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Setting the record straight on ADHD

Curtis McDonald, MD

With many kids learning at home, I’ve noticed an increase in the number of parents wanting to talk about Attention Deficit Hyperactivity Disorder (ADHD) during their kids’ appointments. ADHD is a misunderstood condition, so it’s worth discussing. The more parents know, the better equipped they will be to help their child get the support they need to succeed.

ADHD is not a behavior problem

The most important thing to recognize is that ADHD is not a behavioral issue or discipline problem. An ADHD diagnosis won’t cure a child who is defiant or acts out. Nor will it suddenly help a failing student do well in school. Rather, ADHD is a cluster of symptoms that may include trouble paying attention or being overactive. There are three types of ADHD:

  • Hyperactive-impulsive: Kids have difficulty sitting still, don’t think before they act, and tend to blurt things out. It’s most common in younger children and boys.
  • Inattentive: Students may be easily distracted or forgetful. They may have trouble following instructions, finishing tasks, and managing their time. This type is most common in older students.
  • Combined: Some kids may have both hyperactive and inattentive symptoms.

To be diagnosed with ADHD, kids must have a certain number of symptoms—and those symptoms have to keep a child from functioning well in at least two different places, such as school, home, or church.

Screening tool offers objective view

Pediatricians today use an objective screening tool to check for ADHD and rule out other problems, such as anxiety, depression, learning disabilities, and conduct disorders. It’s not uncommon for parents to discover that their child needs support for an entirely different issue than they originally thought.

In my own practice, I make the decision to offer an ADHD diagnosis carefully. I believe it’s extremely important to do a complete evaluation and ideally talk to multiple people who work with the child before making a determination. Teachers have a really good idea of what is typical for each age and can identify when a child is struggling. Parents also need to answer hard questions, assess other life factors with a critical eye, and fill out a lot of paperwork. Older patients need to have honest conversations about what’s going on in their home and academic life.

An ADHD diagnosis will inform medication and treatment decisions, so there’s value in being cautious before using that label. For example, while it’s possible to diagnose a patient as young as four with this condition, many ADHD behaviors are typical child behaviors. It’s often better to wait and see how the child matures. Likewise, a doctor can diagnose a teen or tween with ADHD. However, if the student isn’t interested in school or refuses to follow the treatment plan it won’t change their trajectory.

Treatments help motivated patients

Sometimes though, ADHD is the spot-on diagnosis and exactly what a child needs to get them on track. It is extremely rewarding to be able to help these patients. Some kids need classroom accommodations, such as special chairs, a spot in the front, permission to stand and quietly move around, or oral instead of paper exams. Many of my patients with an ADHD diagnosis are in fact doing better with distance learning because they have even more control over their environment.

Medications are also a tool and can help calm physical symptoms while increasing attention and focus. These prescriptions make the part of the brain that controls executive function work better, giving students greater ability to control their movements and impulsivity. Medications can help, but students still have to work hard and make good decisions.

Talk about concerns

With families navigating the disruptions caused by COVID-19, it’s no wonder that ADHD worries are cropping up. Kids are under a lot of stress and may be acting differently than usual, and parents may be more able to tune into concerns. If you’re worried about the symptoms you’re seeing in your child, make an appointment with your pediatrician. Your doctor can help assess what’s going on in your child’s life and whether ADHD may be an issue for them.

Learn more about ADHD

Dr. Curtis McDonald is a pediatrician at Vancouver Clinic and the father of four children. His goal as a provider is to empower moms and dads with information so that they can make the best choices for their families.