The Legitimacy of ADHD

When I was younger, I used to hear about a child being ADHD and think it was just an excuse for the child being hyper and not listening. Boy was I wrong! I never realized until I began working with kids in the schools who had ADHD that it was a legitimate diagnosis. And then after having a child of my own with ADHD, I learned even more about the intensity of the disorder.

Attention-Deficit/Hyperactivity Disorder, are more commonly known as ADHD, is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. But it’s not quite as black-and-white as the definition sounds. For many years, research showed there were clear structural differences in the ADHD brain. The largest review ever of ADHD patient brain scans was carried out at Radboud University Nijmegen Medical Centre and published in 2018. Researchers reported that people with ADHD had smaller brain volume in five subcortical areas, and their total brain size was smaller, too. These differences were greater in children and less in adults. Another interesting finding was that the amygdala and hippocampus are smaller in the brains of people with ADHD. These areas are responsible for emotional processing and impulsivity and had previously not been definitively connected to ADHD. Parts of the ADHD brain mature at a slower pace (approximately one to three years) and never reach the maturity of a person who does not have ADHD.

The brain is a busy communication network where messages are relayed from one neuron (brain cell) to the next. There is a gap between neurons, which is called a synapse. Imagine 2 people talking into an empty, hallow can connected by a string. In order for the message to be passed along, the synapse needs to be filled with a neurotransmitter. Neurotransmitters are chemical messengers, and each one is responsible for different functions.

tin-can-telephone

The key neurotransmitters for ADHD are dopamine and noradrenaline. In the ADHD brain, there is dysregulation of the dopamine system. For example, there is either too little dopamine, not enough receptors for it, or the dopamine is not being used efficiently. Stimulant medications help ADHD because they encourage more dopamine to be produced or keep dopamine in the synapses longer. This is why people with ADHD can become calm and relaxed by drinking coffee.

There are several types of brain imaging techniques such as single-photon emission computer tomography (SPECT), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI) that allow researchers to study how the ADHD brain operates and functions.

adhd-brain

There are variations in blood flow to multiple areas of the brains in people with ADHD compared to people who do not have ADHD, including decreased blood flow to certain prefrontal areas. Decreased blood flow indicates decreased brain activity. The prefrontal area of the brain houses the executive functions and they are responsible for many tasks including planning, organizing, paying attention, remembering, and emotional reactions.

One study published in 2010 found that children with ADHD do not have the same connections between the frontal cortex of the brain and visual processing area. This means that the ADHD brain processes information differently than a neurotypical brain.

So, if you can easily see the difference in an ADHD brain vs a neurotypical brain, then why is ADHD not diagnosed via a brain scan? Well, as Dr. Thomas E. Brown explains in his book, “A New Understanding of ADHD in Children and Adults: Executive Function Impairments,” tests such as PET and fMRI scans give an insight into how the brain is functioning at the moment the test was performed. Like a photo, they capture one moment in time. However, they do not take into account how the brain operates in different situations, in the way a clinical test can during a detailed interview.

There is no objective test to diagnose ADHD. Instead, a detailed evaluation is carried out by a clinician. It includes an in-depth interview with the patient, a review of school reports and medical history, and possibly tests to measure attention, distractibility, and memory. With that information, the clinician can determine if the diagnostic guideline for ADHD set by the Diagnostic and Statistical Manual of Mental Disorders (DSM) is met.

Now in it’s fith edition and known as the DSM-5 (this is the first edition that does not use a Roman numeral), the publication doesn’t offer treatment or medication advice for the 157 disorders described in it’s pages. Instead, it was designed to help healthcare professionals better identify and diagnose mental disorders that impact personality, cognitive functioning, mood, and identity. The manual also provides uniform diagnostic codes for each issue which are used for medical billing and data collection. Without the proper coding listed in the DSM-5, US health insurance companies will not cover treatments and/or medication costs.

