ADHD in the News
This past week Attention-Deficit/Hyperactivity Disorder research findings made headlines when The New England Journal of Medicine published a report stating that in some states the birth month of August saw a 33% increase in ADHD diagnoses in young children when the school kindergarten cutoff was September 1. This supports other studies that have also concluded that younger children who are being compared to their same grade peers, not same-aged peers, are more likely to be seen as inattentive, impulsive and hyperactive.
Does my son have ADHD or is he just spirited?
This topic of young children and ADHD comes up quite frequently. There are over 6 million children diagnosed with ADHD in our country, making it one of the most common neurodevelopmental conditions in children. Neurodevelopmental disorders are simply disorders that are a part of a group of conditions with the onset of symptoms in the developmental period. So, in order to assess ADHD I want to understand what their behaviors are or were during the critical first five years of their life.
Let me paint a picture for you of how an ADHD evaluation in a young child typically gets started. I get a call from a pre-school director asking for me to come in and do an evaluation on one of their students that they have been having trouble with for months. Before even hearing all the details of how challenging this child is, I typically have a sense of what their behavior looks like at school.
It is likely to be a boy who doesn’t follow directions, struggles to play with his peers and when he does sit still proves to be quite bright. Teachers have tried everything and they are at their wit’s end because it is so disruptive to the rest of the class and they argue that it is not fair to the other students. Yes, Mrs. Jones I will come in and observe little Johnny next week. First, I need to talk to his parents.
When I do talk to the parents they are typically concerned and cautious. It is common for parents to say that they used to think their kid was just energetic, creative and free-spirited and that they love that about him. It wasn’t until they started pre-school that they felt their child was being made to conform to the school’s rules and their kid is no longer just able to be themselves. Typically, at this point, the parents want an outside opinion. Does my child have something wrong with them? Are they ADHD?
I have the parents, as well as the school, complete some background and behavioral questionnaires and I go in and observe. I typically like to see a period of time that is identified as challenging and then one that typically goes well. If in fact, little Johnny is showing signs of concern, he will show it in different environments. I also want to see if he ever gets hyperfocused, a commonly misunderstood aspect of ADHD (in some people) in which the brain focuses very intently on things that interest them. It is common for me to hear about how a kid can’t do homework, is distracted on the soccer field, can’t find their shoes or coat in the morning but they can build Legos or play video games for hours.
When I arrive at the school I am generally greeted by the director who walks me down to the class all the while talking to me about the challenges of this kid. It is usually a conversation mixed with things that are great about them (they are creative, funny, and bright) but also difficult to manage. They will tell me stories about them running around the classroom, spending 20 minutes in the bathroom, playing nicely sometimes with peers until they decide to change the rules, being particularly loud and at times argumentative.
When I arrive to the classroom, I usually sit in the back and try to make myself unnoticeable to the students. They are usually deep into play and don’t notice me. There is always a kid or two that might make eye contact or even say hi but the vast majority of the kids are engrossed in what they are doing. After the director points out who little Johnny is she leaves and I get my pad out. I want to make note of it all- what is he doing, who is he around, are kids drawn to him or staying away, what is his volume, energy level, attention span, interests, how many activities does he do, what seems to be the dynamic between he and his teachers- the observations are vast.
At some point throughout my time there a teacher will approach me. They will generally say that they are so glad that the parents agreed to have me come out and they proceed to tell me what their concerns are. I would say most of the teachers I have worked with are invested in their students and they tell me the wonderful things about them as well as the struggles. My role is to provide ideas and recommendations after I observe the child, get back forms and write a report.
At the preschool age, I rarely make a formal ADHD diagnosis. Children’s brains are still developing at this time and months can make a huge difference. However, if there are concerns around how the child is functioning socially, emotionally and or behaviorally I address those concerns right away.
At the grade school level, typically age 7 and older, when doing an ADHD evaluation I look for the following occurring for at least 6 months:
Inattention – wanders off task, lacks persistence, has difficulty sustaining focus, is disorganized
Hyperactivity – excessive motor activity in inappropriate settings or times, excessive fidgeting, tapping, highly talkative
Impulsivity – acting without forethought, actions can have high potential for harm, desire for immediate rewards, inability to delay gratification as compared to same-aged peers
It is common that children with ADHD have low frustration tolerance, irritability and can be moody. While they may be creative and free-spirited, these mood qualities plus the three diagnostic features above are largely what distinguishes a free spirit from a child who may have ADHD.
Here are just a few (of many) ideas are that helpful in the classroom:
Structure – be sure there is a picture chart of what happens first, next and then last. Be sure that the child with ADHD knows where they sit and try to keep routines as consistent as possible. Prepare them for changes in rules or plans whenever possible.
Reduce Distractions – as much as possible when you want the student to be focused on something consider using desk dividers, consider their placement in the room, possibly have them away from windows, doors and busy areas. Consider sitting them near highly focused children who won’t be as disrupted by the possibility of tapping and movement.
Movement – sometimes it can feel counter-intuitive to have an already hyperactive kid moving around but that is exactly what their brains and bodies need several times throughout the day. Strategies that students can do together and it will benefit them all are things such as stretching, jogging in place, jumping jacks and dancing while singing. You can also have an ADHD student be a helper, sit in alternative seating that moves with them, or have a sensory or fidget box that they can access freely.
Many of these ideas can also be applied at home. Raising a child with ADHD is a great opportunity to tap into a creative and unique mind balanced with teaching them mindfulness and self-control. If you think your child may have ADHD I would suggest asking the school and other adults around them what they observe and then consider meeting with a child development specialist to discuss plans on how to help your child.
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