ADD / ADHD

ADD (Attention Deficit Disorder) or ADHD (Attention Deficit and Hyperactivity Disorder) describes a spectrum of behavioral presentations in children who have trouble focusing and concentrating mixed with hyperactivity and impulsiveness.  The going idea of why some kiddos are more hyper and inattentive than others really stem way back to our Homo Habilis brains.  In fact, without people (children included) with this dominant mode of thinking and activity, we would not have made it this far as a species.  Let me explain why your child acting like they have an external motor on 24/7 and why having to remind them 27 times to put on their socks is actually a benefit to the human race.

Current thinking on this brain mode has to do with what anthropologists call the explorer or adventurer gene.  Some brains are wired to be the first to step into a new situation or to be less concerned with the million potential safety concerns of what is around the corner.  If we did not have these types of people, we probably would not have ventured far from the cave back in the day and we wouldn’t have risk-taking entrepreneurs or athletes today.  This drive is such a part of the brain for some people that if they are not given frequent new stimuli, the brain gets BORED and will go to sleep pretty readily.  We often see this when kids who have ADHD go from 100 mph to sleep in seconds rather than the slow drifting off to sleep like what we see in others.  Again, all this sounds awesome right?  Almost like a superpower – endless energy and drive for exploration.  

But this drive for seeing what is next or only being able to hyperfocus on things that are interesting can, at times, conflict with modern schooling practices.  Most families think that a well-rounded education is a good thing, whereas Little Jimmy would rather learn about robots all day and could care less about reading, unless it is about robots of course.  Modern schooling is not structured to handle this type of kiddo, broadly speaking. So, in order to get a child a well-rounded education, to give them opportunities to explore all there is to learn in the world, we need to work with school staff to help us convince the brain of an ADHD kiddo that this stuff is worthwhile to prevent them from going in shut off/sleep mode.  

Things that we can always start with in regard to possible treatment for kids who are on all cylinders all the time start with energy expenditure and consistent routines for sleep, waking, eating, and discipline.  Step one – run them ragged.  Every kiddo with ADD or ADHD who has a remote interest in anything athletic should do that.  These kiddos are awesome at sports that other kids find taxing.  Soccer, Basketball, Track, Swim, etc.  Anything that sounds like cardio for kids.  I often will tell families that, on top of getting that kiddo into sports, also sign them up for Karate ASAP.   Out of all the physical activities studied to help with ADHD Karate seems to be the most promising in strengthening neural networks in the brain to help focus while running on all cylinders.  

I also always recommend dietary changes such as those recommended from the CHADD group.  This usually starts with eliminating dyes added to foods (though the research that started this trend is not great, I still don’t like color chemicals in kids’ foods regardless) and picking carbohydrates that need to be processed by the body first before going straight to the brain.  These are complex carbohydrates.  Anything that is beige or processed has a lot of simple sugars that can give a kiddo with ADHD super-fast acting sugars that add to super-fast acting behaviors.

There are also school accommodations such as preferential seating, structured notes to help focus on important information, and chunking information/assignments into smaller, more manageable, components.  At home, breaking up homework activity into 15–30-minute increments with stretch and running breaks to dispel excess energy can also be helpful.  Frustration often brings its own issues for children with ADHD as they tend to struggle developing grit and resilience to work through failure, which makes sense when you are wired to be in perpetual movement toward the next great thing.  Having a framework for rewarding the work process that fosters a growth mindset, rather than solely the end product quality, is tantamount to their success in school and beyond.   Also, having deadlines for things far in advance can foster a healthy version of “intensity” to school or homework, which plays to their adventurous spirits.  

Once we have done all the behavior and executive functioning modifications and training mentioned above (and more), your pediatrician may discuss medication as an option for helping with school and home life if struggles continue to persist.  The medicine is really much better at helping with concentration, though it will often help with hyperactivity and impulsivity, too.  For instance, teens with ADHD who are taking ADHD medication have been shown, in multiple studies, to get into less car accidents when on their ADHD medicine than when they are not medicated.  These medicines have been around for a long time, and we know the possible side effects of the medicines such as appetite suppression, insomnia, tics, and stomach aches.  If the kiddo is on the right type of medicine and the right dosage, these side effects usually do not occur.  Having said that, it usually takes 3-4 changes in dosing amount/medicine type to find the perfect fit for a child with ADHD as no kid with ADHD is exactly the same as the next.  And, again, these medicines are not cures for ADHD and should in no way change a kiddo’s personality or demeanor. 

Often times I let children know that if we use a medicine for their ADHD, it will only get them part of the way and that their job, while on the medicine, is to learn as much as they can about themselves and how they learn best.  What works for them when planning a big project?  Which subjects come easier than others?  What is the best way to tackle a difficult homework problem?  We want children to start recognizing these patterns so, over time, they can get off of the medicine and we can work with a kid’s interests and neural networks to develop metacognition in regard to their studies and future endeavors in high school, college, and beyond.  

A quick word on the current state of ADHD evaluation:  It seems impossible, but ADHD is a diagnosis that is both over and under diagnosed simultaneously.  Let me explain.  Over the past 10 years there has been a dramatic increase in the number of children (and adults) diagnosed with ADHD.  Is this due to a decrease in stigma around ADHD, overzealous pediatricians and psychiatrists, fed up teachers?  Honestly, it is probably a combination.  So, when getting a child evaluated for ADHD make sure to ask the pediatrician or psychiatrist what the range of normal is in terms of behaviors for children in their age group to see where your child sits on the scale of “normal”.  And, at the same time, I see ADHD under diagnosed; pediatricians write off a child struggling with home or school life as depression or anxiety rather than digging deeper.  When we ask the right questions to the right people, we may see that the patient actually has ADHD and their difficulty forming friendships and interacting with authority (parents and teachers) stems from the ADHD neural pathways in their brain.  I can’t tell you how many times I have had a child or teen with diagnosed depression who saw dramatic changes in mood and social engagement after starting ADHD medication, a stark contrast to the stagnation experienced while taking antidepressants or participating in CBT based therapies.