School Psych Made Simple

A.D.H.D. edition

What is A.D.H.D.?

Attention Deficit Hyperactivity Disorder is one of the most common childhood behavior disorders. Approximately 9 - 10% of children ages 3 - 17 have been diagnosed with ADHD according to the 2012 National Health Interview Survey (Bloom, Jones & Freeman, 2014). The major symptoms of inattention, hyperactivity, distractibility and impulsivity are associated with many challenges in the educational environment. What is also tricky about the disorder is that it looks vastly different from one child to the next.

ADHD comes in Different Sizes and Strengths

ADHD is not an all or nothing disorder. It isn't like a diagnosis of diabetes - either you have it or you don't. It is a disorder on a continuum and it can present in small, medium and large levels of severity. It is usually when the person is significantly and persistently impaired by their symptoms that a diagnosis is made. And no two people with ADHD manifest symptoms in the same way. In the DSM- V, ADHD is divided into sub-types in which the symptoms cluster in different ways.

  • ADHD, Predominantly Hyperactive-Impulsive Presentation: Kids who have this type of ADHD have symptoms of hyperactivity and feel the need to move constantly. They also struggle with impulse control. I like to think of these kids as The RoadRunner variety of ADHD.
  • ADHD, Predominantly Inattentive Presentation: Kids who have this type of ADHD have difficulty paying attention. They’re easily distracted but don’t have issues with impulsivity or hyperactivity. This is sometimes referred to as attention-deficit disorder (or ADD). With this type - think Dorie from Nemo.
  • ADHD, Combined Presentation: This is the most common type of ADHD. Kids who have it show all of the symptoms described above. This is the jackpot of ADHD and I think of Kramer from Seinfeld for this type.

Why my kid? How did this happen?

The causes for ADHD are still unknown, however, the scientific community is certain about the fact that it is a brain-based biological condition. Here are some other facts that are known about the origins of ADHD:

  • Genes and heredity: Studies show that AHDH runs in families—meaning it may be genetic. If your child is diagnosed with ADHD, there is a significant chance that you have it too, even if you’ve never been diagnosed. As many as 35 percent of children with ADHD have a parent or sibling who also has the disorder.
  • Differences in the brain: Certain areas of the brain may develop at a slower pace or be less active in kids with ADHD. Johns Hopkins Medicine reports that kids with ADHD also may have lower levels of a brain chemical called dopamine that helps to regulate mood, movement and attention.
  • Environmental factors: Prenatal exposure to alcohol and cigarette smoke could increase the chances of getting ADHD, says the National Institute of Mental Health. So does exposure to high levels of lead during infancy and early childhood. There’s no evidence that sugar or food additives cause ADHD. Find out more about sugar, food additives and ADHD.
  • Brain injury: Traumatic brain injury (TBI) is a lot less common than ADHD. But ADHD-like symptoms are sometimes present in the relatively small number of kids who have TBI. Recent studies show high rates of attention problems in acquired brain injuries (such as concussion and brain tumors).
  • Motivational Factors: Children with ADHD are often very adept at remaining focused for hours on end with things that are of particular interest to them. This is true for most of us - it is easier for me to remain focused on a movie that is a funny, uplifting comedy than remaining focused on a documentary about the life cycle of the ring-tailed Lemur. However if I needed to focus my attention on the ring-tailed Lemur, I could do so. People with ADHD have a much more difficult time doing this due to brain chemistry and not lack of will power.

Will it go away?

Many people wonder if maturity will provide the key to lessening the symptoms of ADHD I've heard parents say, "He'll grow out of it; give him time," or "She is just on the immature side." These things may be true, and we know that the area of the brain associated with regulating attention and focusing (the Pre-frontal Cortex) is the last area of the brain to fully develop. However, in general, the ADHD symptoms from childhood tend to morph into other symptoms in adulthood if they are not understood and addressed.
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Source: AdderallRx

What will be impacted if my kid has ADHD?

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The area of the brain that is responsible for performing Executive Functions is the Pre-Frontal Cortex. This also happens to be the part of the brain that is slower to develop in kids with ADHD. When Executive Functions are compromised, kids will have difficulty:
  • Keeping track of time
  • Making plans
  • Making sure work is finished on time
  • Multitasking
  • Applying previously learned information to solve problems
  • Analyzing ideas
  • Looking for help or more information when it is needed

Social Skills

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Children with ADHD often have trouble with developing age-appropriate social skills. They often lack the awareness of their own place in space and often become what I call a Space Invader which makes other children uncomfortable. They are often impulsive and don't recognize that they may hurt someone's feelings by sharing an opinion that might be hurtful, even if they feel it is true. The impulsivity can also be seen during conversations and game play when the child with ADHD interrupts and doesn't take turns fairly.


How is ADHD diagnosed?

Diagnosing ADHD is not an easy endeavor. Many symptoms are similar to typical behaviors to some degree. There is no one test that definitively confirms a diagnosis. It is a collaborative effort between home, school and the medical practitioner to make the diagnosis. To be diagnosed with ADHD, kids need to have had several symptoms for at least six months before age 12. The symptoms must be severe enough to negatively affect your child’s social skills and schoolwork and they must be evident across more than one setting.

The first step would be to get a complete physical exam in order to rule out any other physical conditions that may mimic symptoms of ADHD such as seizure disorders and hearing impairments.

Seeing a mental health practitioner well versed in teasing out organic attentional issues from other environmental and situational conditions such as reactions to a divorce or a move would be the next step. This professional will administer behavior rating scales to both parents and school personnel to determine if the targeted behaviors occur across more than one setting. They may also provide a continuous performance test which is a computerized test which evaluates a child's impulse control and ability to sustain attention. Close observation of your child at home and in school are also important aspects of the diagnosis.

What are the treatment options?

The treatment of ADHD starts with a solid understanding of what the disorder is and how it affects the child's functioning. Demystifying the disorder and taking the blame off the child and the parents are the first steps to dealing with the symptoms in a positive and effective manner.

Since the symptoms of the disorder are seen behaviorally at home and at school, you will want to consider treatment approaches that are consistent in both settings. Behavior modification strategies that look to build lagging executive functions by reinforcing the use of planners for homework and charts to accomplish tasks at home are useful tools.

Social skills development groups can provide children with the practice they need in understanding the nuances of social interactions that they seem to miss in typical play settings like the park and at recess. Improving mindfulness and helping children focus their attention on purpose, in the moment, without judgment can also improve the neuronal connections located in the Pre-Frontal Cortex that build attending and impulse control skills.

Educational support in the form of Accommodation Plans and Individual Educational Plans may also be helpful to address the impact the disorder has on learning. Providing environmental accommodations like preferential seating and scheduled movement breaks may be all a child needs that has a mild case of ADHD. Another child whose symptoms are more severe may require special education support and a formalized behavior intervention plan in school.

Stimulant and more recently, non-stimulant medications have been found effective in lessening the impact of the symptoms of ADHD. These medications work by balancing the brain chemicals responsible for focus, attention and impulse control. Some side

effects of the medications include loss of appetite, irritability, and difficulty falling asleep.

These side effects often dissipate over time.

Having a support network of people who are experiencing the same challenges of raising a child with ADHD is a very important resource. Below are some excellent links to online communities and information sources to help navigate the highs and lows of parenting a child with ADHD.