Wednesday, August 15th, 2012
It can be very difficult to recognize the symptoms of ADHD in your child. You can certainly reference reputable and helpful sites (here’s one example from the National Institutes of Health) that list the common symptoms. But when you go through the list – fidgeting, can’t sit still, interrupting, being easily distracted, having trouble following directions, not able to wait for a turn – you might conclude that all young kids do these things. And to a degree, you would be right.
To give parents a better sense of how clinicians approach ADHD, I spoke with Dr. Steven Kurtz, who is the Senior Director of the ADHD and Disruptive Behavior Disorders Center at the Child Mind Institute. Here are some key take-home messages that I derived from my conversation with him.
Dr. Kurtz agreed that many kids can show the behaviors associated with ADHD. However, kids with ADHD demonstrate these behaviors with much more frequency and intensity than other kids – in fact they show about 3 times the intensity and frequency. So there is a matter of degree here. Kids with ADHD also have a consistent pattern of demonstrating this higher frequency and intensity – these behaviors can be regularly observed in the home as well as in school. To give a better sense of what the behavior of kids with ADHD might look like, Dr. Kurtz gave me the following examples at different ages.
Imagine a 4-year-old being on a platform to the monkey bars at a playground, seeing another child walk by on the ground with a big ice cream cone, and literally walking off the platform without looking to take the ice cream (and getting a trip to the ER in the process).
Imagine circle time at school with the teacher reminding all the children to stay on their bottoms (“criss cross applesauce”) and having to address the one 5-year-old who scurries into the middle of the circle to grab the materials – which happens day after day, well after others have learned the “simple” skill of waiting.
Imagine being the 2nd grader whose teacher – even in April – has to tell you where the “Do Now” work goes, when others learned that in September, and feeling like you are hearing it for the first time.
Unless you have observed lots of children, it may be difficult for you to determine if the frequency and intensity of your child’s behavior may be a signal to be evaluated for ADHD. That is why it is helpful to consider the impressions of teachers, who see lots of kids on a daily basis. Keep in mind that only licensed clinicians are able to make a formal diagnosis of ADHD – so if a teacher (or teachers) make the suggestion to you, you should consider it seriously and talk to your pediatrician and school about potential recommendations for a professional evaluation.
The primary reason to seek out an evaluation is that kids with ADHD show evidence of impairment – these behaviors have negative consequences for them and interfere with their functioning. (Just re-read the examples above to prove the point). Kids with ADHD struggle with day-to-day things – especially in school – and can also experience problems with peers (as things like not being able to take turns can affect social interaction). A comprehensive evaluation will help provide a full picture of a child – their behavior at home as well as in school. Since kids with ADHD can show a variety of the symptoms (there is no one typical profile) and don’t always show signs of ADHD, the focus will be on assessing those symptoms that indicate increased frequency, intensity, and impairment. It’s also critical to keep in mind that kids with ADHD are not just “misbehaving” or suffer from a lack of good parenting. Rather, the idea is that they have difficulties coordinating their attention and directing their behavior (and the root of this is assumed to be biological in origin). Dr. Kurtz refers to this as “attention modulation disorder” – they often pay attention to the wrong things. The goal is to set up a treatment program that can help parents (and teachers) aid kids with ADHD to direct their attention to the right things. And while medication is helpful for some kids, a key element is to utilize behavioral therapy that will provide many practical ways to help shape a kid’s attention and behavior.
Kids with ADHD who do not receive interventions often go on to experience many difficulties down the road in school. The typical window for reliably seeing the first signs of ADHD is now believed to be between 4 and 7 years of age. Dr. Kurtz suggests that the average parent will wait 2 years after ADHD is suspected before seeking an evaluation, which he believes is akin to digging a deeper and deeper trench for a child. All that said, keep in mind that 3-7% of kids will be diagnosed with ADHD – that’s a lot of kids, but really the vast majority of kids do not have ADHD according to clinical diagnostic guidelines. If you suspect your child might have ADHD, the idea of the evaluation is to decide on a plan. In some cases, that might only involve tracking behavior closely over time – in others, some type of immediate treatment plan may be suggested.
There is no doubt that recognizing ADHD symptoms is not easy. Keeping in mind some of these tips may at least give you a framework for viewing your child’s behavior and development over time, and for interpreting the feedback of others. Being vigilant about these observations and having a good dialogue with your pediatrician and school may help you understand if you may need to seek out an evaluation.