What Parents Should Know About ADHD
Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder that is related to difficulties in behavior and school life. As the most comprehensively studied pediatric health disorder, public debate and controversy regarding the diagnosis and medication treatment exists. With the various treatment options that are available to children with ADHD, for example, medication, parent training, and behavioral therapy, stimulant medications are the most utilized. It is not uncommon to hear a parent say their child has ADHD because they are very active and crazy. Parents did not get this idea on without prompting from pharmaceutical companies that have pushed this way of thinking through ads. Instead of asking if their child is engaging in typical childhood, age appropriate behavior, parents turn to medications to mellow out their child. Many people question whether ADHD is being properly diagnosed or is being misapplied as an answer to the question of why many children are unruly or seem incapable of focusing on a task.
Attention Deficit Hyperactivity Disorder (ADHD) has evolved throughout the past 50 years in symptoms, diagnosis and treatment options. As it has become a recognized neurological disorder and medications have been found to help, the diagnosis of ADHD seems to have skyrocketed. According to the review performed by Dr. Daniel Connor, the number of school children diagnosed with ADHD was very low and the number was close to zero for adolescents and adults before 1970. In the United States, the number of ADHD cases increased almost eight times from 1980 to 2007 when compared to the number of cases 40 years ago. The most current data provided by the Centers for Disease Control (CDC) estimates that approximately 15 percent of children ages 4-17 have been diagnosed with ADHD and that 3.5 million children use stimulant medications which is 2.4 million more than 1990. The CDC reports that boys were more likely than girls to have ever been diagnosed with ADHD. Research shows that boys are wired differently and in general are more physically active and less able to sit still than girls of the same age. Whether that means they are ADHD is an entirely different matter. Many are being categorized as ADHD and are subjected to treatments for that condition. Attention Deficit Hyperactivity Disorder was known as Attention Deficit Disorder but was renamed in 1994 and broken down into 3 subtypes: inattentive type, hyperactive-impulsive type and a combined type.
In the last 20 years, the increase in ADHD diagnoses and prescriptions for stimulants correspond with the advertising by pharmaceutical companies to publicize the syndrome and encourage medications to doctors, educators and parents. "Behind that growth has been drug company marketing that has stretched the image of classic ADHD to include relatively normal behavior like carelessness and impatience, and has often overstated the pills' benefits." (Schwarz 1). Advertisements for stimulant medications are found anywhere from magazines, to commercials, billboards, medical journals, social media sites and brochures sitting in the doctors office. Pharmaceutical companies entice parents with ads stating their child will have better test scores, perform more chores and gain independence when using ADHD medications. To combat the parents who are resistant in having their child evaluated for ADHD, pharmaceutical groups have posted lists of famous people with ADHD to reassure parents that their child is in good company with their diagnosis. Like parents, they are targeting educators: "The idea of unleashing children's potential is attractive to teachers and school administrators, who can be lured by ADHD drugs' ability to subdue some of their most rambunctious and underachieving students." (Schwarz 7). Stimulant medications have been acknowledged to be effective in improving test scores in children with a proper and careful ADHD diagnosis by improving their concentration. The concern expressed by some experts regarding the misleading and overabundant pharmaceutical ads is that some doctors may be tempted to prescribe medications to healthy children, simply to improve grades or self-esteem. Some parents and others believe that too many children are now being categorized as ADHD as a convenient means of justifying the use of prescription medications to sedate or chemically alter the behaviors of children who might be "too energetic".
In general, it is hard to evaluate mental conditions, and so a condition like ADHD takes time to be evaluated properly. Many people associate words like "hyperactive", "wild and crazy", or "out of control" when they hear ADHD, but for those kids who do not display those symptoms, the diagnosis of ADHD can be puzzling and they may go undiagnosed. Families should understand the symptoms of ADHD, as they will assist their child's healthcare professional in making a diagnosis.
