ADHD is probably one of the more recognizable terms used in Middle and High School. It is one of the first ‘maybe’s’ teachers and parents consider when a child is disruptive, difficult to contain, fidgety and/or forgetful.
It is important to know the symptoms of ADHD, such as concentration problems and hyperactivity, are often confused with, masked by or perpetuated by other disorders and medical conditions. Before treatment options can be considered, an accurate diagnosis must first be made.
Before exploring treatment options, let’s first explore what ADHD is, and how it may present different in boys and girls. A common misconception is ADHD diagnosis among boys and young men have been increasing, while the true statistics indicate diagnosis to be increasing most among young women and mothers.
It is important to understand ADHD is not the result of bad parenting, or a poor upbringing. There are of course methods to improve the development of a child with ADHD, but the core deficit arises from the biochemistry of the brain.
ADHD in Children
It is 3 to 4 times more likely for boys to be diagnosed than girls. The CDC estimates in a classroom of 30 children, 1-3 kids have ADHD. Typically, symptoms begin to manifest around the age of 7 or 8, sometimes a little later in girls. Despite our current level of understanding, 40% of kids are untreated.
There are two types of ADHD: hyperactive and inattentive. You can infer a good amount from the names alone. Hyperactive ADHD kids are the ones who you see jumping around and misbehaving. Children with inattentive ADHD are the ones who seem content staring at a tree outside the window, or a spot on the wall.
As one might expect, Hyperactive ADHD is far easier to identify. Both types of ADHD impact children developmentally. As a result of being unable to interact, pay attention, and concentrate, like their peers, they are at risk of being delayed socially, academically and emotionally.
Symptoms of Hyperactive ADHD (also known as ADD)
- Fidgets, ‘squirms’, looks uncomfortable when expected to sit alone and quietly
- Difficulty sitting still – constantly making up excuses to leave a quiet situation in order to experience greater stimulation
- Difficulty maintaining ‘quiet time’
- Talkative, always eager to get in a word
- Impulsive – difficulty controlling impulses
- Always “on the go,” struggles to remain still
- Interrupts conversations, or butts in when others are talking
- Often considered ‘difficult to keep up with’
- Climbing, running – when at a wedding ceremony, this is the child running up and down the aisle, or swinging around the pews.
- Will shout out answers in class, before the teachers finish presenting them completely – will try to complete other’s sentences
- Will sometimes use others possessions without asking for permission
- Struggles with turn taking – is eager to jump to the head of the line
While every child struggles with each and every point above, children with Hyperactive ADHD display these traits with greater regularity and frequency.
75 % of boys and 60 % of girls who have ADHD, fit a hyperactive classification.
Symptoms Inattentive ADHD
- Difficulty paying attention – be it in the classroom, during a long conversation, or during recreational activities
- Fails to follow through when given instructions – whether it is at school or home, the child has difficulty finishing tasks after they have begun (loses focus quickly)
- Difficulty organizing – this can be in school, in a child’s room, when asked to carry a complex activity requiring several steps
- Avoids activities requiring concentration, or sustained attention
- Appears to not pay attention when being spoken to
- Struggles / Fails to pay attention to details
- Makes frequent mistakes on homework and in-class assignments
- Misses deadlines, turns in work late, saves work for the last minute
- Often misplaces or loses personal items (homework, house keys, pencils/pens etc.
- May appear to be distracted during conversations or during activites requiring attention
- Easily distracted
Combined Type ADHD
There is a third classification beyond hyperactive and inactive, and it is called combined type. It is fairly rare, considering a child needs to show 6 of the 9 symptoms in both hyperactive and inattentive diagnostic considerations. These symptoms must cause significant difficulty in the child’s life, and cause considerable distress.
The Impact on Development
While hyperactive ADHD/ADD is more common than the inattentive type, the impact on the child’s development is largely the same. When a child is unable to concentrate or focus at home or school, they are not able to experience the aspects of their world necessary to facilitate their development. It may seem like the only impact is at school, but it extends far beyond merely the classroom.
ADHD inhibits the child’s emotional and social growth. Rather than learn from their peers, and take guidance or cues from the adults in their life, they are focused on the latest video game or a tweety bird outside the window.
It is difficult to expect a child to grow based on the instructions from playstation or nature alone. A child needs many sources of stimulation to discover their world. Video games from time to time are fine, but the same goes for just about any activity.
Technically speaking, diagnosis requires a child demonstrate 6 of the 9 primary symptoms associated with ADHD. The symptoms need to have been noticeable for a minimum of 6 months in at least two settings – typically, at home and at school. The symptoms must interfere with the child’s ability to function. Additionally, a minimum of two of the symptoms must have been present before the age of 12.
The qualifications for older adolescents are largely the same, the only difference is that they need to demonstrate only 5 of the 9 symptoms in multiple settings. These are the technical details required for diagnosis, but an accurate diagnosis can only be made by a qualified medical professional: either a physician, a psychiatrist or a clinical psychologist. However, it’s critical for parents and educators to know the warning signs because early detection, ADHD treatment, and school accommodations can make a world of difference for a child with ADHD.
- 40% of children who have ADHD have at least one parent who has ADHD.
- Parents of a child with ADHD are three times more likely to separate or divorce than are parents of children without ADHD.
ADHD Testing: Children and Adolescents
Most if not all mental health disorders include the symptom of an attention deficit. Therefore, the presence of an attention deficit, statistically speaking, is more likely to be associated with a condition other than ADHD. Further, ADHD is a diagnosis of exclusion. A diagnosis of exclusion, in this case, requires that all other causes of an attention deficit be ruled out before attributing them to ADHD.
Other clinicians typically diagnose ADHD with a clinical interview and/or a behavioral checklist/s from a parent and the school. Unfortunately, this method of assessment is often insufficient for diagnostic accuracy because, as we now know, many disorders can manifest in what appears to a layperson as ‘ADD or ADHD’ due to the presence of an attention deficit. Behavioral checklists are fallible and they are quite susceptible to confirmation bias, exaggeration, or underreporting.
Confirmation bias (providing elevated ratings on a behavioral checklist confirming a pre-established conclusion the person has ADHD) causes a false positive ADHD diagnosis (someone without ADHD diagnosed as having ADHD). In some cases, parents/teachers/raters will be resistant to having their/a child labeled as “ADHD” and will fail to report the true scope and/or severity of their child’s symptoms on the checklists, resulting in a false negative diagnosis (someone with ADHD is diagnosed as not having ADHD). DPS is aware of these diagnostic shortcomings and in response, have developed a research-based system to prevent the aforementioned shortcomings found in traditional ADHD diagnostic processes.
There are a number of assessments available which make it possible to test your son or daughter in order to provide test-contingent hypothesis to either support or refute whether there is a cognitive profile that is or is not consistent with an ADHD diagnosis. The hypothesis tests are based upon copious amounts of research in the field of neuropsychology and the patterns of test scores that suggest an ADHD vs. “another” condition. Individuals who genuinely possess an ADHD condition should have a neuropsychological profile that yields a preponderance of ADHD vs. non-ADHD test results. This actuarial approach towards diagnosis is the best way to ensure the most accurate diagnosis.
These assessments utilize measures of intelligence, attention, processing speed, mental control, memory, language, executive functioning, motivation, constructive praxis, motor ability, symptom/performance validity testing, and a detailed clinical history to establish an ADHD diagnosis. The rule out of a medical cause of an attention deficit is also included in the assessment process and we work in conjunction with primary and specialist care physicians to ensure we have the entire clinical picture, prior to making a formal diagnosis.