The DSM-5 is primarily used in the USA where as most of the rest of the world turns to the World Health Organization’s (WHO) International Classification of Disease (ICD) which covers all diseases, not just those that are phychiatric in nature. American Psychological Association (APA) encourages healthcare professionals to consider DSM-5 and ICD as, “companion publications,” designed to be compatible with each other.

I recently did a course on International Open Academy on ADHD (thank you Groupon) and learned that there are gender specifications of how ADHD presents itself. According to the APA in 2013, 5% of school-aged children are affected by ADHD and the ration from boys vs girls is 2:1. Historically, ADHD was thought to be a disorder that mostly affected boys since boys tend to be diagnosed at a much higher rate. Checklists, rating scales and treatment protocols tend to focus on the typical male presentation of ADHD. Research suggests that ADHD may occur almost as frequently in girls as in boys but may be underdiagnosed in girls. The discrepancy in diagnosis is thought to be due in part to the way the symptoms manifest in girls and biases in perception and referral. Boys tend to display symptoms of hyperactivity/impulsivity, the kinds of behaviors that draw attention. Girls are much more likely to present with inattentiveness/forgetfulness and be seen as more distracted or day dreamers.

Even girls with ADHD-hyperactive type tend to display less physical energy than boys. Girls are more likely to display behaviors such as chewing on their clothes or hair, being overly talkative or being more emotionally reactive. Girls also tend to try and cope with their symptoms by immersing themselves in tasks that they can do well. This outward appearance of success can be deceiving and mask problem behaviors. As a result, their struggles don’t immediately garner attention.

Unfortunatly, due to the way ADHD symptoms are presented in girls, they are often time misdiagnosed and 3 times more likely to have been previously treated with antidepressants and were reported as having difficulty with school work and having a strenuous relationship with their parents.

When a child receives a diagnosis such as ADHD, treatment is a family process. Every family member is impacted in some way and it takes every family member working together to manage it successfully.

Create Structure

Structure means establishing and maintaining a daily routine. Knowing what is coming up helps to keep anxiety in check and creates consistency. Establish simple routines for mealtimes, playtime, homework, bedtime, etc. Give your child specific tasks such as setting the table or laying out her clothes for the next day.

Have a Set Bedtime

Sleep is sometimes difficult for children with ADHD. Poor sleep can exacerbate their symptoms. Establish an evening bedtime ritual such as a bath or story and a firm ‘lights out’ time.

Break Things Down

Children with ADHD can easily become overwhelmed with too many instructions or tasks. Be specific in what you say. Break instructions or information down into smaller pieces. Instead of saying, “Go brush your teeth, put your shoes on, grab your book bag and meet me at the door”, you may have to break the steps down to one or two at a time.

Make It Visual

Consider using a big, colorful calendar, cute checklists or behavior charts to help your child remember to do things. Even young children can benefit from visual cues such as pictures or symbols.

Create Quiet Spaces

Children with ADHD are often quite distractible. Create quiet spaces for homework, reading or just relaxing. Ideally, this is an electronics-free zone as electronics can overstimulate and exacerbate impulsivity.

Practice ‘Stop, Think and Go’ Style Activities

Learning to control impulses is a key skill for some children with ADHD. Children’s games such as pick-up-sticks, Simon Says, Red Light-Green Light, and Jenga rely on those skills to be successful. Do homework with your child. Ask questions that require a thoughtful response.

 

Help Your Child Be Organized

Organization is key for children with ADHD. Use a homework planner. Pack her book bag together the night before. Have a designated pace for homework and establish a routine for picking up and putting away personal belongings.

Manage Behavior

Learn effective behavior management strategies. Ideally, you want to encourage positive behaviors. Reward with praise such as “I like how you put your books away when you finished.” Sometimes your child will break the rules. Be flexible but consistent in holding them accountable. Mistakes are often perfect teachable moments.

