• ADHD

Attention-Deficit Hyperactivity Disorder

You may have heard the terms ADD and ADHD used interchangeably. ADHD stands for attention deficit hyperactivity disorder. Previously, patients who exhibited attention deficit without hyperactivity were diagnosed as having attention deficit disorder or ADD. In 1987, the The American Psychiatric Association changed the diagnostic criteria of ADHD to include a subset of patients without hyperactivity, effectively making the ADD diagnosis obsolete. This article includes information on all forms of ADHD, including that which was previously referred to as ADD. 

Attention-deficit/hyperactivity disorder (ADD/ADHD) is a neurodevelopmental disorder that impairs personal, social, academic, and/or occupational functioning. It often involves dysfunction in attention, memory, perception, language, problem-solving, or social interaction. 

Onset is frequently by age 4 and invariably before age 12; the typical age of initial diagnosis is between 8 and 10 years of age. Children with ADHD may have trouble paying attention, controlling impulsive behaviors, or be overly active. They do not grow out of the normal childhood tendencies to have difficulty focusing and/or behaving. A child with ADHD might be prone to daydreaming, forgetting or losing things, fidgeting, talking too much, making careless mistakes or taking unnecessary risks. They may struggle with resisting temptation and/or have difficulty getting along with others.

There are three types of ADHD: 

1. Predominantly Inattentive, which is categorized by the child having trouble organizing or staying on task, paying attention to detail, or following instructions or conversations. They are often easily distracted. 

2. Predominantly Hyperactive-Impulsive, where the child fidgets and talks a lot, has difficulty sitting still, is constantly moving, feels restless, and struggles with impulsivity, such as interrupting, grabbing things from people, speaking at inappropriate times, or exhibiting an inability to wait his or her turn. 

3. Combined Presentation, which shares symptoms of the first two types equally. 

ADHD is about twice as common in boys, but the ratios vary by type. Behavioral history may reveal low frustration tolerance, opposition, aggressiveness, poor social skills and peer relationships, sleep disturbances, anxiety, depression, and mood swings, among other concerns. Boys tend to present on the hyperactive end of the spectrum, making their symptoms hard to miss. Girls, on the other hand, usually exhibit symptoms of inattention, which they can take great pains to cover up. Parents are encouraged to look for signs that their daughter is staying up late to finish homework or wanting to avoid school, two behaviors that can indicate she is unable to focus and may have ADHD.  

To receive a diagnosis of ADHD, symptoms must be present for more than six months and be present before age 12. They must be more pronounced than expected for the child’s developmental level, occur in at least two settings (such as home and school) and interfere with normal day-to-day functioning. 

The multi-step process to diagnose ADHD requires a medical exam, hearing and vision tests to rule out other problems with similar symptoms to ADHD, a checklist for rating symptoms of ADHD, and a history of the child from parents, teachers, and sometimes directly from the child.

Current research shows that genetics plays an important role in understanding the cause(s) of ADHD, which are largely unknown. Current studies focus on the role of dopamine, norepinephrine, and, most recently, serotonin neurotransmitters. Other possible causes being studied are brain injury/head trauma, exposure to environmental agents (such as lead) or alcohol/tobacco in utero (or at a young age), and premature delivery or low birth weight.  Research does not support the popularly held view that ADHD is caused by eating too much sugar, watching too much television, parenting, or social and environmental factors such as poverty.

Healthy lifestyle habits will help your child manage ADHD symptoms: eating a healthy diet, getting at least 60 minutes of physical activity every day, limiting screen time, and getting the recommended amount of sleep.

Conventional Treatment

ADHD assessments include gathering a history of prenatal exposures (drugs/alcohol), perinatal complications (which may include traumatic brain injury, cardiac disease, and/or sleep-disordered breathing), picky eating, and family history of ADHD. Assessment should also include consideration of developmental milestones (particularly relating to language) and ADHD-specific rating scales, as well as educational and behavioral records.  ​

It is important for parents to remember that ADHD can be successfully managed. Once there is an ADHD diagnosis, a child will likely receive a medication prescription. Physicians and advocates will provide recommendations to help find a more appropriate classroom setting and guide parents on how to handle their child’s behavior. Successful treatment plans will include close monitoring, follow-ups, and needed adjustments along the way.

In most cases, ADHD is best treated with a combination of behavior therapy and medication.  For preschool-aged children with ADHD, behavior therapy training for parents is recommended as the first line of treatment.  Behavior therapy focuses on strengthening positive behaviors and eliminating unwanted/problem behaviors. The therapy can be targeted toward the child, the parents, and/or educators.  Previous research has found that behavioral peer intervention, which is a form of behavior therapy in which teachers train other students to support a child’s positive behaviors, can be effective as well.  

Stimulant drugs are most widely used as ADHD treatment to help children focus and stay calm.  Frequency and amount of dosage should be evaluated regularly by the physician to ensure optimal response and to monitor for side effects.  Nonstimulant drugs are sometimes used, but data is mixed as to their efficacy compared with stimulant drugs. Antidepressants can be used when stimulants are ineffective or have unwanted side-effects, but they are less effective and not generally recommended as first-line treatment medications.  

