Tuesday, September 17, 2013

ADHD: What Parents Need to Know

What is Attention Deficit (Hyperactivity) Disorder or ADHD?


Attention-deficit Hyperactivity Disorder is “a condition of the brain that makes it hard for children to control their behavior”. (1) All kids have problems with their behavior from time to time, but kids with ADHD have behavior problems that interfere with regular life and are continual. ADHD used to be called Attention-Deficit Disorder or ADD. ADHD usually lasts your whole life. A lot of adults have ADHD.
Kids with Attention-Deficit Hyperactivity Disorder (ADHD or AD/HD) can have different kinds of symptoms:

  • Inattention: These kids have trouble with paying attention, are disorganized or daydream too much.
  • Hyperactivity: These kids are always moving, can't sit down or talk too much.
  • Impulsivity: These kids act and talk without thinking, interrupt a lot or show poor judgment.
  • Combination: The above symptoms can occur in different combinations.
For more on ADHD and Your School-Aged Child, read what the American Academy of Pediatrics has to say in this one-page parent hand-out.

Is ADHD a learning disability?
ADHD and learning disabilities are two different kinds of challenges. But they do often come together. Find out more about learning disabilities and some of the other problems that sometimes come along with ADHD. Your may hear these called by the medical term co-morbidities.

What is attention?
Check out this site that explains the basics of attention, and difficulties with attention.

How common is ADHD?
Attention-Deficit Hyperactivity Disorder is the most common behavior disorder in school-aged kids. About 8-12% of kids have it (2).

What causes it?
The exact causes of ADHD are not yet known. Experts think that ADHD is caused by differences in the way messages are sent in the brain. ADHD seems to run in families, so it may be inherited.

How is ADHD diagnosed?
ADHD is usually only diagnosed in school-aged kids (ages 6-12), because it is hard to diagnose in younger children. The diagnostic process has many steps, and you, your child's school and other caregivers will all need to provide information about your child's behavior. To find out about diagnosis, read the American Academy of Pediatrics clinical practice guideline:
How is ADHD treated?
The best treatment for ADHD is usually medication, combined with behavior therapy (including training parents in behavior therapy) and setting things up for your child at home and at school to make it easier to pay attention (3,4). Because ADHD is a chronic (on-going) condition, treatment must also be on going. Usually you will have a long-term plan that includes goals for your child. When all the parts of the treatment plan are in place, and everyone (child, parents, teachers, doctors, caregivers, etc.) works together, treatment will be most effective.
To find out more about what to expect in the treatment process, read the American Academy of Pediatrics clinical practice guideline:
What if I think my child might have ADHD?If you think your child may have ADHD, you should have them checked by their primary care provider or a psychiatrist. Sometimes a sight or hearing problem, family stress, worry, a learning disability or communication problems can affect a child's attention and behavior. You should also get help from your school system.
What can the school system do for my child?
If your child is struggling in school, ask your school system in writing for an evaluation of your child. They are required to provide it, at no cost to you. The purpose of an evaluation is to find out why your child is not doing well in school. A team of professionals will work with you to evaluate your child. If they do not find a problem, you can ask the school system to pay for an Independent Educational Evaluation (IEE). There are strict rules about this, so you may not get it. You can also have your child tested again privately, and pay for it yourself. But check with your school district first to make sure they will accept the private test results. By law, the school system must consider the results of the second evaluation when deciding if your child can get special services.
If testing shows your child has ADHD, the school system may start your child in a special education program.

