As we embark on a new school year (where did the summer go?), you may be experiencing excitement, anxiety, and for some of you, even a little bit of fear as kids move on to the next academic level. Consider yourselves fortunate if your child enjoys school, likes to learn, and does homework without a fight. Many others have a very different experience of school. Academic demands are heightening and, as early as pre-k, we are seeing a shift in the expectations of our kids. While this is true, this is often a time when parents and teachers alike are surveying for any barriers to learning, which may include concerns for ADHD. In fact, some of you may have already been encouraged by a teacher or counselor to explore this possibility.
When a child between the ages of 4-18 (this is a change from previous age range of 6-12) exhibits academic or behavioral problems along with inattention, hyperactivity, or impulsivity, it makes sense that educators consider ADHD, which is one of the most commonly diagnosed disorders of childhood. While ADHD can be diagnosed and treated in adulthood, it is most often outgrown by adulthood. There are many different types of ADHD, including hyperactive/impulsive subtype, inattentive subtype, and any combination of the two. Symptoms are varied. The list below was taken from the American Academy of Pediatrics website: healthychildren.org
At least 6 of these symptoms must be present in order to qualify a diagnosis in a child under the age of 17, while five symptoms are required for diagnosis age 17 and older. These symptoms must occur by the age of 12, for a period of at least 6 months, and cause clinically significant impairment in school, relationships, and/or organized activities.
You may be thinking, “That sounds like my 6 year-old son!” Many of these symptoms are developmentally appropriate in children. The key distinguishing feature is that there is no significant interference on behavioral or academic functioning. In fact, these symptoms are present in the majority of 4, 5, and 6 year-olds without necessarily meeting the criteria for ADHD. Given the fact that many of these symptoms can actually be developmentally APPROPRIATE behavior, parents often ask, how do I know if my child has ADHD?
The short answer is: it’s complicated.
Given the fact that symptoms of ADHD can mimic symptoms of other disorders or illnesses, it is imperative that other emotional disorders (i.e.: depression, anxiety, oppositional defiant disorder, conduct disorder), developmental disorders (i.e.: learning disorders, processing disorders, language disorders, or neurodevelopmental disorders), and physical disorders (i.e.: tics, sleep apnea) be ruled out prior to diagnosis. This process is initiated via formal evaluation and discussion with your pediatrician. Rating scales completed by the parent(s) and primary teacher are also requested. We formally request psychoeducational testing, which is also required in order to uncover any barriers to learning. This includes cognitive abilities, processing issues, and some measures of attention. School psychologist observation of the child is also important. Once all of this information is gathered, typically within 2 months, the diagnosis is either ruled in or ruled out.
If your child meets criteria for a diagnosis of ADHD, a good psychoeducational evaluation will offer recommendations for interventions to enhance learning in the classroom. This may include separate testing space, extra time for exams, minimizing distractions, and “fidget tools,” to name a few. First line treatment for kids’ ages 4-5 include parent and/or teacher administered behavior therapy. For school-aged children and adolescents, stimulant medication (i.e.: Ritalin) is recommended as first line treatment, and/or behavior therapy initiated by parent and/or teacher. Stimulants are not without risk, requiring careful consideration prior to any initiation.
The bottom line: you know your child better than anyone. If there are concerns that symptoms listed above may be interfering in your child’s learning, don’t hesitate to initiate a discussion with your healthcare provider.