What exactly is attention deficit hyperactivity disorder (ADHD)? It is a diagnosis so common among children that many adults, teachers, doctors, etc. do not even think twice about it. A child presents behaviors of ADHD and suddenly they are on medication with no explanation on exactly what this diagnosis is or how to handle it. It is a diagnosis that is thrown around without really trying to understand it.
J showed signs of ADHD very early. As a nurse and a mom, you pick up on behavior that your children display which is not entirely normal. At 3 years old, I started to see signs in J that he could possibly have ADHD. He was restless, moved around a lot, easily distracted, could be hyper focused on a topic, etc. and most importantly he would seem to calm down after drinking a Mt. Dew.
Now, I know that giving a 3 year old a Mt. Dew is not something most parents would do. I knew that stimulants are often given to children with ADHD to help control symptoms. They seem to have the opposite effect versus making them more hyper. Knowing this and out of desperation, we decided to give J Mt. Dew to see what would happen. To my dismay, it calmed him down. Recognizing this I knew that he could possibly have ADHD. However, I do not recommend that parents rush out to buy their hyperactive child Mt. Dew. It was not something we gave J all of the time. It was only when his behavior was so uncontrollable, did we give him a small drink of the soda. It is also hard to determine if his behavior is due to being a typical 3 year old or possibly ADHD. Only a physician or a psychologist/psychiatrist can determine that diagnosis. Diagnosis is not often made until after the age of 7.
J was first evaluated for ADHD when he was 5 year old. When he started kindergarten, it was obvious to teachers and the psychologist who evaluated him that he has ADHD. Initially, the psychologist and psychiatrist gave him the diagnosis of rule out ADHD without really examining it further. I accepted the diagnosis at face value based on what they had said and based on what knowledge I knew at the time. J was immediately started on medication. He was given clonidine. Little did I know the extent of J's ADHD.
J's symptoms progressively got worse as he grew older. We tried various medications and combinations thereof to try and help control some of his behaviors. After struggling for a few years, we finally got J into a month long program designed to help determine exactly what was causing his behaviors. The psychiatrist diagnosed him with severe ADHD combined along with three other diagnoses. After hearing the diagnosis, I started researching ADHD to understand it better.
There are so many facets to ADHD including types and severity. I was already aware that a child or person could simply have attention deficit disorder (ADD) and not the hyperactivity part. I was also aware a child could have both the attention and hyperactivity disorders. However, I was not aware that ADHD is considered to be a type of neurological disorder. A disorder in the brain which involves an imbalance of neurological signals.
ADHD has been known by many different names and descriptions. However, research conducted within the past 35 years indicates that ADHD is a neurodevelopmental disorder versus "brain damage" or hyperkinectic disorder (Zayats & Neale, 2019; Mahone & Denckla,2017). It is a neurological disorder which involves a dysfunction in how the brain receives, interprets, and responds to information (Marcel, 2018). Imaging scans of the brain show children with ADHD to have a brain that is 10% smaller than normal (Rodden & Nigg, 2020). The actual causes of ADHD are not fully known. In recent years there has been a shift from psychological and environmental causes to biological and biopsychosocial causes (Mahone & Denckla, 2017). The most recent studies point to genetics as being one of the causes.
According to Zayats and Neale (2019) genetics does contribute to the development of ADHD; about 60-90% can develop the condition if it is present in a family member. It is more prominent in identical twins versus fraternal twins (Zayats & Neal, 2019; Marcel, 2018). Although research is demonstrating genetic involvement, the causes still remain highly variable. A child's environment can still be a contributing factor. The latest research is showing inflammation can also be a risk factor for the disorder. Other factors include: exposure to drugs and alcohol, inadequate or no prenatal care, low birth weight, prematurity, nutritional deficits, etc. (Marcel, 2018).
