Child Behavior

Healthy children are often energetic and love to play. Some children may be overenthusiastic, or may struggle with concentrating and staying on task. When this happens, the child might be experiencing symptoms of ADHD or attention deficit hyperactivity disorder. If you are concerned that your child’s energy or lack of focus is more than expected for a healthy child, you’ll want to consider the diagnosis of ADHD.

What Is ADHD?

ADHD is less a disease and more a condition. It is a way of perceiving the world around you. Children with ADHD do not pay much attention to things that do not interest them, and are easily distracted from things they find boring. They may be antsy to get going, find they think better when moving around, and make impulsive choices. In certain settings (hunting, sports) these characteristics are adaptive, and may aid the individual in achieving their goals (catching a prey quickly, scoring a goal). On the other hand, many of these traits can cause a child with ADHD to struggle at school, at home, and in maintaining healthy friendships.

Signs of ADHD In Children

Every child has moments when they struggle to pay attention, listen, follow directions, sit still, or wait their turn. For a child with ADHD, these struggles are harder and occur more often. Many times children with ADHD display some of the following behaviors.

Inattentiveness

Children who are inattentive or easily distracted often struggle to focus their attention. This includes trouble concentrating, as well as staying on task or having trouble listening to directions. Many children with ADHD miss important details in instructions, and might not finish what they start. They might seem absent-minded, forgetful, and lose track of their things. They might also seem prone to daydreaming.

Hyperactivity

A child with ADHD might seem to be hyperactive or fidgety. This might manifest as restlessness or being easily bored. Children with ADHD typically have trouble sitting still or staying quiet at appropriate times. They also tend to rush through tasks and make a lot of careless mistakes. Hyperactivity might also cause them to climb, jump, roughhouse, call out, or just get up and walk around when they shouldn’t.

Impulsivity

Children with ADHD often exhibit impulsive behaviors where they act too quickly without thinking through what they are doing. They also tend to interrupt, push or grab, and exhibit a general sense of impatience. This might include doing things without asking for permission first, or taking things that don’t belong to them. Children with ADHD are also prone to taking bigger and bigger risks, followed by intense emotional reactions. This is particularly concerning among adolescents with ADHD who are at risk of inappropriate sex, abuse of drugs, and driving miscalculations.

Organization

One of the most difficult skills to master in children with ADHD is organization or skills of executive function. Executive function can be divided into seven areas: adaptability, planning, self monitoring, self control, working memory, time management, and organization. Typically, a person with ADHD carrying out an assignment had difficulty trying to get started, staying focused through the end, planning and prioritizing, organizing their activities, and managing their time. Frustration can come easy to those who are less adaptable to change, who have trouble monitoring themselves, and who lack self control.
Parents and teachers tend to notice signs of ADHD when a child is young. Though these behaviors tend to develop gradually as the child matures.

ADHD Causes

The exact cause of ADHD is not completely clear. There is strong evidence that suggests that ADHD is genetic. Many children who have ADHD have a parent or close relative who also has ADHD. Premature children also seem to be at higher risk for developing ADHD. Environmental toxins such as narcotics during pregnancy may play a role.It’s important to note that research does not support ADHD being caused by poor parenting, or giving a child too much sugar.

Diagnosing ADHD

If your child has started to show signs of ADHD or you are concerned about their hyperactivity or lack of attention, you should schedule an appointment with your child’s doctor. Their pediatrician will perform a thorough checkup, including a vision and hearing check, to be sure there aren’t other conditions that might be causing their ADHD symptoms.

Diagnosing ADHD starts with the pediatrician asking about your child’s health, behavior, and activity. They talk with parents and kids about the things they have noticed. They might also ask you to complete checklists about your child’s behavior. A similar checklist might be given to your child’s teacher for a comparison of their behavior at home and their displayed behavior in the classroom setting.

This information will then be used to determine some of the following:

• Is your child struggling to pay attention?
• Is there hyperactivity or impulsivity above normal levels for the child’s age?
• Have the behaviors been going on since the child was very young?
• Do hyperactive or inattentive behaviors affect the child at school as well as at home?
• Are other health issues to blame for the problem with inattention or hyperactivity?
• Are other behavioral or learning issues present?
• Are mood or anxiety* problems present?

(*Approximately one third of children with ADHD suffer also from anxiety, depression or learning issues.)

ADHD Treatment

ADHD treatment strategies employ a multi-tier approach and may be adjusted over time based on the child’s age, the results of treatment, or your child’s performance.

Behavior Therapy

Therapists can work one-on-one with your child to help them develop the social, emotional, and planning skills they need to overcome common ADHD challenges. For children diagnosed before age 6 years, this is the primary form of therapy.

ADHD Medications

While seen by some as controversial in the past, modern advancements have made the thoughtful application of medications for ADHD more effective than ever before. These prescription medications activate the parts of the brain that help a child pay attention, slow down, and use more self-control. Medication is only occasionally used on children before the age of 6 years.

Parent/Child Coaching

Therapists and ADHD specialists can work with parents and children to help them learn the best ways to respond to behavior problems that are part of ADHD. This includes techniques to help guide your child through the therapeutic process as well as helping them manage their day-to-day challenges toward increasingly positive outcomes.

School Support

Teachers and academic staff can help kids with ADHD do well and enjoy school more. This might include things like teaching techniques, providing a student with guidance, and access to resources through the therapeutic exchange. Also, schools can offer support through child study observations and evaluations and accommodations in the classroom, such as longer time to complete tests, or preferential seating to reduce distractions.

Diet, Sleep and Exercise

As with almost all conditions in pediatrics, the best path to a great outcome begins with good self care. Eating a healthy diet, maximizing sleep at night, and getting regular exercise can help establish a framework from which the good work described above can begin. Minimizing play screen time to 1-2 hours per day can also improve outcomes. There are only so many hours in a day. It is just not possible to live socially, attend school, exercise regularly, get enough sleep, and do your homework if you spend too much time on video games. School performance reduces proportionally as the hours of video gaming increase.

Many parents ask about non medical treatments, and about elimination diets. While it is never good to eat too much processed food, there is little evidence that reducing it from the diet improves ADHD symptoms. Likewise, avoiding sugar and food dyes has never convingly been proven to help. Some work was done with fatty acid supplements, but they too have not been proven to help ADHD.

Conclusion

Without professional treatment, it can be hard for a child with ADHD to succeed in school, and to build long-term healthy friendships. This may lead to low self-esteem, depression, oppositional behavior, acting out, academic struggles, and family conflict.

Fortunately, our understanding of ADHD and its causes has helped therapists to empower children with ADHD to overcome their challenges. This includes the family support system as well as ways to maximize a child’s academic success. If you have any questions, your pediatrician is there to help.