If your child has the diagnosis of ADHD, they have the right to be on a 504 Plan and accommodations in the school. Examples of some accommodations for a child with ADHD would be to sit at the front of the class, space between the child’s desk and the desks of the other students, written daily schedule or picture schedule, extra set of textbooks to keep at home, and breaking lessons down into sections, etc.

Knowing how to best help your child succeed in the classroom and at home will help them be able to become a successful adult. Adults who struggle with ADHD who were not properly guided or went undiagnosed as a child will struggle with a multitude of challenges. These challenges are, but not limited to:

  • Lack of focus
  • Hyperfocus
  • Time management skills
  • Disorganization
  • Forgetfulness
  • Impulsivity
  • Poor self-esteem
  • Emotional regulation
  • Lack of motivation
  • Anxiety and restlessness
  • Fatigue
  • Poor relationships

If you suspect your child may struggle with ADHD, bring your concerns to their doctor and request a DSM-5 be done. If your child does indeed have ADHD, help them learn essential life skills to become the best and most successful version of themselves that they can be. It will also require a little extra patience on your end as they find their new normal.

-The Lazy Mama

 

 

Poem, Author Unknown

A.D.H.D.

Take my hand and come with me,
I want to teach you about ADHD.
I need you to know, I want to explain,
I have a very different brain.
Sights, sounds, and thoughts collide.
What to do first? I can’t decide.
Please understand I’m not to blame,
I just can’t process things the same.
Take my hand and walk with me,
Let me show you about ADHD.
I try to behave, I want to be good,
But I sometimes forget to do as I should.
Walk with me and wear my shoes,
You’ll see its not the way I’d choose.
I do know what I’m supposed to do,
But my brain is slow getting the message through.
Take my hand and talk with me,
I want to tell you about ADHD.
I rarely think before I talk,
I often run when I should walk.
It’s hard to get my school work done,
My thoughts are outside having fun.
I never know just where to start,
I think with my feelings and see with my heart.
Take my hand and stand by me,
I need you to know about ADHD.
It’s hard to explain but I want you to know,
I can’t help letting my feelings show.
Sometimes I’m angry, jealous, or sad.
I feel overwhelmed, frustrated, and mad.
I can’t concentrate and I lose all my stuff.
I try really hard but it’s never enough.
Take my hand and learn with me,
We need to know more about ADHD.
I worry a lot about getting things wrong,
Everything I do takes twice as long.
Everyday is exhausting for me…
Looking through the fog of ADHD.
I’m often so misunderstood,
I would change in a heartbeat if I could.
Take my hand and listen to me,
I want to share a secret about ADHD.
I want you to know there is more to me.
I’m not defined by it, you see.
I’m sensitive, kind and lots of fun.
I’m blamed for things I haven’t done.
I’m the loyalist friend you’ll ever know,
I just need a chance to let it show.
Take my hand and look at me,
Just forget about the ADHD.
I have real feelings just like you.
The love in my heart is just as true.
I may have a brain that can never rest,
But please understand I’m trying my best.
I want you to know, I need you to see,
I’m more than the label, I am still me!!!!
Author Unknown

❤️❤️❤️❤️❤️❤️❤️❤️

The Results Are In!

It finally happened! After pushing and fighting for my son for so long, the ADOS was scheduled! The Autism Diagnostic Observation Study is a 2-3 hour where they have a script of things to say, ask, or do with certain toys or objects and write down word for word what the child says or how they respond to the situation. Dr. G would bring out a tiny doll set with a mommy, daddy, brother, and baby and then create a situation for them like saying, “Uh-oh, the baby is crying.” Then wait for Killian to respond, if nothing happened she would repeat herself saying the exact same thing. She used different scenarios and would write his response. Then she brought out a few random objects to see what he would do with them. One of them was a CD and Killian was overly fixated on the colors as the disc spun with “atypical visualization.” He would continue to spin it and intently watch in silence and was seemly oblivious to what was being said and done around him. During the Lego portion he would ask for more pieces without making eye contact and instead hyperfocused on the dragon that he was creating. Dr. G would not respond to him the several times he asked until he would make brief eye contact and tell her he needs more pieces, then she would acknowledge his statement and reply.

