Helping kids with ADHD to focus, work and learn

By Leslie Cardé | Contributing Writer

The teacher calls to say that your child isn’t paying attention, is disrupting the class and just isn’t focused. You’ve noticed the child neglecting chores at home and putting off assignments.

And, when you think back, your child was a bit wild as a toddler, which you chalked up to the “terrible twos” — and beyond.

Are these behavioral issues, or could it be something else? Now, your pediatrician has suggested it could be attention-deficit hyperactivity disorder, but that diagnosis requires a professional to sort through the symptoms.

“To make a diagnosis of ADHD, there must be significant inattentiveness or hyperactivity, or impulsive behaviors,” said Susan Fielkow, M.D., a developmental behavioral pediatrician at Children’s Hospital, New Orleans.

“Some of those features can be dominant, or can be in combination with one another, but the symptoms must be greater than for their age-related peers.”

Home vs. school

The behavior must also exist in at least two different environments, as well.

So if a child is a terror in your house, but a model citizen at school, the behavior might be chalked up to something within the home environment. If your child seems like the typical child at home, getting along with siblings, but their teacher is telling you a different story, perhaps there’s a problem at school — anything from being bullied to a learning disability, which could cause frustration and acting out.

To hone in on what’s actually happening, a professional has to consider many aspects of the child’s life.

Are they on medications for allergies, which might have side effects? Are they getting enough sleep? What is the psychosocial dynamic at home and at school?

There is a long list of symptoms that fall under the ADHD umbrella. They include:

• Inability to pay attention to details

• Inability to focus

• Not paying attention when someone attempts to engage them

• Trouble with following up on instructions

• Disorganization, which turns into an inability to function

• Losing things

• Procrastinating (time management and organizational skills are causing problems)

• Easily distracted

• Squirming

• Running or climbing in inappropriate places

• Always on the go, as if driven by a motor

• Interrupting people, making it impossible to have conversations

According to experts, the inattentive component of ADHD can fly under the radar, more than the hyperactivity, which can be obvious even in a toddler. Most children are diagnosed between the ages of 6 and 12, but it can be younger.

“Kindergarten is a breeze for some of these kids, and even first and second grade may not pose challenges for them,” Fielkow said.

“But, by the end of 3rd grade, the demand on a student starts to increase, and they can’t get by any longer without paying attention, because the work is more difficult and requires some degree of concentration," she said. "In general, higher functioning kids can mask it longer, until the curriculum catches up, and then both teachers and parents begin to see the underlying problems.”

The disorder runs in families. A mother who took her child to her physician recently for a diagnosis was surprised to learn that she had many of the same symptoms, but she had just accepted the fact that she could never read the newspaper all the way through, among other difficulties. Now that mother is being treated, and she is able to do things she never thought she was capable of.

In addition to the role genetics play, researchers are looking at environmental factors, brain injuries, nutrition and social environments.

According to Fielkow, it’s also important to remember that

For the roughly 5-12% of children who will be diagnosed with ADHD, there is no cure. The medications often given to amplify focusing capabilities are of two basic types — stimulants and non-stimulants.

Although it may seem counterintuitive to prescribe a stimulant for someone who is already hyperactive, the drugs work by increasing certain brain chemicals which play essential roles in thinking and attention.

Teaching organizational or study skills to the child has been shown to be effective in improving academic function and socialization skills with peers.

Children with a diagnosis of ADHD are also entitled to certain academic accommodations at school, such as preferential seating, reduced classwork or extended time on tests.

Schools may also accommodate through the 504 Plan, which qualifies children for special education services.

Parents and teachers can generally help kids with ADHD by keeping routines, organizing everyday items, and having consistent rules.

“Most importantly, it’s critical for parents to differentiate between the can’t and the won’t,” Fielkow said. “With a diagnosis of ADHD, it isn’t always about discipline or having an oppositional child. It’s a medical diagnosis which requires a certain amount of patience on everyone’s part.

"Modify your expectations so that an ADHD child isn’t expected to be taken to fancy restaurants that require two hours of sitting still. Try 10 minutes at a time initially, and see how that goes," Fielkow said. "Remember, whatever system works for your child is the one you should be using.”

For more information about ADHD, go to the website for Children and Adults with Attention-Deficit Hyperactivity Disorder at: www.chadd.org or call 1-866-200-8098

--- Leslie Cardé

functional impairments change over time, because it takes time for the frontal lobe of the brain to develop.

A child diagnosed at the age of 4 can grow out of symptom impairment by the time they reach adolescence.

But, for an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present before the age of 12.