What is special education?Special education means “educational programming designed specifically for the individual.” It can really help your child do betterin school. If your school-aged child qualifies for special education, they will have an Individualized Education Plan (IEP) designed just for them.
What do I need to know about the laws that have to do with special education? What are our rights?
What do we need to know as my child prepares for college?
What about medication?There is lots of news lately about medications and kids. Some people think medication is prescribed too much. Others see it working and think it is a great idea. Whatever your feelings, be sure you know the basic facts about ADHD medications. Stimulant medicines like Ritalin, Dexedrine and Adderall have been used for a long time and have a good track record. A newer medication that is not a stimulant, called Strattera, may help some kids who haven't done well on the stimulants. However, Strattera may have some risks.
  • The National Institute of Mental Health has great general information for parents on what you need to know when your child is taking a medication.
  • Recent studies indicate that stimulant medications do not contribute to risk for later substance use, dependence or abuse. In fact, treatment with stimulants may reduce those risks.(5)
  • The National Institute of Mental Health and Columbia University conducted a study in 1999 of ADHD treatments. The findings of this study of multi-modal treatments (a combination of medication and behavioral treatments) indicate that (6):
    • Medication alone is as effective for ADHD symptoms as multi-modal therapy
    • Medication is more effective than behavioral alone
    • Multi-modal treatment is better for ADHD associated with co-morbidities (coexisting conditions). Co-existing conditions include anxiety, oppositional-defiant disorder (ODD), conduct disorders, etc.
There are also other kinds of medicine that your child's doctor may try if the stimulants don't work. Sometimes, your child's doctor may need to try a few different medicines at a few different doses to find the one that works best for your child. You could think of the brain as a black box that we can't see inside. The doctor doesn't know how a medicine will affect the brain until he or she tries it. Nine out of ten kids improve on stimulant medication.

If your child's doctor prescribes a medication for your child, make sure you ask about the benefits and risks of taking the drug. If your child is just starting medication, you can use this sheet to keep track of how they're doing and share it with your child's doctor at your next office visit.

Remember: if your child takes a medication and their behavior improves, it is really your child's own strengths coming out from behind the ADHD. Give the credit for improvement to the child, not to the drug.
  • Listen to the YourChild podcast interview with UM's Dr. Layla Mohammed about ADHD and medications.
  • See a video about concerns with abusing stimulant medication, including medications for ADHD.
What about alternative and complementary treatments?You may feel desperate for a "silver bullet" that will cure your child's problem. Some of the alternative treatments may sound reasonable, and may even be developed by doctors or specialists. But if they are not scientifically proven, you risk spending time, money and hope on false promises. On the other hand, you and your child's doctor might decide it's worth it to try a low-risk alternative treatment.

Some treatments that the National Institute of Mental Health and the American Academy of Pediatrics warns have not been proven to work in scientific studies are:
  • Restricted diets
  • Allergy treatments
  • Medications for motion sickness to correct inner ear problems
  • Mega-vitamin and mineral supplements
  • Chiropractic adjustment, bone realignment, applied kinesiology and realigning bones in the skull
  • Treatment for candida yeast infection
  • Eye or vision training
  • Special colored glasses
  • EEG biofeedback
Some alternative treatments, such as mega-vitamins and special supplements, may actually be dangerous to your child. Use caution, and talk with your child's doctor if you are considering alternative and complementary treatments. Your child's doctor needs to know all treatments being used, as some may interact with prescribed treatments.
biofeedback could be a useful treatment for ADHD (7,8,9,10,11,12,13). Biofeedback has the added benefit of getting kids actively involved in developing their own coping strategies. This can be empowering. However, biofeedback treatment can be expensive, especially if your insurance doesn't cover it. For more on biofeedback:
What about girls with ADHD? ADHD seems to be more easily recognized in boys than in girls. Girls with ADHD tend to draw less attention to themselves than boys do, and the “squeaky wheel gets the grease.” Some experts believe that girls with ADHD may act very differently from the typical picture we have of the kid with ADHD.

It's possible that girls with primarily hyperactive-type ADHD act like tomboys. They may be active, messy and disorganized. Girls who have trouble paying attention may act more like daydreamers, and may go unnoticed at school because they are so quiet. Finally, girls with a combination of the two may be hyper-talkative, rather than hyperactive, and also be silly and excitable.

When girls with ADHD fall through the cracks and go undiagnosed, they pay a high price. They may not do well in school and their self-esteem may suffer. They may come to think of themselves as not very bright, quitters or low achievers. If you suspect your daughter may have ADHD, you should find a professional who has experience in diagnosing ADHD in girls, and have your daughter evaluated.