Several symptoms need to be present before the age of 12 before a diagnosis of ADHD is made. Symptoms fall into two types: inattentive and hyperactivity/impulsivity. According to the latest DSM criteria, symptoms can merely be present as opposed to causing impairment. In adults only 5 out of 6 symptoms need to be present (Mahone & Denckla, 2017) for the diagnosis. The symptoms are then classified as either mild, moderate or severe (CHADD, 2020).
Symptoms can cause mild to severe impairment in children. Mild classification is given when there are few symptoms present beyond what is required and little to no impairment in school and other activities is observed. Moderate classification is given when the number of symptoms is in between mild and severe and there is moderate impairment in activities. Severe classification is given when a child displays many symptoms and their severity is significant enough to have a major impact on school, family, and other social activities (CHADD, 2020).
Symptoms of ADHD are varied. Children with ADHD tend to behave younger than their age, have emotional outburst and responses that are overblown. Fidgeting and inability to sit still are very common. They are easily distracted - much like how a dog can be distracted by a squirrel. A child with ADHD can struggle following directions, completing tasks, loses things, talks constantly, forgetful, makes mistakes, interrupts/intrudes, and so on (CHADD, 2020).
Children diagnosed with ADHD often have another co-existing condition such as anxiety or mood disorders, learning disorders, etc. It is actually rare if a child is only given the diagnosis of ADHD without another behavioral disorder (Mahone & Denckla, 2017). However, a child diagnosed with ADHD is at risk for developing the following: poor school performance, low self-esteem, social isolation, injuries due to accidents, occupational failure in adulthood, suicide, divorce, and so on (Faraone & Larsson, 2018). ADHD diagnosis has most recently been recognized as a public health concern which causes billions of dollars every year. The US education system bears about 1/4 of the costs each year (Mahone & Denckla, 2017).
J has ADHD combined, severe. This means he has both the inattentive and hyperactivity/impulsivity symptom areas. His symptoms and behavior are so extreme that he cannot be handled without medication. Medication is the most common way of treating ADHD. However, it is only effective about 70% (Zayats & Neale, 2019). This is largely due to there being so many different causes behind ADHD. With J, we have tried multiple medications. We have now circled back to a previous medication but have added a "booster" type medication to help it along. Medications are also not a cure and they do not totally suppress symptoms. ADHD varies from child to child. Medications that work well for one may not work for another. Since medications are not a cure, children with ADHD may also need therapy on a regular basis to help them to respond and manage their impulses better.
Gone are the days we give J Mt. Dew. He now takes two medications to assist with his ADHD symptoms. They do not take them away entirely. He still shows many of the signs of symptoms just not so severe that it will interfere with his daily activities. By evening the medications have worn off and he is back to bouncing around and talking incessantly. Fortunately bedtime is not too far off and he receives a medication to help him sleep.
Now that I have more knowledge about ADHD, I have been working on changing my mindset related to how I respond to J. It has not been easy. He is so smart and I forget how much he struggles with just the simplest things. His struggles do not lessen his intelligence nor his abilities. I just have to remember to give him time and patience.
References:
Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) (2020). About ADHD. Retrieved from https://chadd.org/about-adhd/adhd-and-autism-spectrum-disorder/ .
Faraone, S.V & Larsson, H. (2018). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, 24:562-575. Retrieved from PubMed.
Mahone, E. M. & Denckla, M. B. (2017). Attention deficit/hyperactivity disorder: a historical neuropsychological perspective. Journal International Psychology Soc, 23(9-10);916-929. Retrieved from PubMed.
Marcel, C (2018). Attention deficit hyperactivity disorder: dietary considerations. CINAHL Information Systems. CINAHL. Retrieved on July 11, 2020 from CINAHL database.
Rodden, J. & Nigg, N. (2020). Is ADHD a spectrum disorder? The ADHD Brain. Retrieved from https://www.additudemag.com/adhd-is-spectrum-disorder/ .
Zayats, T. & Neale, B. M. (2019). Recent advances in understanding attention deficit hyperactivity disorder (ADHD): how genetics are shaping our conceptualization of this disorder (version 2; peer review 3 approved). F1000 Research. Retrieved from PubMed.
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