ADHD?

    Kids, Questions, and the Classroom

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    1308_ADHD_FYou may have noticed that your child can’t sit still, seems to be in motion constantly, cannot pay attention, or moves quickly from one activity to the next without completing tasks.

    Organization may be a completely foreign concept.

    Then, at the first parent-teacher conference of the new school year, your child’s teacher looks at you and asks: Have you ever thought about putting him on medication?

    And just like that, the suspicions you had are validated. Your child may have attention deficit disorder, or be hyperactive, or both.

    Mary Delmonte of Richmond had that conversation with a teacher when her son Mathew was in first grade. “We knew he was having learning problems, even in kindergarten. Matt could not sit still in class or at home, he constantly fidgeted. He had trouble at night going to sleep because he just could not turn his mind off.” She added that, “while he was always doing something when I was talking to him, he seemed to be able to later recount what was said to him.” As he progressed in school things got worse, and reading was very difficult for him.She was worried.

    Attention deficit hyperactivity disorder, (ADHD) is an increasingly common Diagnosis. Information released in April of this year from the Center for Disease Control and Prevention (CDC) showed that an estimated 6.4 million children ages four through seventeen have received an ADHD diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent rise in the past decade.

    Symptoms of ADHD relate to the inability to pay attention, impulsivity, or hyperactivity. A child can have one or all three symptoms. These behaviors are seen early on, usually before age seven. There is no specific test for ADHD. Diagnosis is most frequently based on reports by parents and teachers.

    A pediatrician, child psychiatrist, or psychologist can assess a child. It’s also important to rule out other physical conditions first. Hearing problems, ear infections, undetected seizures, vision problems, anxiety, depression, sleep disorders, or learning disabilities can sometimes mimic ADHD symptoms.Only a physician or psychiatrist can Prescribe medication.

    Ryan Stein is a technology resource teacher with Henrico County, former fourth grade teacher at Pinchbeck Elementary School, and winner of the Virginia Lottery Super Teacher award in 2011. He also has ADHD and was diagnosed as a child. “I was always in motion and had too much energy. My parents chose not to medicate me. I’m glad. I was able to channel all that energy into sports before and after school and I developed strategies that helped me be successful in school.” That success manifested itself as a student and an educator. In addition to winning top teacher awards, Ryan also coaches basketball, creates software programs (used by hundreds of students), and has written a book titled The Parent Teacher Conference. His understanding of what it’s like to have ADHD has enabled Him to create strategies that help students with similar diagnoses. “We do workouts – jump, dance, sing. Movement stops sleepiness, increases attention. We do five-minute activity bursts…” Ryan says.

    Stein maintains that activity before a child begins schoolwork helps improve focus. In the classroom, if a child is having problems paying attention, he allows him to take a quick walk, or if he is fidgeting, he allows him to use a squeeze-ball under his desk to help burn off energy.

    Stephanie Smith, MD, is another professional with ADHD. This local pediatrician says, “I sailed through school despite difficulty paying attention.” But when it came time for medical school she began to have problems. She saw a counselor and was diagnosed with attention deficit disorder and given a prescription for Adderall. “I took the medicine long enough to pass my boards, then stopped.” As a pediatrician, she has chosen to specialize in treating children with ADHD.

    Her practice, Focus MD in Mechanicsville, is a national franchise founded by another pediatrician with ADHD. The Focus MD physician spends at least one hour with each child before making a diagnosis or prescribing treatment. In addition, neurocognitive testing is performed, which Dr. Smith maintains provides clear diagnoses of ADHD. Dr. Smith says if medication is prescribed, it’s critical to get the dosage right and monitor the child’s reactions.

    She adds, “With these medications you have to really know what is happening.You must know how the child is reacting and manage the dosage very carefully.” Additional testing later helps determine if the medication and strategies are working.

    Similar to Stein’s recommendations, Dr. Smith suggests parents and kids use strategies to improve their focus. For Some, creating a game out of listening is helpful. For example, while listening to a professor, in addition to processing the information, she might count how many times a speaker uses verbal filler, like “um” or “etcetera.” These little games help her pay attention. Dr. Smith also thinks that exercise is very important to the ADHD child, as well as proper diet and nutrition.

    Another critical component of any child’s health is sleep, and there seems To be a relationship between sleep and ADHD disorders.

    Many parents of children with ADHD report their children have problems falling asleep at night and getting up in the morning. Research studies on this topic are mixed but it appears that ADHD may make it difficult for a child to fall asleep at night and conversely, leave him fatigued the next morning. Researchers Wondered if sleep disorders, such as sleep apnea, could also result in some of the symptoms of ADHD. A study in the journal Pediatrics noted this: “Parents of children with mild or moderate symptoms suggestive of ADHD were twice as likely to say their children had difficulty falling asleep or were unwilling to fall asleep.Overall, researchers found 77 percent of the children with significant symptoms were considered to have significant sleep problems by their parents. But when these children were observed in a sleep clinic, only 20 percent had diagnosable sleeping disorders.” So, while it seems that ADHD makes it difficult for a child to fall asleep at night and wake up the next morning, if a child has a sleep disorder, it can also mimic the symptoms of ADHD.

