The American Psychiatric Association states that 5 percent of children have Attention Deficit and Hyperactivity Disorder, also known as ADHD. However, the diagnosis of ADHD continues to rise, from 7.8 percent in 2003 to 9.5 percent in 2007 and to 11.0 percent in 2011, resulting in an increase in the number of children being put on medications. The medical community is appropriately taken aback at this dramatic trend and the realization that we are potentially over-medicating young, growing brains.
Undoubtedly, some children truly have this diagnosis and their daily function is greatly improved with medication. However, if you suspect your child might have ADHD there is some important information you should know before talking with your doctor and accepting a new prescription on your child’s behalf.
First, here are many other conditions that might mimic ADHD. These should be ruled out before a diagnosis of ADHD is given.
▪ Lack of sleep. Kids – and adults – can become super hyper or loopy during the day when they stay up past their bedtime.
▪ Poor sleep quality. While they may technically be sleeping long enough, their quality of sleep may be poor. Reasons include television or computer screen time close to bedtime, which keeps the brain partially awake all night, or even the possibility of obstructive sleep apnea where the brain does not get enough oxygen at night. If your child routinely snores, mention this to your doctor.
▪ Boredom. Some children appear inattentive and unable to focus because they’re bored. Your child might be gifted and their current grade level isn’t stimulating enough. Discuss with school.
▪ A deeper problem. If your child has an unrecognized learning disability they may act out or “space-off” to cover up their struggles. Hyperactivity or inattentiveness could also be a sign of depression or anxiety.
▪ Exposure to tobacco or caffeine. Children exposed to too much of either may behave more erratically.
▪ Environmental circumstances. Divorce, recent trauma or other events unique to the child.
▪ Parental misconception. A child may be behaving normally for their age. Sometimes parents need to rethink what are appropriate expectations for their child’s age.
If your child is given the diagnosis of ADHD there should be a long discussion about how to treat it. Medications used to treat ADHD have side effects, which should be thoroughly considered before you expose your child. You and your doctor should also review reasonable expectations with medication. Taking a pill will not turn your child into the best-behaved kid on the block. In fact, I’ve seen several children use their new-found powers of concentration to stir up mischief.
If you choose to medicate, there are ways you can help your child beyond just taking a daily pill. Children with ADHD are often bright, talented individuals who process information differently. When some simple changes are made to their environment they can become very successful in their daily functioning.
▪ Plan and prepare for morning chaos. Getting up and out the door in the morning is especially stressful for families with an ADHD child. Planning ahead can help. Select clothing and pack the book bag the night before. Using a visual chart can help remind children of the steps to take to do this. Avoid television and computer exposure in the morning. Make sure your child is getting enough sleep and wake them early enough to allow a little spare time for routines that get off-track.
▪ Avoid restlessness from hunger. Provide your child with a nutritious breakfast that contains protein (eggs, butter, peanut butter, yogurt) so he doesn’t feel a mid-morning crash. Proteins release energy more slowly than carbohydrates. That’s why cereal eaters are frequently hungry again well before lunch time.
▪ Work with school. Your child’s school should provide environmental accommodations to help your child succeed; for example, sitting in the front of the room so there are less visual distractions and getting spelling test word lists in advance of peers as it will likely take them a little longer to learn. Your child should be allowed to take tests in a different room where it is quieter and she should be given a little extra time as her attention will likely wander. Some children benefit from a “hyperactivity helper,” usually a quiet toy that allows them to fidget at their desk to burn off their extra energy while staying seated and not distracting their peers. One amazing teacher replaced her student’s desk chair with an exercise ball. Be sure to update your school with the new diagnosis and request accommodations, usually referred to as a 504 plan, for your child.
▪ Allow decompress time. After working so hard to be good at school, children need a little “wiggle time” when they get home to let out all the extra energy. Organized sports or just a good ol’ fashioned romp in the yard can do wonders.
Any child on a stimulant class of medication for ADHD should initially see their doctor every one to two weeks. Once the right medication and dosage is found, visits can be spaced to every three months. These visits help monitor your child’s weight, blood pressure, heart function, and both positive and negative reactions to the medication.
Properly diagnosed and treated, managing ADHD is an achievable goal.
Amy Seery is a pediatrician for the University of Kansas School of Medicine.