As the mother of a young adult with ADHD, I understand the complexities of helping them to achieve at their highest capabilities while also fostering independence. It is often a tight rope to walk.
However, we parents must keep in mind that our children are often 1-3 years delayed in executive functioning skills and possibly other developmental areas. That means we often have to intervene a little more than other parents of children the same ages. This is often a relief for parents to learn.
I’m frequently asked three questions: “What really is ADHD?” “How do I know if my child truly has ADHD?” And “Should we try medication?”
ADHD stands for Attention Deficit Hyperactive Disorder. First, I don’t like the word “disorder” and prefer “difference.” No two people are alike so disorder can have both diminishing and negative connotations. Second, the word “hyperactive” is often a misnomer for some individuals with a diagnosis of ADHD, as many do not display the hyperactive component and instead may be inattentive which is a subcategory.
After all of that, what is ADHD and who makes that diagnosis?
The reason this is all so confusing is because the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the international manual that defines and classifies “mental disorders” such as ADHD. Hundreds of trained professionals in the fields of neurology, speech language pathology, social work, psychology, psychiatry, pediatrics and nursing with various additional trained professional advisors gathered data and information to compile the most accurate lists of traits and characteristics associated with mental disorders. This became the standard for which anyone with certain traits would be diagnosed.
If someone displays 5/9 characteristics/symptoms in the DSM-5 of Attention Deficit Hyperactive Disorder then a diagnosis will be considered. There are also additional criteria that are considered. The tricky part comes in the assessment of the individual. Who is assessing? How are they assessing?
My opinion as a professional working with individuals for the past 26 years and that of a parent is this shouldn’t be done lightly or without multiple points of input and information. The trend has been to go to a doctor or the child’s pediatrician, get some medication and see if it “works.” If the medication “works,” the individual has ADHD and if it doesn’t, then something else is going on.
This approach has various flaws and problems, least of which is ADHD has many facets and throwing medication at one observable characteristic (such as difficulty focusing) without consideration of the entire situation is like throwing darts in a dark room hoping you hit the dartboard. If it not only hits the vicinity of the dartboard and actually hits the bulls eye, wow, what a miracle! I believe a bit more scientific and individual approach is needed when we are discussing not only applying a DSM-5 diagnosis to an individual but also when attempting to actually do something to support them.
ADHD affects executive functioning, which encompasses impulse control, emotional regulation, memory, attention, persistence behaviors, planning and prioritization, organization, time management, flexibility, initiation, motivation, and metacognition. Executive functioning is also vital for problem solving, reasoning, language comprehension and use, information processing, reading, writing, relationship management and more. Executive Functioning is responsible for all of us humans functioning successfully and independently in the world. Knowing ADHD has all of these components, where do we start to treat if we don’t have clear results about which areas are impacted?
Edward Hallowell, M.D., and John Ratey, M.D. in their book Driven to Distraction describe ADHD as a “neurological symptom whose classic defining triad of symptoms include impulsivity, distractibility and hyperactivity.”
Russell Barkely, Ph.D defines the current clinical view of ADHD as “… the current term for a specific developmental disorder seen in both children and adults that is comprised of deficits in behavioral inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness). This disorder has had numerous different labels over the past century, including hyperactive child syndrome, hyperkinetic reaction of childhood, minimal brain dysfunction, and attention deficit disorder (with or without hyperactivity).” www.russellbarkely.org
These definitions give us a general idea but it is agreed among professionals that it is a combination of observations and assessments by various individuals that helps determine if a diagnosis of ADHD is appropriate. As these definitions show ADHD isn’t just one or two areas that are affected. It encompasses numerous behaviors and characteristics in many areas of daily living that impact independent living, learning, language, thinking, writing, reading, emotions, self-concept and self-control, and physical/sensory information, basically all the cognitive areas needed to function. What we do know is the brain of someone with ADHD is different on MRI studies compared to that of someone without ADHD.
Diagnosis should be made by a team of professionals or at the least, a neuropsychologist. Some patients choose to see a psychiatrist or a neurologist, which is understandable. However, consulting with a psychologist or educational specialist is vital to assess various areas of performance. Parents report they “know” their child has ADHD and are often accurate in this knowledge. Getting this professional diagnosis will help later on with IEP’s, 504 plans, school accommodations and College Board accommodations. Additionally, the professional assessments are integral to a good coaching plan.
Information about how the individual is performing in academic/career areas is important and a trained professional will not only assess strengths and weaknesses but will be able to explain how someone is performing. Knowing that someone has poor sustained attention is helpful but it is more valuable to understand what situations/triggers cause decreased attention. Do they have difficulty engaging in activities initially or do they engage instantly and then lose it along the way? Different assessment tools will reveal this information, which can be used by a coach later.
Medication decisions are always tricky. Personally, I’ve witnessed the differences between medicated and non-medicated individuals and I have to say the medicated individuals do better. Multiple studies have confirmed differences in brain function of individuals on medication versus those not.
I would advise if considering medication, work with a physician who is experienced and will work collaboratively to titrate doses. It needs to be mentioned that medication needs may change and vary as the patient’s conditions, lifestyle, growth and development change. There may be times when once dosage works well and at another it is too much or too little. It is a dynamic process not something static. It does take time for some side effects to decrease. Often decreased appetite is a problem. There are compensatory strategies to help alleviate these issues and can be addressed as part of a coaching process. It is important to keep in mind that medication alone is not the answer. Medication is used in conjunction with modifications, accommodations, coaching, counseling, alternative techniques and compensatory strategies.
I completely respect those who do not wish to medicate their children or themselves. There are many alternative treatments that have positive effects. Working with a coach who understands these options may be helpful. There are non-stimulant medications that are effective as well as dietary modifications, mindfulness training, supplements and behavioral strategies that should be considered regardless of medication decisions.
Parents often know when their child is showing signs of ADHD and should listen to that wisdom. Finding a good professional team of specialists to work with a client with ADHD from diagnosis to medication decisions to coaching will make the difference in how well someone functions and achieves those skills in which they are capable. As with any other medical condition, one size does not fit all. Every person is unique and while a diagnosis of ADHD may mean a set of behaviors/symptoms to qualify, how each individual manifests those symptoms under which conditions is unique to them. Therefore, their treatment/coaching options should account for that.