    While some parents choose behavioral modification and accommodations, others feel their child needs more. For those parents, the decision is whether or not to try medication. The primary drugs used to treat ADHD are central nervous system stimulants. Although these drugs are stimulants, they have a calming effect on people with ADHD. Ritalin and Adderall are two of the most commonly prescribed.

    Are ADHD drugs safe? The American Academy of Pediatrics says that, “taken as recommended, these drugs are effective and safe for most children with ADHD.” And the same study from the CDC that noted the increase in diagnoses of ADHD in the population, stated: “About two thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with ADHD, but can also lead to addiction, anxiety, and occasionally psychosis.”

    A contrasting report, published in the March 2013 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, found that nine out of ten young children with moderate to severe ADHD continue to experience serious symptoms and impairment long after their original diagnoses, and in many cases, despite treatment.

    That study was led by investigators at Johns Hopkins Children’s Center and is the largest long-term analysis of preschool children with ADHD. The study showed that nearly 90 percent of the 186 youths Followed continued to experience ADHD symptoms six years after diagnosis. Most surprising was this finding: “Children taking ADHD medication had just as severe symptoms as those who were medication-free.”

    So, the contrasting opinions about the efficacy of ADHD drugs held by professionals and parents are also shared by the medical community.

    There are also side effects to consider.Typical ones include loss of appetite, difficulty sleeping, and trouble concentrating.You should contact your doctor immediately if your child is experiencing serious side effects like hallucinations, depression, anxiety, aggression, irregular heartbeats, or chest pain.

    About medication for ADHD, Mary Delmonte says, “Matt will have to deal with this all his life. You don’t grow out of this and I feel it is better for him to learn ways to accomplish what he needs rather than take a drug.” In addition, she is concerned about side effects of stimulants and possible addiction later on. She chose instead to get the school to develop an individual education plan (IEP) that allowed Mathew to get up and move to the back of the classroom when he could no longer sit still, as well as other minor accommodations. She also sent him to a specialized service provider, a brain training center called Learning Rx, in Richmond.

    Learning RX owner Ed Lawrence says, “We don’t diagnose or treat ADHD as such. What we do is test for areas of strength and weakness in learning – such as reading ability, processing speed, reasoning – then we work with the child to strengthen the weak areas so that the ADHD has less effect.” In Mathew’s case, his mother will tell you reading Was torture for this young man, as it took him three to four months to finish one book. “After working with the tutors at Learning Rx, he was able to read four or five books a year and loves it now.” Delmonte adds that Mathew, who will start seventh grade this year, is progressing well in school.

    What school services are available? Services differ with each school division but most offer testing. If a child is deemed exceptional education (ED), then services will depend on his classification. The IEP is written by an ED teacher and reviewed with the parents. Services might include self-contained classes, collaborative classes, or just being observed and helped by the class’s teacher. Children can be re-evaluated during the year and moved from one class to another, with a new IEP written each time there is a change.

    ADHD will definitely make it more challenging for your child to learn and fit into the typical school environment. But as Ryan Stein says, “It can be an asset. I use my ADHD to get a lot accomplished.” And he is not alone in that perspective.According to Entrepreneur Magazine, ADHD is a common disorder among entrepreneurs, and can actually be a sought after trait in CEOs. CEOs must juggle multiple roles and tasks and move from one area of expertise to another quickly, make fast decisions, and have high energy levels. David Neeleman, founder of Jet Blue is one such CEO with ADHD. He says, “I knew I had strengths that other people didn’t have, and my parents reminded me of them when my teachers didn’t see them. His career advice for youngsters with ADHD? “Look at the positives of having ADHD,” he says. “And don’t get discouraged.Don’t give up.”

     

     

    If Your Child Has ADHD

    • Let your child know ADHD is not automatically a liability, that many successful people have it, and help him or her think in terms of how it might be an asset.

    • Involve his school. Have your child tested at school or get testing privately. If issues at school are significant, request an IEP.

    • Consider boosting skill sets and confidence with services like Learning Rx and Brain Balance Center.

    • Work with your child on finding strategies that will help him focus in school and at home. Provide exercise before study. Allow her to have ways to burn excess energy in any setting where sitting still and listening is important: a squeeze-ball under the desk, a pen for doodling, etc.

    • Consider medication; talk with a child psychiatrist, pediatrician, or make an appointment with a specialist in ADHD, like Focus MD. If medication is prescribed, monitor your child carefully. Proper dosage is critical for best results.

    • Some parents (and some schools) host homework clubs immediately after school where getting the work done is a shared goal. Parents can take turns managing it.

    • At home, remove distractions from workspace – no noise, nothing on the desk but the homework. Break the work into small segments with a break after each.

    • Organization for those with ADHD is a challenge. Help your child with aids like calendars, planners, and timers. Teach him to put important things in the same place each day.