During the make-believe portion of the test, Killian had a very difficult time pretending that one object was something else. He did not respond well to social intrusion and would become upset if Dr. G would try to play along with him. The dolls were always referred to as “that guy” or “this guy” instead of by name or pronoun of mommy/daddy/sister/brother. When she would grab the disc and say, “This is a space ship,” Killian would reply with an irritated voice, “No, it’s a disc.”

He exhibited functional play with cause-and-effect toys and throughout the entire 3 hours his sentences were disjointed and sometimes incoherent even though his words were said in a correct fashion and included some complex vocabulary. He would engage in brief conversation but usually it was only with topics of his choosing or interest, otherwise he would ignore or even start talking about something completely off topic. He showed zero interest or even recognition in Dr. G’s feelings or emotions when the social press portion of the exam took place. His eye contact was fleeting during the Reciprocal Social Interactions segment. His imagination was limited in play and in the end he met the cut-off criteria for Autism in the ADOS-2 classification.

Based off of my large family history of anxiety and the results of the DSM-5 questionnaire that I and his teacher, Mrs. E, filled out, in addition to the behaviors witnessed during the ADOS, Killian tested positive for Autism and Generalized Anxiety Disorder. His anxiety results showed high levels during social peer interactions and communications.

Killian was also diagnosed with Sensory Processing Disorder and ADHD (Attention Deficit Hyperactivity Disorder). Ya, I know, It’s a lot. But you know what? The second I got off the phone with Dr. G and I had conformation that proved my claims correct, I printed up the copies of his ADOS progress notes and diagnostic results and I danced around my front room. I felt like I could finally breath as a huge weight had been lifted off of my shoulders. My heart didn’t feel as heavy and my stress melted away. I finally had answers and reasoning! I finally had proof!

Now, this is going to sound really bad but there is truth in this. Autism is “The Golden A.” As soon as that diagnosis has been given and the child has been labeled as Autistic, your world has COMPLETELY opened up to specialists, therapists, school mandated assistance that the law will crack down on to make sure that it is being held to the letter. An IEP will be written and I PRAY that he will be given a one-on-one aide at school, even just part-time for the most troublesome parts of his day once he starts Kindergarten in September.

And as happy as I am with all of this, I am also extremely overwhelmed and my anxiety starts creeping in. I start wishing that I had a personal assistant to help me schedule my life. We are now adding ABA Therapy (Applied Behavioral Analysis) to this schedule along with speech therapy and an audiology screening. I am having to call and find people who accept his insurance AND are accepting new patients. I have to fill out even more paperwork for each of those places and add him to the waitlist hoping that a slot will open up for him before he ages out of the specific program that would be best suited for him. I am trying to figure out when we can schedule appointments around school, behavioral therapy, chiropractic care, occupational therapy, little brother’s speech therapy, and the everyday doctor’s appointments like dentists, general practitioners, and pediatrician appointments.

This is all just the very beginning but I am happy to be where I am now.

And then the realization hit that I still needed to break the news to my husband. The man who hears the word Autistic and only sees the kid flapping his hands in the corner of the room while rocking and making the same loud sound over and over again. The man who thinks that Autism means that the child is mentally retarded and can’t do anything. The man who told me he didn’t want to put a label on his son when I told him about the ADHD diagnosis and said that it doesn’t matter because it won’t change how he is with him and then said he doesn’t want to talk about it. The man who used to tell me that everything that was wrong with Killian was my fault and that there is something wrong with me.