Find out what some of the recent research on girls with ADHD has to say:
What are some tips for parents of kids with ADHD?
  • Try to focus on your child's good qualities. "Catch" your child behaving well at least three times a day and tell them you noticed. Work up to more than three times a day.
  • When you catch your child , simply describe to them the behavior you saw that you'd like to see more of. For example, “You really stayed with me at the mall today.”
  • Tell your kid what you want them to do, instead of what you don't want them to do. (Say "Walk." instead of "Don't run.")
  • Your child with ADHD will need lots of feedback from you. Provide immediate, constructive feedback often throughout the day. Again, keep it brief, specific and descriptive.
  • Kids with ADHD sometimes have trouble eating well because of their medications and trouble sitting still. Make sure your child gets regular meals and snacks of healthy food.
  • Vigorous exercise is also very helpful for your child, but make sure they stay safe. Kids with ADHD may need to be watched more closely than other kids their age because they can be active and impulsive. There are certain things you should do to keep them safe, like make sure they wear a helmet when biking or roller-blading.
  • Kids with ADHD often have trouble sleeping. Learn what to do when your child has problems with sleep (This hand-out is also in Spanish.)
  • Help your child develop good social and communication skills, which will help them form fulfilling friendships with other kids.
  • Make sure your child's other caregivers are also familiar with daily routines and behavioral goals. This will ensure that your child gets consistency throughout the day.
  • More tips
  • Spanish tips
  • Still more in-depth attention strategies and tips
  • Listen to the YourChild podcast interview in which UM's Dr. Layla Mohammed shares her tips for parents of kids with ADHD.
How can I help my child improve their behavior?
  • Don't try to change lots of behaviors at once. Target one to three behaviors at a time to work on.
  • Talk about the behavioral goals with your child.
  • You'll probably want to focus closely on target behaviors for tracking and feedback for an hour a day or for limited time periods on a regular routine. Doing this all day long is too grueling for both you and your child.
  • Reward your child with privileges and special activities like a trip to the park or a family picnic for successfully meeting behavioral goals.
  • Keep a few rules and enforce them consistently. (Choose your "battles" carefully.)
  • Offer choices, but keep them simple.
How should I set up the house and our routine to help my child?
  • Keep a regular routine and provide lots of structure, so your child knows what to expect.
  • Post lists and reminders for the routines in key places around the house. For example, you might keep a list of things to bring to school by the front door or in your child's backpack.
  • Keep your home organized. Store things as close as possible to where they are used, and have “a place for everything, and everything in its place.”
How do I get my child's attention?
  • No more yelling a laundry list of instructions from the other room while you're doing something else. You already know that doesn't work anyway.
  • To get your child's attention, get down on the floor in front of them, and put your hands on their shoulders. When they make eye contact with you, say, “There you are.” and then tell them what you need to say.
  • When you give directions, give them one at a time. Break down big jobs into several smaller jobs.
  • Repeat your directions, and make lots of good eye contact. Expect to have to repeat yourself over and over.
  • Try writing a checklist for multiple tasks and break big jobs down into do-able chunks.
What are some tips for parents of younger kids with ADHD?
  • For young children, routines are especially important.
  • Post picture lists of routines in key places around the house. For example, the steps to get ready for bed on your child's bedroom wall or over the bathroom sink.
  • Strike a balance between high energy and quieter activities throughout the day. Follow some restful, quiet reading and snuggle time with a trip to the park to get the wiggles out, and vice versa.
  • Choose your battles—focus on one behavior you want to change at a time.
  • Frequently, throughout the day, offer choices between two alternatives that are both acceptable to you. For example, “Do you want to wear your red jacket or your yellow sweatshirt?”
  • Plan ahead to be sure your child is not overtired or hungry during shopping trips or other potentially “risky” outings.
  • Before going out, review the “behavior guidelines.” For example, keep your hands to yourself and use inside voices.
  • You might want to take “practice trips.” Go out somewhere you don't mind leaving so you can leave if your child does not follow the behavior guidelines.
How can we cope with the challenges of raising a child with ADHD?
  • Teachers will change each year, but parents are always there. That's why you are your child's best and most important teacher.
  • Plan for one-on-one time with your child each day. Even just 10-15 minutes every day will go a long way in letting your child know they are special to you. Follow your child's lead during this special time. This will help both of you feel connected and loving toward each other.
  • Stay calm and in control of yourself. You can't force your child to behave the way you want them to, but you are in complete control of your own behavior.
  • Act the way you want your child to act. Be a good role model.
  • Get support. There are a lot of other parents out there going through the same thing as you, and you can help each other with ideas and just by listening. (See the last section, which lists contact information for CHADD, a support group with local chapters.)
    • In the Ann Arbor area, a CHADD support group meets one evening a month to talk about concerns and learn more about ADHD in children, adolescents and adults.
  • For more ideas, check out these survival tips for parents.