"Common symptoms include: impulsivity, restlessness, poor organizational skills, tendency to procrastinate, tendency to be willful and stubborn, low tolerance of frustration, tendency to have many projects going on at once with trouble with follow-through, tendency to multi-task, trouble following sequential directions, trouble with authority, strong desire to be free and independent, love of excitement and danger, poor tolerance of boredom, trouble in showing one's work, heavy reliance on intuition, and a desire to strike out in new directions, regardless of what is the order of the day." (Hallowell qtd. in "ADHD in Kids" 3).
It can take time to make the right diagnosis of ADHD. Filling out a standardized form and knowing a few symptoms is not an effective way to diagnose. Dr. Daniel Connor suggests that "a multi-informant, multi-method, developmental assessment of symptoms, impairment, course of illness, precious assessments and treatments, school and social function, and comorbid conditions" will establish the clinical criteria for an ADHD diagnosis to be achieved. There are other conditions, referred to as a comorbidity that physicians may need to consider which have ADHD-like symptoms, for example learning disabilities, emotional regulation issues, and auditory processing disorder.
Due to payer and clinical time limitations, many physicians diagnose ADHD without fully evaluating the child, which can lead to over diagnosis or under identifying ADHD in children with complex and comorbid presentations, further reinforcing the public perception that ADHD is being over diagnosed. Schwarz further illustrates this point, "...some of the field's longtime advocates say the zeal to find and treat every ADHD child has led to too many people with scant symptoms receiving the diagnosis and medication." In fact, according to the CDC, ADHD is the second most diagnosed condition, coming in second to asthma. In addition, primary-care physicians with very little mental health training are being left to make an ADHD diagnosis because insurance plans are refusing to pay for mental health specialists. Conveniently, pharmaceutical companies have developed web-based continuing education courses for physicians who would like to learn more about the diagnostic process, which furthers the concerns about the perceived over diagnosis and over medicating of ADHD.
Once a child is diagnosed with ADHD, the physician or mental health practitioner will inform parents about the treatment options available and what educational strategies may be used to help the child manage their ADHD. Treatment plans should be determined on a case-by-case basis, as some children with ADHD may not need medication. Stimulant medications such as methylphenidate or amphetamine works by balancing chemicals in the brain, which are responsible for focus, attention and impulse control, making these effective in helping manage the symptoms of ADHD. (Morin 10). For many children with ADHD, behavioral and psychological therapy along with educational and family support can be effective. Additionally, research has proven that parent skills training is effective in improving behavior in children as parents learn to be clear and specific in their requests to their child and by using praise and rewards for good behavior. (Shute 1).
Dr.'s Irene Loe Heidi Feldman address the characteristically low academic performance of children with ADHD, noting that "children with ADHD are 4 to 5 times more likely to use special educational services than children without ADHD." Teachers play a significant role in determining the level of academic performance for the child by helping to develop an appropriate plan for support and accommodations. "Many think ADHD is simply about kids who can't focus on their work or sit still, but there is a great deal more to it, experts say, and student achievement in school suffers because the condition is misunderstood." (Strauss 1). Teachers can facilitate appropriate accommodations to ensure the child's success in the classroom such as, reducing potential distractions, using positive peer role models, allowing time for movement, preparing for transitions and letting the child play during recess, instead of using it to finish class work.
A child's emotional and physical health depends a lot on their parents and siblings. Parents can take measures to gain control over the factors that can reduce the psychological effects of children with ADHD. For example, children with ADHD can perform their tasks well if the tasks have predictable patterns. They perform well when they are focused and organized and they know exactly what is expected from them. Following a routine, setting clocks and timers, keeping home neat and organized, and simplifying children's schedule can help to achieve just that.
