ADHD has got to be one of the most talked about disorders in the media today. I see everything from radio show posts to facebook memes talking about it. And I’ll admit to you that almost nothing stresses me more than seeing so much faulty information about ADHD out there in the media. I have been working with children who have ADHD for more than 25 years, and it pains me to see so much misinformation still so prevalent.
There is a lot of information about medication for ADHD and other types of treatment. How can a parent know what is best? How do you know if it really is ADHD?
In order to know what treatment is best, you must first start with a proper diagnosis. You don’t go to your family physician and have them just start handing out antibiotics, right? They have to know that what they are treating is the right match for the treatment.
Well, it is my opinion that really the only way to determine whether a child has ADHD is with something called “cognitive” testing done by an experienced Neuropsychologist.
Brain scans do not show ADHD… no, not even PET scans. A lot of very wealthy investors want you to believe that ADHD shows up on these scans, but in blind studies, the people giving these scans could not differentiate ADHD from other disorders, or no disorder at all.
Psychiatrists, psychologists who do not do “testing,” and pediatricians are permitted to diagnose ADHD, but they do so primarily based upon reports from the teachers and the parents. And since teachers and parents are not qualified to diagnose ADHD, or understand how it mimics other problems and greatly over-diagnose ADHD, this has lead to the current situation in which ADHD is overdiagnosed in our nation as a whole. Almost all people, including children and adults who do not have ADHD, focus better on medications for ADHD; so if a pediatrician gives a medication for ADHD, and the child does better, they assume they had the right diagnosis. This is very problematic.
With cognitive testing, a Clinical Neuropsychologist can look at the FUNCTIONALITY of the brain. We give many many types of tests, designed to tap into how the brain is functioning in many different ways and in different parts of the brain. When we see a pattern of function that is showing us clear deficits in the prefrontal cortex, compared to other areas, it is likely to be ADHD. These evaluations also allow us to look at many other types of factors: emotions, behavior, family dynamics, school and environment, health, injury history. They also allow us to rule out other causes or multiple causes. Remember that the point of diagnosis is to match the treatment to the problem. This is never so effective as when conducted by a neuropsychologist.
Is medication the only solution? What can be done?
The issue of whether to medicate a child with stimulant drugs is a deeply personal choice that should be made between the psychologist, the physician, and the parents of the child. No one has a child’s interests at heart more than their parents, but at times, parents can be too either eager to use medications (because the lifestyle and schooling has become so unmanageable) or too resistant to medication (because they’ve heard myths about their kids getting “hooked” or turning into “zombies.”)
A big part of the equation on whether or not to use medication stems from how severe the child’s symptoms are. If the symptoms are relatively mild, other approaches may be helpful. In very severe cases, I am a proponent of medication because severe ADHD can have long-lasting and very harmful effects on learning and educational achievement, later occupational successes, self-perception, depression, anxiety, friendships, romantic relationships, and being able to function in society. The child’s health history and reaction to medications must be considered. A psychologist can see how much of the difficulties can be addressed behaviorally, as to minimize the need for medications.
There are other treatment approaches. And while none of them show the efficacy of medications in clinical studies, there are many families which prefer to use these options, especially if the symptoms are milder or this is a better fit for their value system. These interventions may involve changes in nutrition, exercise, changes in environment, pacing and scheduling, holistic care, and alternative (and soothing) options like yoga. I often say to parents that there is no real harm in throwing all of these options at the child, and then see if it is enough to give the child the improvements and benefits before going to medication.
But if you do decide to go the medication route, realize that if your child is now a “zombie,” then something is wrong with their dosage. The best result is when your child is able to enjoy life and learning, not fit into a perfect mold of the perfect child. If your child seems too sedated, or has an unusual reaction, go BACK to your physician, talking about your fears and what you see, and allow your doctor to try some different medications or dosages before giving up. It can take up to a couple of months to find just the right fit for a child.
