Attention-Deficit/Hyperactivity Disorder

Brian is a warm and caring child who has much energy. He often plays very rough with his little sister and seems unable to share or take turns. He is very excitable and finds it hard to settle down.

Sue is a very talented artist. However, rather than taking notes and making eye contact with the boss during meetings, she often doodles and daydreams. Sue seems flighty, as if she has a million things on her mind.  She is unorganized, and often loses things.

Both Brian and Sue have Attention-Deficit/Hyperactivity Disorder, or ADHD.  It is sometimes also called ADD or Attention Deficit Disorder. Attention-Deficit/Hyperactivity Disorder or ADHD is commonly diagnosed in childhood. However, ADHD affects adults also. Many children and adults with ADHD don’t even know they have it. Yet a proper diagnosis and treatment could mean a better quality of life for the individual and those around him or her. ADHD consists of a group of symptoms such as an inability to pay attention and constantly being on the go.

General Information:

ADHD is now the umbrella term for concerns with hyperactivity and inattention. ADHD is prevalent in 3-7% of school age children and 4% of adults in the U.S. ADHD involves differences at the brain level. ADHD is associated with less activation and interaction of multiple brain areas involved with: attention, organization, regulation & expression of behavioral responses to situations. Brains of people with ADHD have more difficulty in: alerting, sustained attention, response inhibition, planning, working memory, cognitive flexibility, and fluency. For low excitement activities, their brains save energy by not fully attending. If a situation is life-threatening or fun, then parts of the brain that seek pleasure and avoid pain activate allowing for improved attention at that time.

Treatment Considerations:

Research indicates that individuals with ADHD are best served when they receive intensive and ongoing expert care, not only for the purpose of addressing current symptoms, but to reduce future risk factors. Untreated, individuals with ADHD are at greater risk for depressive symptoms, drug and alcohol abuse, school delinquency, academic failure, and accidents (including motor vehicle accidents).

Sleep: The number of hours of sleep generally necessary for optimum brain functioning depends on age. Consider the following guidelines: 11-13 hours for preschoolers; 10-11 hours for pre-adolescents; 9-10 hours for adolescents; and 7-9 for adults. If falling asleep is difficult, you/your child may be experiencing a disruption in the body’s natural production of the hormone melatonin, which aids in sleep, and you may wish to consider, in consultation with your PCP, the use of melatonin before bedtime. If sleep remains a problem, further consultation with a therapist and possibly a sleep specialist is recommended.

Diet: In regards to diet, while research has demonstrated that sugar and artificial food coloring and additives (AFCAs) can amplify behaviors associated with ADHD, they do not cause the symptoms of ADHD. It may be helpful to monitor what impact dietary or environmental factors have on you/your child’s symptoms. You may wish to meet with a registered dietitian and/or allergist to develop a plan for ruling out potential irritants and improving functioning generally. In the meantime, monitor any notable behavioral changes that consistently occur after specific environmental, and especially dietary, exposures (e.g., caffeine, red dye,sodium benzoate). In terms of diet, generally follow a principle of reducing intake of simple carbohydrates (sugar, corn syrup, refined flours, pasta) and increasing intake of protein (found in lean meats, fish, and low-fat dairy products) and fiber (found in whole grains, nuts, and fruits and vegetables) as much as possible. Lastly, there is some evidence that decreasing the ratio of omega-6 fatty acids (found in vegetable oils) to omega-3 fatty acids (found in cold-water fish, or taken in supplement form, and many nuts), reduces symptoms relating to poor attention and concentration (as well as having significant health benefits relating especially to cardiovascular health).

Exercise: In regards to exercise, a daily 20-30 minute period of physical activity that elevates the heart rate is a well-established baseline for therapeutic benefit. This can be accomplished simply by a brisk walk or bike ride.

Medication: Medication management remains the primary research-proven intervention consistently shown to significantly reduce the symptoms of ADHD. It is recommended that you schedule a medical consultation with a psychiatrist/child psychiatrist. Finding a medication and dosage that provides you/your child with the maximum therapeutic benefit with the fewest medical risks or side effects may take time and expertise beyond the training or experience of your general practitioner. In preparation for your appointment, you are strongly encouraged to download a copy of “The ADHD Parents Medication Guide” produced by the American Academy of Child and Adolescent Psychiatry.