To say that my anxiety was in full blast was an understatment. I didn’t know how to tell him. He can be a conspiracy theorist when it comes to doctors and will say that they don’t know what they are talking about and are only trying to get money out of you. I was scared that when I told him, he would respond with all those thoughts and reactions geared at me again. I was terrified that he would be in denial and say that the doctors and myself don’t know anything and that there is nothing wrong with him. He would see the very physically capable son of ours and say, “Look at him! He can walk, talk, and do everything that any normal kid can do. He isn’t sick or dying! He is perfectly fine and there is nothing wrong with him! He just needs more discipline and you aren’t being strict enough with him! It’s your fault for the way he acts!” Every one of my fears about our marriage falling into the statistic of divorce with a special needs child came to me. Even though we both are very against the idea of divorce (obviously in the instance of abuse we believe safety comes before staying).

I was scared. I know I needed to tell him. I needed it not only for our marriage and the fact that he is the father of this child and deserves to know what is going on with his son, but I needed to tell him for me. I needed help with my stress and the weight of going through everything completely on my own for so long. Even though he is not an emotionally empathetic man, I needed my husband to share in this new life WITH me.

So, one night after I put the boys to bed, I asked him to pause his game because I needed to talk to him about something very important. I told him that it was regarding Killian and that I was really nervous to tell him. He got worried that something deadly was wrong and I immediately squashed that fear so he then got frustrated and told me to just spit it out because he needed to know if there was something going on with his son. I reminded him about all of the therapies and doctor’s appointments and evaluations and testings that I had mentioned to him that I have been taking Killian to and he said yes. I then let him know that I got the results back.

I took a deep breath and said, “Killian has been diagnosed with High Functioning Autism, ADHD, Generalized Anxiety disorder, just like my entire family and myself have, and Sensory Processing Disorder.” To which he just calmly replied with, “OK. Is that it?”

I was pretty taken aback. I mean, on one hand I’m like, Is that it?! That’s a long list dude!  And on the other hand I’m thinking Oh thank God! That went WAY better than I had anticipated.

I asked him if he believed us and he said yes and asked why he wouldn’t. I told him that he normally says doctors don’t know anything and make things up and he says, all shocked, “When have I ever said that?!”

“Umm..like EVERY time you go to the doctors.”

“Oh well that’s different. That’s for me,” he says. As if that makes all the difference in the world. *Rolls eyes*

I asked if he had any questions and he said that he didn’t. We did the tests and paperwork and this is what it says. He said he knows that Killian is a little different from other kids his age but he will never love him any less.

I started crying. I told him that I was so afraid to tell him and when I told him why, he said he has no memory of ever telling me those hateful things about it being all my fault or that something was wrong with me. He apologized for having ever said it and asked me to please forget that he ever did since he doesn’t even remember it. I explained to him why I am always so stressed and exhausted when he gets home from work is because my brain never shuts off. I am constantly thinking of things that I need to get done in the house, or appointments that I need to make, doctors I need to call, therapy schedules, school and how he was sent to the office twice this week for hitting kids and the teacher. I told him that I really needed his help carrying this responsibility. Even if that just means he take a little more initiative around the house and with the boys before they go to bed or let me be cranky and frazzled until they are in bed and I can just sit down and talk to him.

He then took it a giant step forward and apologized for adding to my stress by not being more self-reliant and always asking me to do everything for him (find his glasses, get his night-time meds, get him food/drink, etc.) when he is fully capable of doing simple tasks for himself instead of asking me to go and do things for him while I singlehandedly get the boys fed, food put away, get them in their jammies, teeth brushed, and into bed while he stays laying on the couch playing a video game.

That realization and apology was not at all expected but it is definitely VERY appreciated and welcomed.

My friends and family have been praying for me and for my husband’s mind to be open and accepting of this information. And to them, I again thank you.

Our journey has only just begun and I know that there will be a lot of trials and tribulations ahead. But for now, I am rejoicing in the answers we have and the acceptance that was made.

-The Lazy Mama