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Does My Child Have ADHD?

Every parent has asked themselves at some point the magic question: Does my child have ADHD? It is impressively frustrating to have to ask your child a hundred times to do something. I know as a parent, I have often thought, “If I have to ask you one more time to …x, y, z… head is going to explode.” But there is a definite difference between kids who simply don’t listen and those who have true ADHD.

What is ADHD?

ADHD is attention deficit, hyperactivity disorder. There are essentially three types of ADHD:

  1. The kid who can’t focus and has just the attention component.
  2. The kid who is all over the place hyperactive
  3. And the kid who has the two combined symptoms.

There is an official set of diagnostic criteria (outlined in the Diagnostic and Statistical Manual of Mental Disorders). In short, the criteria requires that the child has symptoms in more than one setting (e.g., at home and at school). If the child is great at home, but only has trouble at school, then the child needs school help (or may be related to poor teaching). If the child is great at school, but terrible at home, then the child needs help at home (it may be related to poor parenting). If the child has trouble in both home and school, chances are the problem is the kid.

ADHD Signs and Symptoms:

When you read through the list, don’t pick and choose (your child would need most of the symptoms to get a diagnosis). Keep in mind that some of these behaviors are pretty normal. With kids who have ADHD, it’s often extremes of these and very frequent. Here’s a sampling of observed symptoms.

  1. Inattention
    1. Has a hard time paying attention
    2. Doesn’t seem to listen
    3. Easily distracted
    4. Is forgetful in regular daily activities
    5. Makes careless mistakes in schoolwork
    6. Loses things (e.g., homework, books, etc.)
    7. Has trouble organizing tasks and activities
  2. Hyperactivity/impulsivity
    1. Can’t stay in a seat (constantly running and climbing on everything)
    2. Is constantly moving
    3. Blurts out answers before the question is completed
    4. Has trouble waiting for things (e.g., in lines)
    5. Fidgets in a chair
    6. Talks excessively
    7. Interrupts conversations
    8. Easily looses temper

How is ADHD diagnosed?

ADHD is diagnosed by a qualified health care professional (e.g., pediatrician or psychiatrist). In addition to clinically evaluating the child and taking a good history, there is usually formal testing done. Commonly this is done with measures like the Vanderbilt or Connors tests. These are forms that the parents and teachers both fill out and the doctor will score. It is worth noting that even if a child has symptoms of ADHD, if the child is not having impairment (e.g., the child has a hard time focusing, but is still a straight A student), then the child will not meet a diagnostic criteria. The child has to be having problems as a result of the ADHD.

How young is ADHD diagnosed?

As a general rule, kids are usually school-aged when diagnosed. This is when most kids are regularly in a second environment during the day, the requirements are increased on them, and problems really come to a head. Officially, a diagnosis can be made as young as 4, but typically medications aren’t recommended in that early age group. Most kids get diagnosed in 1st or 2nd grade.

How is ADHD treated?

There are a handful of approaches to treating kids with ADHD. The first is behavioral therapy. This can be effective in some kids, but is generally not the cure all that parents hope and want it to be. The second option is medications. Typically this is with the stimulant drug class. Contrary to what you may think (my kid is already stimulated enough, right?), the medication is stimulating the part of the brain that helps with control and focus. The medications won’t make your kid more hyper. There are a number of medications in this drug class and deciding which is best for your child is a decision you and your doctor should make together. It is worth mentioning that the medications have side effects, most notably: suppressing appetite and causing trouble sleeping.

(Note: there is a small, but significant involvement with the heart in some select patients. Before starting your child on meds, your doctor should discuss it with you).

It is important to remember when you are discussing treatment that you do not have to medicate kids who have ADHD. Most people opt to medicate because it often improves the quality of life, but it is not required. Scientifically, medication has been proven to be the single most effective treatment for ADHD. It is worth mentioning that there are lots of other popular alternative treatment options out there. While most of them don’t have a lot of scientific background, they are not usually harmful either (there’s nothing wrong with improving a diet or making sure children get more regimented sleep, etc.). Unfortunately, there isn’t a cure for ADHD, but there is significant improvement that can be made in the lives of those dealing with it.

If you are concerned your child may have ADHD, discuss it with your pediatrician. But remember, some failure to listen and crazy behavior out of kids is normal.

Recognizing Anxiety In Children

Recognizing and diagnosing anxiety disorders in children can be really tricky. There is often a lot of overlap between anxiety, depression, ADHD, and other disruptive behavioral disorders. Anxiety disorders is a broad term that encompasses generalized anxiety disorders, obsessive compulsive disorders, separation anxiety, and phobias (including social anxiety). As you’ll see, so many of the symptoms can fit into lots of different diagnoses.

Anxiety Symptoms

Must be:

Excessively worried and anxious about a number of situations (largely over exaggerated or unrealistic).

May have:

  • Guilt
  • Fear
  • Irritability
  • Poor sleep
  • Weight loss
  • Sleep disturbances
  • School problems (including not wanting to go)
  • Poor concentration
  • Restlessness
  • Experience brief panic attacks (with pounding heart, shaking, fear, sweating)

Should you treat anxiety?

If the answer is yes to most or all of these, you should strongly consider treatment for your child.

  1. Does the anxiety inhibit your child from normal life functioning (e.g., social interactions, school)?
  2. Is the anxiety present more often than not? (Specifically, has it lasted more than 6 months, more than 3-5 times a week, lasts for hours–not just a few seconds or minutes).
  3. The anxiety does not have another explanation that needs to be addressed (e.g., substance use/abuse, depression from a major life event like death or divorce).
  4. Is there a strong family history of anxiety?

How do I treat anxiety?

The most effective treatments utilize a combination of techniques: behavioral therapies, medications, and counseling,

  1. Behavioral therapies: these approaches work on teaching the child to changes his/her thoughts into a more positive context when faced with anxiety provoking situations. The child may learn relaxation strategies, distraction techniques, etc.
  2. Medications: Most anxiety disorders are treated with a class of medications called selective serotonin reuptake inhibitors (SSRIs). Interestingly, it is one of the same classes of drugs used to treat depression. Because of the complexity of the brain and the high rate of what are called comorbid conditions (meaning increased likelihood of having more than one mental involvement at a time), your pediatrician may look into treating other things first. For example, I have had patients with both ADHD and anxiety, and we’ve opted to treat the ADHD first. Personally, I don’t like throwing too many things at a kid all at once (it makes monitoring what’s working and side effects very difficult). Sometimes, fixing the biggest problem first, makes the second problem seem nearly insignificant and easy to manage without need for more medications.
  3. Counseling: I have seen some parents who have remarkable skills at being able to walk their child through panic attacks and anxiety provoking situations. While some of those parents have innate skills, many learned them through hours of counseling with their child.

What about the “not so bad, but still anxious” kid?

So if you’re reading this and thinking, ‘Yeah, but Dr. Wonnacott, what about my kid that has a tendency to be anxious, but I don’t necessarily want to medicate?’ First look at the grown-ups in your child’s world. Are any of them “high strung” or “anxious?” Is there anything you can do to help relax the grown-up who is influencing the child? Second, look into a number of the behavioral therapies that are used in kids with full-blown anxiety disorders. Even if your child doesn’t meet a complete diagnosis, many of the skills learned there can be utilized as you child encounters stresses as an adult (e.g., deep breathing, mindfulness, relaxation, counting, object focusing, body awareness).

You know your child best, and are best equipped to help him or her. If your child is really struggling, and you’re really worried, talk to your pediatrician. We’re here to help.