Recognizing Signs of ADHD and Helpful Advice from Dr. Pinkston
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It is that time of the year again; time to buy pencils, notebooks and book bags. For some parents, this may be the first time. For other parents, our children are taking those next big steps into those harder subjects. All parents want their children to have a smooth transition into their school year but there are always those things that need a little extra attention. Attention-Deficit/Hyperactivity Disorder (ADHD) can often make transitioning into the school year more difficult.
Recognizing Signs of ADHD
I often hear parents coming in and telling me that my child has ADD and not ADHD. What parents are trying to often communicate is that their child is more inattentive but doesn’t have all the behavioral difficulties they see on TV related to ADHD. ADHD actually has 3 subtypes.
- Inattentive: The child often has difficulties sustaining focus on a task, makes frequent or careless mistakes and has challenges in following instructions. I tend to see higher rates of females being diagnosed with the inattentive type compared to the other types of ADHD.
- Hyperactive/Impulsive: Excessive fidgeting, instability to stay seated, difficulties waiting for their turn and making quick decisions without considering the consequences. Typically, I see more boys coming in for treatment for this because these behaviors often bother others in the classroom.
- Combined type: Some children show elevated scores/elevated behaviors in both their inattentive behaviors and hyperactive/impulsive behaviors and will meet criteria for a combined type.
What I have noticed in my own clinical practice is that those children with a combined type or hyperactive/impulsive type of ADHD tend to get recognized first. These may be the children who can’t stop passing notes in class, shouting out the answers, bouncing around their seats like Ray Charles or even giving the kid in front of them a wet willy! I find that my inattentive children come in a little later. I notice that it is when the big shift from basic addition and basic reading is now transitioning to word problems and more difficult reading comprehension that concern is raised. This would make sense that a child with poor sustained attention can do 2 + 2 – 2 is 2 when laid out like a simple math problem but once you start telling them that Sally had 2 buckets of water, Jane had 2 buckets and John spilled 2, clearly, we are pushing that sustained attention a little bit.
The Assessment Process
- Consult a pediatrician. While most think of the pediatrician as the person you visit for a cold, vaccinations or sports physical; your pediatrician plays a major role in your child’s behavioral healthcare. Typically, your pediatrician will review your child’s medical history, observe your child’s behavior in the office and supply you with questionnaires to help clarify a diagnosis.
- Consult a specialist. At times, your pediatrician may recommend that you see a specialist for your child’s behavior. This specialist may be a counselor who can help work with you and your child on strategies to improve behavior. Your pediatrician may refer you to a psychologist who will do a more comprehensive evaluation if your child may have some cooccurring behaviors that need more objective testing data such as a learning disorder.
ADHD Treatment
- Medication treatment: Medication may be prescribed to help manage symptoms. This would be done in collaboration with your healthcare provider.
- Behavioral therapy: Your child may meet with a counselor to help develop better organizational skills and manage impulsivity.
- Parent training: Parents often look to professionals for advice on better strategies to help their children with ADHD. It is important to note that ADHD does not just occur in the school setting but is present anywhere the child is (including home).
- School collaboration: A parent can collaborate with the school in applying for an IEP or 504 plan to help make reasonable accommodations for the child’s learning that may include extended test taking times or seating changes.
Helpful Advice from Dr. Pinkston
- If your child is already on medication, make sure you have enough medication now to last until your follow up appointment with your provider. Pediatrician’s offices tend to get a large influx of refill calls around this time of year. Pharmacies at times can even have some of these medications on back order.
- Observation and documentation is key. Keep a notebook about your child’s behaviors. Key details may be how many times you must prompt them to do something, how long it takes them to do a task, how many steps of a task they complete before believing they are done and things of this nature.
- I often find that children with ADHD struggle with anxiety or poor self-esteem. I think a lot of this stems from realizing at some point that things are harder for them than others. Sometimes an authoritative parenting approach can add to this, so instead I would suggest a more collaborative and problem-solving approach to addressing their difficulties. I do want to be clear and say that setting clear expectations for your child and having established routines is very important. Telling a child that they can clean their room whenever they want this week may not be the best strategy but instead offering that they can clean their room before dinner, after dinner or even do half before and after dinner if they struggle to sustain their attention long enough to clean it in one go around.
- Seek out information on ADHD from reputable sources. TikTok, while entertaining, really is not the best place to learn about ADHD. I find that a lot of people who state they have an ADHD diagnosis do a good job about talking about their experience with ADHD but what we don’t know is what other cooccurring things that may also be going on with them that they attribute those symptoms to their ADHD. I have found that in a TikTok era, people tend to spread a diagnosis catchment as wide as they can to bring in the most number of subscribers or viewers they can.
- Consult with your medical provider about possible changes in diet and exercise that may help benefit attention and focus. A standard question I ask during any ADHD evaluation is about the number of sugary foods and caffeine that someone may eat/drink each day as a way to keep their focus. I have found that many of my ADHD patients tend to be strong users of caffeine during our time of initial evaluation. At times, this can be counterproductive, leading to difficulties with anxiety, inability to sleep or stomach difficulties. You may find that your pediatrician may suggest supplements or foods that are high in omega-3 fatty acids. Your medical provider may also be able to discuss online supplements or remedies parents seek out online that may not be as effective as promised or not cost effective. Discussing changes to diet, exercise and sleep may be a great first step towards improving attention and focus prior to starting medication treatment.