The question that comes up most often when I tell people what I do is some variation of "My child's teacher tells me that I should get him checked for ADHD because he can't sit still in class, what should I do?" which is inevitably followed up by "I don't want to put my child on medication if I don't have to and I don't even know if there is really something wrong with him". This question is both extremely complex and also quite simple to answer. It is complex because diagnosing ADHD is not as straight forward as one may think-- there are lots of reasons a child may be struggling to pay attention or may appear overly hyperactive. It is also complex because there are a variety of ways to think about ADHD and the treatment of ADHD even when a correct diagnosis is made. It is easy to answer, because there are a few basic steps you can take as a parent to make sure your child is getting the support they need. This post will walk you through some of the important information you need to know as a parent, while also giving you concrete steps to take to support your child.
It's important for me to explain that I do not see ADHD as a deficit or a disorder. In fact, I believe the name is entirely off base when broken down. Some years ago, the diagnoses of ADD and ADHD were combined to ADHD to make it simpler. Now, if a child is diagnosed with ADHD and is not hyperactive, the person diagnosing will name it ADHD-- Inattentive Type. Conversely, if a child is hyperactive, they will diagnose as ADHD-- Hyperactive Type. Doesn't make a whole lot of sense since ADHD stands for Attention Deficit Hyperactivity Disorder, but I don't make the rules. It is also a mistake to believe that children with ADHD have an attention deficit. In fact, they do not-- or not in the way you might think. Children and adults with ADHD are able to focus quite intensely on something that they identify as very important-- or for children, something they find very fun. This is why a child with ADHD might throw a huge fit when you tear her away from building her Leggo tower after an hour but can barely take 2 minutes to focus on her math homework. Finally, I believe it is an incredible misnomer to call this a disorder. Anyone who has spent any time at all with a child or adult who truly has ADHD will tell you that they are more adventurous and creative than others in their peer group. They are able to solve problems in ways that their peers cannot and those who make it through the very difficult years of childhood often find themselves in high positions in companies, respected by many. So one must ask, is there really something wrong with these kids or is there something wrong with the way we understand and teach them?
The Farmer and the Hunter
It may be helpful for parents who do have a child with ADHD to think of them as a hunter while their peers are more like a farmer. This explanation was developed by Thom Hartman and has endured over the years as one of my favorite ways to conceptualize children with ADHD. Farmers are able to plan ahead, attend to somewhat boring tasks for a long time, think before they act etc. Hunters don't have that luxury. They are constantly on the look out for threats and prey. When a bird flies by above, they notice. When there is a rustle in the leaves, they notice. They don't have time to sow their grain, they have to find their prey and not get killed in the meantime. Both personality types are important in our society and there are many professions that lend themselves much better to the Hunter's approach. And yet, we devalue this skill set because it is not useful in our current school system and, let's be honest, it can be distracting and frustrating for us farmers who are trying to plan and plant and build!
A brief look at the DSM-V will show you that there are other reasons a child may be exhibiting the same behaviors associated with ADHD. A child with an Anxiety Disorder may behave similarly to a child with ADHD-- and yet the treatment plan would be very different. For example, Posttraumatic Stress Disorder behaviorally will have the following symptoms: (1) difficulty falling or staying asleep, (2) irritability or outbursts of anger, (3) difficulty concentrating, (4) hypervigilance, (5) exaggerated startle response (APA, 2013). Generalized Anxiety Disorder would be demonstrated by: (1) restlessness or feeling keyed up or on edge, (2) being easily fatigued, (3) difficulty concentrating or mind going blank, (4) irritability, (5) muscle tension, (6) sleep disturbance (APA, 2013). Now let's look at ADHD. Those symptoms are: (a) often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities (b) often has difficulty sustaining attention in tasks or play activities, (c) often does not seem to listen when spoken to directly, (d) often does not follow through on instructions, (e) often has difficulty organizing tasks, (f) often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, (g) often loses things necessary for tasks or activities (h) is often easily distracted by extraneous stimuli, (i) is often forgetful in daily activities (APA, 2013).
So, if you go to your friendly family doctor and tell her that your teacher is concerned that your son has ADHD and tell her what you have observed, you are very likely going to walk out of that office with a diagnosis of ADHD for your child and a prescription to match. The trouble is, your family doctor doesn't have the training to distinguish the two in the way that a mental health clinician or Psychiatrist would-- and yet this is how many of our children are being diagnosed.
The problem with this is pretty huge. A child with anxiety put on a stimulant medication is going to be in big trouble. And, often, instead of taking them off that medication and re-evaluating the diagnosis, physicians tend to put them on another medication and then we have children on "medication cocktails" and parents feeling like they don't know what to do. This is not what you want for you or your child.
So What Do I Do?
First, you need to ask yourself a very important question. Does this issue need to be dealt with because she is driving me and her teachers nuts or because I can see how frustrating it is for her that she isn't doing well socially and can't focus in school? If your child is antsy in the school setting but overall doing pretty well socially and academically-- why are you worrying about it? Join a support group, get a counselor for you and learn how to be the best parent you can be for your brilliant and unique child. On the other hand, many children with ADHD have such poor impulse control that they are unable to make friends and become frustrated and angry with themselves when they try to take tests at school. If your child is at risk of lowered self esteem because this issue is not treated, then you must look into this further for your child's sake. In addition, poor impulse control can lead to very risky behavior (climbing to the top of 30 foot trees). If you are worried about your child's ability to be safe physically it is also important to look into treatment options.
Next, if you decide to seek out treatment find someone who knows what they are talking about. Please, I know you love your family doctor. He has always been so kind to you and your child and he knows you better than other professionals. It's less scary to go to your family doctor and your family doctor will do a much better job than I will at diagnosing strep. But I'll do a better job diagnosing ADHD. So reach out to someone who knows. It may be best to go to a counselor first. A Psychiatrist is really there to utilize medicine to treat mental health disorders. While some also provide counseling, they often depend on counselors to do that part of the job. Start with someone who's job isn't to prescribe medications. If your child needs them your counselor will certainly refer you to an excellent local psychiatrist.
After that, sit down and have a real talk with your teachers. If you have a good counselor, they can give you a wealth of ideas on how to make the school environment more friendly for your child. If your child has ADHD they are likely to be very tactile. They will be able to focus more if they are doodling when the teacher is teaching. They will focus more with a stress ball in their hands. You'll need to help your teacher to understand this if your teacher doesn't already. It's not an issue of disrespect, it's an issue of focus. If there are charter schools in your area that have a more experiential curriculum, your child may be better off in that environment. Your child is likely to learn far more about science and math running around in the woods and building forts than he will sitting at a desk. The more a child's environment matches their learning style the less they will need their medications.
Finally, get your own support. The biggest mistake that parents make is to send their kids to the counselor and not get any support for themselves. No one taught you how to deal with this when you were in high school-- you need help! Get involved in a support group if you are the social type and hire a counselor if you're more of an introvert- or do both! Through this, you can learn patience and gain a sense of humor about the quirky behaviors of your child.
Good luck and enjoy!
Written by Lara B. Stevenson, M.A., LPCA
American Psychological Association, 2013. DSM-5.