How can I help my child do better in school?Keep in close touch with your child's teacher and work together to make things as consistent as possible between school and home. Get involved and help the teacher as much as possible.

Sometimes your child's teachers will be very knowledgeable and helpful, and sometimes they will not. Either way, it helps a lot if you learn as much as you can about ADHD, and share with your child's teacher what works best for your child. You may want to share the tips for teachers in the next section (below) with your child's teacher. For more on working with your child's school:
What can teachers do to help kids with ADHD?A teacher who understands ADHD and how to work with kids with ADHD will make a big difference in your child's school experience. Teachers need to understand how to use a program of academic instruction, behavioral interventions and classroom accomodations to help kids with ADHD (14). You may need to help your child's teacher learn more about how to work best with your child at school. Some basic tips for modifying the classroom include:
  • Seating the child near the teacher
  • Repeating instructions
  • Not putting time limits on test and quizzes
  • Helping the child organize
  • Boosting the child's self-esteem
  • Having consistent consequences for unacceptable behavior.
Teachers may appreciate knowing that many resources exist that can help them learn new strategies to teach kids with ADHD. Here are a few:
What about summer plans for my child?
Where can we get information and support?
Websites:
Books:
  • This resource list features books for professionsals, parents, adults with ADHD, and books for young people with ADHD.
  • More books for grown-ups and kids, plus a few audio-visual resources.
Organizations:
  • CHADD (Children and Adults with ADD) is an advocate and information source that sponsors support groups with local chapters. There are over 20 chapters in Michigan. Call or email for one near you. Call 1-800-233-4050. The website has a Spanish section.
  • National Attention- Deficit Disorder Association supports education, research and public advocacy for adults with ADHD.
  • NICHCY (National Information Center for Children and Youth with Disabilities) publishes free, fact-filled newsletters, arranges workshops and speakers, and advises parents on the laws entitling children with disabilities to special education and other services. Call 1-800-695-0285 (Voice/TTY) or (202) 884-8200 (Voice/TTY) or e-mail to nichcy@aed.org with your questions. Spanish language assistance is available.
  • All Kinds of Minds is a non-profit Institute that helps students who struggle with learning measurably improve their success in school and life by providing programs that integrate educational, scientific, and clinical expertise. The Web site offers helpful information for parents.
  • Council for Exceptional Children is a professional organization that provides publications for educators, and can also provide referral to ERIC (Educational Resource Information Center Clearinghouse on disabilities and gifted education). Call 1-703-620-3660.
  • LD Online is an educational service of public television station WETA in Washington, D.C., and has a wealth of information about learning disabilities and ADHD for parents, kids, and teachers, including Spanish language materials.
  • Learning Disabilities Association of America publishes news briefs and a professional journal and provides information and referral to state chapters, parent resources and local support groups. Call 1-412-341-8077.
  • Great Schools provides content from Schwab Learning, The Web site is designed to serve parents whose kids (kindergarten through high school) have learning difficulties, including learning disabilities (LD), attention problems, including Attention-Deficit/Hyperactivity Disorder (AD/HD), and kids who struggle with similar problems but who don''t qualify for special education.
  • ADD Warehouse is a catalog of books, videos, and other products to help parents, educators and health professionals understand and treat all developmental disorders, including ADHD and related problems. Call 1-800-233-9273 (1-800-ADD-WARE).
  • The American Academy of Pediatrics now offers a resource toolkit to clinicians caring for children with ADHD.
  • Internet resources on ADHD in Spanish

References
 
Written and compiled by Kyla Boyse, R.N. Reviewed by John O’Brien, M.D.
Updated July 2009
U-M Health System Related Sites:Department of PsychiatryU-M Pediatrics
Family Medicine



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