Support

At The Brain Possible, our goal is to empower you to take a holistic approach to your child’s treatment. Below are ways in which you can support several aspects of your child’s recovery; before embarking on any, be sure to discuss them with your trusted health care providers.

Physical

Regular exercise is paramount for children with ADHD. Since the ADHD brain often has lower levels of dopamine and strenuous exercise creates dopamine, exercise can have a medicinal effect on children with ADHD. A University of Vermont study showed that half an hour of “moderate to strenuous” exercise each day improved cognitive functioning and decreased ADHD symptoms for students with all types of ADHD. Sleep is also very important to the health of children with ADHD. Make sure your child is getting the recommended amount of sleep for her age. Teens with ADHD may even be at more risk for increased symptoms with decreased sleep, noted a recent study by the American Physiological Society. 

Therapies such as craniosacral, which regulates the flow of cerebrospinal fluid, myofascial release, which helps release tissue trauma, and scalp acupuncture, which encourages the flow of energy through meridians in the head and body, have helped children with ADHD experience greater ease, coordination and relaxation.

Emotional/Social

 Many children with ADHD find it difficult to manage their emotions. They may get overwhelmed by the intensity of their emotions, causing them to abandon their tasks or isolate socially. As a caregiver, you can support them by verbally acknowledging their emotions without judgement and talking them through developing a “big picture” perspective. For instance, they may be overwhelmed by frustration at struggling with a science problem and you can help remind them of how much they’ve learned about science this semester and how capable they are. Canine therapy and equine-assisted or hippotherapy can help children with ADHD learn to regulate their emotions by forming bonds with animals and their therapeutic helpers.

Sensory

A Temple University study found that 95% of the study subjects, children who were on medication for ADHD, improved their sensory control after 40 one-hour occupational therapy sessions. The sessions were tailored to each child and included dry brushing on their skin, work with exercise balls, and moving on swings. Other ways to support your child struggling with sensory overload is to set up a section of a room with a bean bag, low lighting and weighted blankets, giving them a chance to decompress in an area designed to calm their overloaded system. A quick game of catch or ping-pong can help children focus and coordinate their minds and bodies when they’re feeling scattered. 

Sensory integration therapies, such as the Wilbarger Protocol and Floortime, may include games, puzzles, and personal care or household tasks that help children regulate their states of sensory arousal. They also aid in building neuronal pathways for better integration of sensory input from multiple sources. Hydrotherapy, which uses water as a setting for occupational therapy and/or as a means of transferring heat or cold to the body, can also help with relaxation and neurological integration of sensory experiences. Additionally, olfactory and gustatory therapy strengthens children’s senses of taste and smell. These senses activate the brain’s hippocampus, which is where memory resides. These therapies, which can involve repeated timed sessions of experiencing a range of tastes and smells, are thought to help children strengthen memory and decrease impulsivity. 

Intellectual

Within the classroom, children with ADHD are aided by environmental control of noise and visual stimulation, appropriate task length, and teacher proximity. Homework time can be especially trying for children with ADHD. Many children benefit from supportive structures and routines, such as a dedicated homework space and doing their homework at the same time each day. Incentive systems, such as homework contracts and rewards, can help motivate children with ADHD through the challenges of homework time. 

The Perceptual Enrichment Program is a short-term cognitive intervention that can help children with ADHD learn time-management and problem-solving skills. Brain Gym is a series of exercises to help cognitive functioning. The exercises, which can be done at home, are thought to help children meet neurological milestones they may have skipped in their development.

Nutritional/Environmental

Having a healthy lifestyle can make it easier for your child to deal with ADHD symptoms.  Healthy behaviors to model include: eating a healthy diet comprised of vegetables, fruits, whole grains, legumes, lean protein, nuts and seeds; getting at least 60 minutes of physical activity every day, limiting screen time; and getting the recommended amount of sleep. 

Meals rich in protein and complex carbohydrates can provide sustained energy and help stabilize blood sugar. Nutritionists also recommend minimizing sugar and simple carbohydrates to avoid spikes in blood sugar, which can trigger ADHD symptoms. The Ketogenic Diet is a high-fat diet that changes the brain metabolism. Children on Low Inflammatory High Fat Diets, which include the Mediterranean Diet, have been shown to have fewer occurrences of ADHD. Success has also been reported with the Nemechek Protocol. The Nemechek Protocol inhibits bacterial overgrowth in the gut which has been linked to symptoms of ADHD. 

Physiological

In 2004, a brain scan project at UCLA revealed that children with ADHD usually had reduced size of the prefrontal cortices and anterior temporal areas. Adults with ADHD show less reduction in brain size, indicating that the disorder results in developmental delays. Learning programs that help encourage cognitive and sensory processing such as Auditory Processing Therapies, might be helpful in encouraging brain development. While the physiology of ADHD is not yet widely understood, patients have reported benefits of the calming effects of homeopathy and cannabis therapy. Studies have shown that neurofeedback helps children with ADHD learn to stay on-task and regulate their emotions.