Stimulant drugs can be habit inducing, and there is good reason not to take them if they are not needed. They have been abused by teens and adults alike, often as a way to lose weight. But, this rarely happens at the doses that are prescribed for children, and rarely if the child indeed has ADHD. It is in taking stimulants when there is NOT a true ADHD that the drugs run a higher risk of dependency. This is another argument for taking the time, effort, and care to have the diagnosis confirmed by a Clinical Neuropsychologist.
Here are some non-medication options:
Nutrition – the research is still out on this. It may not be the presence of sugar, but the lack of overall nutritional support. There are some theories that children who have a gluten sensitivity are not getting the nutritional support they need. This has not been shown sufficiently in the Neuropsychological literature, but try focusing your child’s diet on a very well rounded access to vegetables, protein, and fruit, minimizing cereals, sugars, flour, and snack foods.
Chiropractic care – Again, psychological-chiropractic studies are few and far between, but chiropractors believe that by balancing the central nervous system through adjustments, the child’s overall neural function will improve, and they point to many correlational studies that suggest this may be the case.
Acupuncture – There are some early studies that may show benefit here. Acupuncture has been shown in correlational studies to temporarily decrease some of the ADHD symptoms, but not everyone benefits in the same way. It won’t hurt to try.
Behavioral and Environmental Changes – Issues such as organization, sleep, discipline, scheduling, etc. may have an impact on how severe the ADHD manifests. Seek a behavioral specialist/psychologist to evaluate possible improvements or ideas in these areas.
Sleep – Sleep is essential, and yet children with ADHD universally have complaints of insomnia. Consider working with a psychologist or sleep specialist to address these matters.
Exercise – Kids with ADHD NEED to move. They have to move like a fish needs water. Get them outside, running, biking, playing sports. That endorphin benefit may help them calm.
Yoga – For some kids who have mild ADHD, yoga alone may be helpful in mitigating their symptoms. The ability to self-sooth through yoga, combined with the physical movements may allow them to “teach” their brain how to self-sooth and self-calm.
Educational interventions – Working with a Clinical Neuropsychologist and/or school specialists may allow for changes in the classroom that may help the child with ADHD. For example, shorter instructions, more frequent breaks, moving their desk to the front of the classroom, minimizing distractions (such as unnecessary decorations and toys), altering how much time they have to complete a task, studying with headphones (with or without music), all of these interventions may allow the child to focus better in the classroom.
There is a lot of information about medication for ADHD and other types of treatment. How can a parent know what is best? How do you know if it really is ADHD?
In order to know what treatment is best, you must first start with a proper diagnosis. You don’t go to your family physician and have them just start handing out antibiotics, right? They have to know that what they are treating is the right match for the treatment.
Well, it is my opinion that really the only way to determine whether a child has ADHD is with something called “cognitive” testing done by an experienced Neuropsychologist.
Brain scans do not show ADHD… no, not even PET scans. A lot of very wealthy investors want you to believe that ADHD shows up on these scans, but in blind studies, the people giving these scans could not differentiate ADHD from other disorders, or no disorder at all.
Psychiatrists, psychologists who do not do “testing,” and pediatricians are permitted to diagnose ADHD, but they do so primarily based upon reports from the teachers and the parents. And since teachers and parents are not qualified to diagnose ADHD, or understand how it mimics other problems and greatly over-diagnose ADHD, this has lead to the current situation in which ADHD is overdiagnosed in our nation as a whole. Almost all people, including children and adults who do not have ADHD, focus better on medications for ADHD; so if a pediatrician gives a medication for ADHD, and the child does better, they assume they had the right diagnosis. This is very problematic.
With cognitive testing, a Clinical Neuropsychologist can look at the FUNCTIONALITY of the brain. We give many many types of tests, designed to tap into how the brain is functioning in many different ways and in different parts of the brain. When we see a pattern of function that is showing us clear deficits in the prefrontal cortex, compared to other areas, it is likely to be ADHD. These evaluations also allow us to look at many other types of factors: emotions, behavior, family dynamics, school and environment, health, injury history. They also allow us to rule out other causes or multiple causes. Remember that the point of diagnosis is to match the treatment to the problem. This is never so effective as when conducted by a neuropsychologist.