Neurofeedback: There is evidence that neuro-feedback techniques may also result in significant reductions in ADHD symptoms, though results are likely to be more gradual. Neuro-feedback therapy is available at Genesis; if you are interested in exploring this option further, please speak with your therapist or other Genesis staff member at 757-827-7707.

Therapy: Beyond symptom reduction, individuals with ADHD have been shown to benefit from environmental accommodations and specialized behavioral plans. You are strongly encouraged to have follow-up consultations with a therapist/child therapist to learn and develop a plan tailored to you/your child’s specific strengths and weaknesses. Children with ADHD typically suffer with low self-esteem due to the near constant negative feedback they receive for failing to meet others’ behavioral and academic expectations. Over time, failure and disappointment become thematic for their interpersonal relationships. As a buffer to this, you are strongly encouraged to make it a daily habit to spend some uninterrupted one-on-one time with your child.

Tips: Research indicates that individuals with ADHD show improved focus and attention when exposed to mild extraneous stimuli. While counter-intuitive, strategies such as listening to music through headphones or manipulating a squeeze ball during activities that require sustained attention, such as homework, should be investigated and implemented consistently if found to be beneficial. While students may protest in the classroom setting if your child is given special permission to complete work with headphones or a manipulative, his teacher can explain that the manipulative is necessary for him in the same way that glasses are necessary for someone who needs glasses to read.

In school: If your child does not currently have an educational plan in place at his school, and there is sufficient evidence that your child’s ADHD symptoms are significantly affecting his academic performance, you are encouraged to initiate a thorough Child Study through the public school system as he may be eligible for a 504 Plan. A 504 Plan will formalize specific academic accommodations appropriate to your child’s ADHD difficulties (such as increased time for taking tests). You are also encouraged to access resources from the Learning Disabilities Association of America and specifically to purchase “The LDA Advocacy Handbook: A Parent’s Guide for Special Education” to help guide through the Child Study and 504 Plan process.  With or without a 504 Plan in place, you and your child’s teachers are encouraged to develop specific educational goals, strategies, and accommodations for your child. Examples of strategies and accommodations for students with ADHD that may be beneficial at school include: preferential seating close to the teacher to limit peer distractions, utilizing hands-on and interactive exercises whenever possible, and trying techniques that introduce mild stimulation to aid in concentration (e.g., allowing your child to manipulate a squeeze ball, or listen to headphones while he works, or to move around at his desk instead of sitting). Also, daily communication should take place between you and your child’s teachers. In lieu of services accessed through the public school system, or as an adjunct to them, you may wish to seek a consultation from a private educational specialist, such as through the National Institute for Learning Development or Sylvan Learning.

You are encouraged to educate yourselves in-depth about ADHD and Learning Disorders. Three recommended resource books are: “Taking Charge of ADHD” by Dr. Russell Barkley, “Parenting Children with ADHD” by Dr. Vincent Monastra, and “Healing ADD” by Dr. Daniel Amen. Parenting a child with ADHD is especially tiring and frustrating and can lead to social isolation due to your child’s behavioral difficulties. This is often exacerbated by the fact that parents of children with ADHD frequently struggle themselves with attention, concentration, organization, and impulse control difficulties. Support groups and educational resources can be found through an organization called Children and Adults with Attention-Deficit/Hyperactivity Disorder  and, for adults specifically, through an organization called the Attention Deficit Disorder AssociationThe University of Michigan Health System  and LD Online both provide excellent resource materials for both ADHD and Learning Disorders.

References:

Monastra, Vincent. (2008). Unlocking the Potential of Patients with ADHD. Washington, D.C.:APA.

Monastra, Vincent (2014). Parenting Children with ADHD: 10 Lessons that Medicine Cannot Teach. Washington, DC: APA.

Resources:

Academic Accommodation Resources

Classroom Strategies

Estate Planning for Parents of Special Needs Kids

Information on ADHD

Reduce the Noise: Help Loved Ones with Sensory Overload Enjoy Shopping

Resources for Military Families

Nutritional Considerations by Cindy Kokoris, Psy.D.