. However, when done properly, parents, teachers, and doctors are much more confident that the diagnosis is correct.

If the evaluation confirms your suspicions that your child has AD/HD there are several things to consider. First, the American Academy of Pediatrics outlines their preferred practices for treating AD/HD:

  • Preschool Children (below 5 years) - Evidenced based parent training, and behavioral therapy should be used for any child under five years old. It is not recommended that medication should be prescribed unless in very rare circumstances. 
  • Elementary Children (6-11 years) - A combination of behavior therapy and medication should be used, when behavior therapy is not effective by itself. The best practice is for both treatments to take place. 
  • Adolescent Children (12 years and older) - Once again a combination of behavior therapy and medication is preferred. Medication should be prescribed with parental consent and child assent (acknowledgment of the risks).
There are a number of books and behavioral programs that have proven effective for the treatment of AD/HD, but the most important standpoint for the parent is to better understand the disorder. I recommend parents keep the following in mind when dealing with their AD/HD child: 
  1. Be Patient - This applies to yourself as well as your child. When you discover your child has AD/HD, it confirms a lot of your previous suspicions, but it also opens up many more worries and concerns. You may be tired of telling your daughter to get her teeth brushed for the 50th time, and if it gets to that point, take a break. Breath. Remind yourself that they need repeated reminders.
  2. Stop the "Should's" - Often we tell ourselves or our partners, "they should be able to...". The next time you are tempted to say this, think about this story. A person I know struggled all their lives with running. Everyone around them could run miles with no problem. This person would get to the 10th yard and start coughing, struggling for breath, and would stop running. This person would shame themselves by saying, "everyone else can do this, I should be able to as well. I must just be lazy...". When this person was an adult they finally got fed up with this problem and decided to prepare for a race. In their preparations they were not able to run more than a half mile without getting winded. They decided to see if there was a biological reason to this problem. A doctors appointment confirmed that this person had asthma (a condition that restricts airways in the lungs) and would need to use an inhaler. Something magical happened when they started using the inhaler; they were able to run 3 miles without wanting for breath. For 25 years, this person had shamed themselves into thinking they were lazy, all because of un-diagnosed asthma. People with AD/HD have a neurological difference from those without AD/HD. Planning and carrying out steps in a process comes easy to neuro-typical people, but not so easy for those with AD/HD. If they have AD/HD, saying "should" never helps. 
  3. Use Humor - A friend of mine who has AD/HD, often zones out and looks like a deer in the headlights. They can be talking about something and then all of a sudden, something catches their attention and they are gone, in a daydream. When this happens they often proclaim with a raised fist, "Dirty ADD". They have learned to laugh at themselves when their neurological differences interfere with their daily living. A client of mine will use the line from Disney's "Up" when they get distracted: "SQUIRREL". 
  4. Get Treatment - Whether it be medication, or behavioral treatment, get something. Often parents will think they can handle it on their own, or refuse to seek any treatment because they don't want to risk their kids' self esteem. However, self esteem often goes down when AD/HD is left untreated. Behavioral therapy can help the child build supports in their lives so the AD/HD is not so impairing. Medication treatment provides a "calm from the storm" so kids can actually focus and use the supports built from behavioral therapy. Above all, get treatment. 
What are your thoughts about the trends in AD/HD? 
How has medication/behavioral treatment helped in your life? 

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