What is ADHD?
Attention-deficit/hyperactivity disorder (ADHD) is a lifelong neurodevelopmental disorder that My dear will impact 7 million children between 3 and 17 years old.
Since ADHD symptoms differ from person to person, it is important to understand the common signs. At the most basic level, ADHD symptoms are divided into three content themes or subtypes:
- Inattention: Difficulty maintaining attention, easily distracted, may lose track of items or conversations.
- Hyperactivity: Difficulty staying still, seeming driven by a motor. Many describe feeling the need to be “busy/on the go” and feeling uncomfortable being still for long periods of time.
- Impulsiveness: Difficulty waiting, may interrupt others. To the OCD CenterWe noticed that children/adolescents diagnosed with ADHD tend to ignore their environment as a source of information to make decisions (proactively). There are multiple reasons why this can happen. For some, it may be due to a worry, such as, “If I don’t tell you now, I’ll forget later,” while others might describe it as an urgent need to “say something” or “do it.” When children/teens engage in frequent impulsive decisions/behaviors, this can have significant ripple effects on them socially, emotionally, academically, and more.
ADHD Diagnosis
Many people may be wondering, “Don’t most children have an impulsive or forgetful moment from time to time?” Yes, they do. While many symptoms of ADHD may resemble typical behaviors of children and adolescents during learning, an important difference is the frequency (How often do the behaviors/symptoms occur?) and gravity (Are they occurring in multiple environments?). Many times, teachers will be the first to identify symptoms, as the school environment can be challenging for children with suspected ADHD. It’s important to contact your child’s teachers if you suspect ADHD to compare what you see at home with what they see at school. While teachers cannot formally diagnose ADHD, this collaboration will help parents gather essential information to determine if a formal evaluation is necessary.
ADHD and anxiety
It is estimated that 4 in 10 children diagnosed with ADHD also have clinically significant anxiety. But what does this mean and what can it look like in a child or teenager?
It is important to understand that the following examples, on their own, are unlikely to cause a clinically significant anxiety problem. Many people, with or without ADHD, experience similar challenges. Instead, assume that the examples are patterns of behavior. Another important consideration is intention. People with ADHD tend to have good intentions and want to succeed. Untreated ADHD can create significant barriers. It is not about lacking the desire to succeed but rather about lacking the necessary skills.
Academically
The effect of ADHD on processing and working memory can make school more difficult, often leading to the false belief that “I’m not smart enough.” “I’m not going to get very far in life.”
- For a child who struggles with inattention, time management challenges can lead to anxiety about being late and being the last one in the classroom because the teacher will call him back, or his tardiness could result in detention.
- A child who has difficulty with organization has trouble finding what he needs when he needs it. They may forget their calculator for math class and feel anxious knowing they can’t go back to get it.
- A child who has difficulty sitting still for long periods of time and/or maintaining attention in the lesson may impulsively blurt out “funny” comments in class to “lighten the mood.” The intent is to be funny, but they missed the timing, which can lead to redirection or consequences.
Each example, when it occurs frequently throughout the day or week, can trigger anxiety symptoms.
Socially
Kids who have difficulty controlling their impulses may say something on social media that sounded “right” in their head. They think they’re over it, but they don’t get a response quickly enough, or maybe they don’t get the response they thought they would. This can lead to anxious worry of “What did I do?” “Are they angry?”
Another common example is impulsively saying something in the moment that you later regret because you didn’t stop and think about whether it was the right time or place.
Both situations, especially when they occur frequently due to lack of skills, can foster anxiety. All they want is to fit in. Children may want to avoid returning to school and their social circle due to fear of judgment and anxiety.
Emotionally
The person who is not diagnosed with ADHD is enduring years of struggle. Many children are not diagnosed until middle school age or later, especially those with primary symptoms of inattention. I hear from the teenagers in our care all the time: “If I tried harder or if I were smarter.” There is a lot of negative self-talk that can really kick in, like, “Why do I always screw up? I’m so stupid. Maybe I’m just a bad person.” The older they get, the longer this narrative can be reinforced despite their best efforts.
This can increase the risk of:
- Low self-esteem.
- Poor academic/social performance (possible school/social avoidance).
- Stimulation-seeking behaviors. Children with uncontrolled hyperactivity have energy and want to do things. Combined with unmanaged impulse control challenges, it could lead to potentially unsafe or higher risk behaviors.
What can parents and caregivers do?
There are six things I recommend parents and caregivers do:
- Identify concerns. Do you notice any symptoms that might resemble ADHD?
- Find out if there is a family history of ADHD. There is a definite genetic component to it.
- Talk to your child’s teachers. Share what you see at home and ask them if they see the same thing.
- Talk to your child’s pediatrician and ask what steps you should take next.
- Consult your pediatrician about evaluations. There are several basic measures that can be given to teachers and parents to complete that can help providers gather enough information to diagnose ADHD with greater confidence.
- Help your child/teenager practice mindfulness. Ed Hallowell, MD, one of the leading experts on ADHD, describes it as “having a Ferrari engine with bicycle brakes.” There is so much going on internally that it is very difficult to be present. Mindfulness can help children slow down their bodies and minds to try to stay more in the here and now.
Treatment for ADHD
Medication management It has been shown to be extremely beneficial in the treatment of ADHD. It may take some time to find the right medication, although many teens describe finding the right medication as if “someone gave me the TV remote control for the first time.” It is as if they now have more power to decide which “channel” (content) to attend to and can “switch channels” more easily, moving on to another task, when necessary.
Cognitive behavioral therapy (CBT) is a great partner for medication management. Medication can help people with ADHD be in charge of their “TV remote” or whatever they choose to focus on. The person still needs to develop the tools to make the responsible decision to “change the channel” from video games to homework, for example. CBT helps people strengthen executive functioning skills that tend to be underdeveloped in people newly diagnosed with ADHD. CBT specifically helps identify negative thought patterns and provides skills to reframe the way a person feels about themselves and their ability to succeed.
Overall, combining medication with teaching skills is a very safe and effective approach to helping children slow down and filter information more confidently.
Adopt a Growth Mindset with ADHD
I want to encourage any parents or caregivers reading this that it is not a bad thing if you notice symptoms of ADHD. Each one has their own strengths and areas of opportunity. Children want to achieve. The sooner someone understands how their brain works and receives counseling, such as through CBT, to develop those areas of opportunity, the more confident and effective they will feel navigating life.
This blog was written in collaboration with Rogers Behavioral HealthADAA partner.
