Attention Deficit/Hyperactivity Disorder

BY JENNIFER WOODWORTH, PSY.D

AD/HD that is not treated with therapeutic or medical interventions can have a large impact on the person experiencing the symptoms and the people they interact with.

As school begins, children will be asked to sit still, focus on lessons, and concentrate for extended amounts of time. The first month of school is generally considered an adjustment period, yet after about four weeks have passed, teachers are able to identify students who may be more fidgety, less engaged, or are having more trouble focusing on school work than their peers. Now, many things can contribute to a decreased attention span; a new baby in the household, beginning or end of a deployment, anxiety, depression, or any other source of increased stress. However, these tend to be situationally based, meaning they are temporary situations and your child may have a change in their usual school connectedness.

Attention deficit/hyperactivity disorder is a medical condition that is continuous and does not “go away,” yet can be exacerbated with stress.

You might have even used the phrases “boys will be boys,” or that your child is “high energy” when explaining some of the impulsive behaviors that may be a part of AD/HD. There is a documented ratio that boys are diagnosed with AD/HD 2:1 to girls and typically present with a more impulsive/hyperactive type. Those who experience inattention or lack of focus may be overlooked as lazy or “daydreamers,” yet these symptoms may significantly impact learning and ability to store and recall information presented in class.

Current research estimates that approximately 10% of children ages three to 17 have ever been diagnosed with AD/HD; 13.5% of boys and 5.4% of girls. This discrepancy may be attributed to behaviors that are recognized by teachers at higher rates; typically the disruptive behavior rather than the inattentive behavior.

Each child with the diagnosis of AD/HD will present with different severities of issues, therefore each child is unique and experiences AD/HD in different ways. AD/HD is typically not diagnosed before the age of four due to typical developmental behaviors that may resolve based on age. Also, environment does not cause AD/HD, however it does impact the symptoms that are present. Sugar and brain injury have not been shown to cause AD/HD symptoms.

When looking through the symptoms, it is common to relate some examples to yourself or your children. However, for a child to be considered for a diagnosis of AD/HD symptoms listed below have to interfere with, or reduce the quality of, social, academic, or occupational functioning. There must be at least six of these symptoms present before the age of 12 and have been occurring for at least six months. Some adults who are diagnosed with AD/HD may be experiencing impairment in their relationships, occupational settings, or deficits in inattention and concentration while attending academic settings; however AD/HD does not begin in adulthood, they must have been experiencing these symptoms prior to the age of 12.

SYMPTOMS OF INATTENTION MAY INCLUDE:
• Failure to give close attention to details, or tendency to make careless mistakes
• Difficulty in sustaining attention
• Appearance of not listening
• Struggles to follow through on instructions
• Difficulty with organization
• Avoidance of, or disliking tasks that require sustained mental effort
• Losing things necessary to complete task
• Getting easily distracted
• Forgetfulness in daily activities
• Child is less likely to act out
• Getting along with other children
• Child may sit quietly, but not be pay attention

HYPERACTIVE/IMPULSIVE SYMPTOMS MIGHT INCLUDE:
• Fidgeting with hands or feet or squirming in chair
• Difficulty in remaining seated
• Running around or climbing excessively (feeling restless)
• Difficulty engaging in activities quietly
• Acting as if “driven by a motor”
• Talking excessively
• Blurting out answers before questions have been completed
• Shows difficulty in waiting or taking turns
• Interrupting or intruding upon others

COMBINED:
• Includes symptoms for both inattentive and hyperactive/impulsive subtypes of AD/HD.
You may stay away from an assessment or diagnosis of AD/HD because you feel it could be stigmatizing or create a negative label for your child or family. Yet, AD/HD that is not treated with therapeutic or medical interventions can have a large impact on the person experiencing the symptoms and the people they interact with.