"When we look at statistics on how children with ADHD fare down the line, in terms of lower-than-average educational achievement...one wonders how much is the disorder itself holding people back, versus how the disorder made them feel about themselves and their capabilities from earliest childhood." (Jellinek 1)
In addition to families, educators can have significant impact on the behavior and psychological effects among children with ADHD. Most ADHD children receive a lot of criticism about their behavior, which Dr. Michael Jellinek illustrates when he describes how a child could receive 3,200 non-positive comments per school year based on a 6 hour day, 180 days of school and negative or corrective comments from the teacher 3 times per hour. Teachers can have a positive influence on a child's success if they are patient, and have a positive attitude (Sherman).
Setting clear expectations and rules can also help the symptoms of a child with ADHD. Rules should be in place for all kinds of activities or behavior; they might even include rewards and consequences. These rules should be simple, clear and easy to understand for the child. If they behave well and follow the rules, it should be rewarded or praised. Praises can have a significant impact on the psychological effects of a child with ADHD, because they are not very used to it. A simple smile, or just an encouraging statement can have a huge impact on the child's psychology and can even improve the attention and focus of the child. It is also equally important to give negative feedback for inappropriate behavior.
Getting better sleep and doing some kind of physical activity are also equally important. Most children with ADHD usually have a lot of energy. If they do not use this energy to focus on some activity they may become chaotic. So it is important that they are involved in some kind of physical activities and this way they can focus their energy on some kind of sports and related skills. This kind of physical activity can improve focus and concentration, reduce anxiety and improve brain function. As a result of physical activity it also becomes easier for them to get better sleep. Parents can also help with the proper diet a ADHD child may need. All these factors can significantly change the behavior of the child with ADHD and in turn can help with their psychological effects.
In conclusion, there is still need for research on the over diagnosis of ADHD and overprescribing of medications for ADHD. Although there are guidelines and specific assessments in place for diagnosis, physicians are either unable or unwilling to follow these guidelines. There is various alternative treatment options available that might be useful for children with ADHD in conjunction with medications but more studies could be done to find what is most effective. There is a need for public education to stop the negative stigma of ADHD. Children suffer psychologically from the negativity that they receive in response to their ADHD, which often portrays itself in ways that they cannot control. In the end, families and educators play a very important role in shaping the future of a child with ADHD.
Works cited:
"Attention Deficit Hyperactivity Disorder". cdc.gov. Web. 29 Mar. 2016.
Connor, Daniel F. "Problems of Overdiagnosis and Overprescribing in ADHD: Are They Legitimate?" Psychiatric Times. Aug. 2011: 14. Academic OneFile. Web. 2 Mar. 2016.
Jellinek, Michael S. "Don't Let ADHD Crush Children's Self-Esteem." Clinical Psychiatry News vol. 38.5 p. 16. May 2010. General OneFile. Web. 4 Mar. 2016.
Loe, Irene M. and Feldman, Heidi M. "Academic and Educational Outcomes of Children With ADHD." Journal of Pediatric Psychology. vol. 32 no. 6 pp. 643-654.14 June 2007. Web. 4 Mar. 2016.
Morin, Amanda. "Understanding ADHD." Understood.org. 2014 Web. 3 Mar. 2016
Schwarz, Alan. "The Selling of Attention Deficit Disorder." The New York Times. 14 Dec. 2015. Web. 3 Mar. 2016
Sherman, Jody, et al. "The Impact of Teacher Factors on Achievement and Behavioral Outcomes of Children With Attention Deficit Hyperactivity Disorder (ADHD): a review of the literature." Educational Research. vol. 50, no. 4. pp. 347-360 Dec. 2008. Web. 24 Mar. 2016.
Shute, Nancy. "Nonmedication Treatments for Attention-Deficit/Hyperactivity Disorder Are Effective." Behavioral Disorders. Greenhaven Press, 2014. Opposing Viewpoints. Rpt. from "ADHD Medication: Can Your Child Go Without?" U.S. News & World Report (14 Jan. 2009). Opposing Viewpoints in Context. Web. 2 Mar. 2016.
Strauss, Valerie. "ADHD in Kids: What Many Parents and Teachers Don't Understand But Need to Know." The Washington Post. 8 Feb. 2016. Web. 24 March 2016