IMPACT ON FUNCTIONING FAMILY
• Children may be seen as defiant or not listening
• Can cause parental frustration: “I asked you 100 times”
• Mood changes, irritability
• Intensity of mood disproportionate to the situation
• Attention for misbehavior (yelling or stomping about not getting the snack of their choice)
• Positive behavior may go unnoticed
• Self-esteem drops (“I can never do anything right”)

SOCIAL
• Engagement in risky behavior, not able to look forward and evaluate consequences
• Low frustration tolerance, easily angers, can lead to “blow ups”
• Being late to events, losing track of time
• Often rejected by peers for being impulsive or saying things without thinking
• Can be rigid with rules, except when applicable to them
• Lack of awareness for how their behavior is impacting others

EDUCATION/OCCUPATION
• Forgetting details, dates, or specific instructions
• Losing interest in boring or repetitive work
• Talking too much, distracting others
• Have difficulty processing information as quickly and accurately as others
• Cognitive problems on tests of attention, decision making, and memory
• Inattention may be seen as lazy, irresponsible, or oppositional or go unnoticed
• At younger ages/grades, school work may not be impacted, however as the child progresses and schoolwork becomes more difficult, grades may decrease
• May take more time to learn skills
• Overwhelmed by multiple step projects
• Self-esteem can be impacted by trouble with school work (“I’m stupid.”)

HEALTH
• Higher rate of accidents/injuries than children not diagnosed with AD/HD

RISK FACTORS
Risk factors are not definitive causes of AD/HD, only items that have been found to correlate with AD/HD.
• First degree relative with AD/HD (mother/father/sibling)
• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• Maternal drug use, alcohol use or smoking during pregnancy
• Maternal exposure to environmental poisons — such as polychlorinated biphenyls (PCBs) — during pregnancy
• Premature birth

CONTRIBUTING FACTORS
These are factors that contribute to intensity of symptoms, however do not cause AD/HD.
• Often co-occurs with other disorders (anxiety, depression, behavioral issues)
• Structure (little or no organization or schedule)
• Rejection by family or peers

PROTECTIVE FACTORS
These are factors that contribute to a person’s ability to understand and manage how their symptoms impact them:
• Involved parents
• Structure
• Organization
• Involvement in activities
• Physical outlets
• Positive social interactions
• Higher IQ

IF YOU SUSPECT YOU OR YOUR CHILD ARE IMPACTED BY AD/HD:
• Contact your primary care physician for a referral to a mental health professional or call your insurance for a covered network provider
• Meet with a psychologist/social worker/marriage and family therapist.
• They will complete a comprehensive assessment which will guide diagnosis and specific treatment for the child and family.
• Treatment may include education about AD/HD, building social skills, learning relaxation techniques, and adding strategies to recognize emotions.
• Meet with a psychiatrist
• There is opportunity for you or your child to be evaluated for medication to assist in managing symptoms (not always necessary but an option)
• Collaborate with the school psychologist, principal, and teacher
• Create a behavior plan, 504 plan, or an individualized education plan that recognizes your child’s challenges and the best way to support them in the educational system
• This applies to college students as well; most campuses have student services to assist with creating a successful
learning environment

PSYCHOLOGICAL ASSESSMENT EXAMPLE QUESTIONS
• Are the behaviors excessive and longterm, and do they affect all aspects of the child’s life?
• Do they happen more often in this child compared with the child’s peers?
• Are the behaviors a continuous problem or a response to a temporary situation?
• Do the behaviors occur in several settings or only in one place, such as the playground, classroom, or home?

PARENTING TIPS
• Break requests down into one or two step directions only, use as few words as possible
• Allow time for child to process information and complete task (wait about seven seconds before repeating your request)
• Point out the things they are doing right
• Keep expectations manageable and age appropriate
• Breathing or “take a break” techniques
• Use rewards that are motivating for the child; they may change week to week (earning stickers, Pokemon, time one on one with a parent)
• Limit screen time
• Increase physical activity, daily outdoor time •

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ABOUT THE AUTHOR:
Jennifer Woodworth is a licensed clinical psychologist in private practice in Vista, CA. She has worked in the mental health field for seven years. Her husband is retired from the Marine Corps and she has three children ages six, eight, and ten.

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