Is medication the only solution? What can be done?
The issue of whether to medicate a child with stimulant drugs is a deeply personal choice that should be made between the psychologist, the physician, and the parents of the child. No one has a child’s interests at heart more than their parents, but at times, parents can be too either eager to use medications (because the lifestyle and schooling has become so unmanageable) or too resistant to medication (because they’ve heard myths about their kids getting “hooked” or turning into “zombies.”)
A big part of the equation on whether or not to use medication stems from how severe the child’s symptoms are. If the symptoms are relatively mild, other approaches may be helpful. In very severe cases, I am a proponent of medication because severe ADHD can have long-lasting and very harmful effects on learning and educational achievement, later occupational successes, self-perception, depression, anxiety, friendships, romantic relationships, and being able to function in society. The child’s health history and reaction to medications must be considered. A psychologist can see how much of the difficulties can be addressed behaviorally, as to minimize the need for medications.
There are other treatment approaches. And while none of them show the efficacy of medications in clinical studies, there are many families which prefer to use these options, especially if the symptoms are milder or this is a better fit for their value system. These interventions may involve changes in nutrition, exercise, changes in environment, pacing and scheduling, holistic care, and alternative (and soothing) options like yoga. I often say to parents that there is no real harm in throwing all of these options at the child, and then see if it is enough to give the child the improvements and benefits before going to medication.
But if you do decide to go the medication route, realize that if your child is now a “zombie,” then something is wrong with their dosage. The best result is when your child is able to enjoy life and learning, not fit into a perfect mold of the perfect child. If your child seems too sedated, or has an unusual reaction, go BACK to your physician, talking about your fears and what you see, and allow your doctor to try some different medications or dosages before giving up. It can take up to a couple of months to find just the right fit for a child.
Stimulant drugs can be habit inducing, and there is good reason not to take them if they are not needed. They have been abused by teens and adults alike, often as a way to lose weight. But, this rarely happens at the doses that are prescribed for children, and rarely if the child indeed has ADHD. It is in taking stimulants when there is NOT a true ADHD that the drugs run a higher risk of dependency. This is another argument for taking the time, effort, and care to have the diagnosis confirmed by a Clinical Neuropsychologist.
Here are some non-medication options:
Nutrition – the research is still out on this. It may not be the presence of sugar, but the lack of overall nutritional support. There are some theories that children who have a gluten sensitivity are not getting the nutritional support they need. This has not been shown sufficiently in the Neuropsychological literature, but try focusing your child’s diet on a very well rounded access to vegetables, protein, and fruit, minimizing cereals, sugars, flour, and snack foods.
Chiropractic care – Again, psychological-chiropractic studies are few and far between, but chiropractors believe that by balancing the central nervous system through adjustments, the child’s overall neural function will improve, and they point to many correlational studies that suggest this may be the case.
Acupuncture – There are some early studies that may show benefit here. Acupuncture has been shown in correlational studies to temporarily decrease some of the ADHD symptoms, but not everyone benefits in the same way. It won’t hurt to try.
Behavioral and Environmental Changes – Issues such as organization, sleep, discipline, scheduling, etc. may have an impact on how severe the ADHD manifests. Seek a behavioral specialist/psychologist to evaluate possible improvements or ideas in these areas.
Sleep – Sleep is essential, and yet children with ADHD universally have complaints of insomnia. Consider working with a psychologist or sleep specialist to address these matters.
Exercise – Kids with ADHD NEED to move. They have to move like a fish needs water. Get them outside, running, biking, playing sports. That endorphin benefit may help them calm.
Yoga – For some kids who have mild ADHD, yoga alone may be helpful in mitigating their symptoms. The ability to self-sooth through yoga, combined with the physical movements may allow them to “teach” their brain how to self-sooth and self-calm.
Educational interventions – Working with a Clinical Neuropsychologist and/or school specialists may allow for changes in the classroom that may help the child with ADHD. For example, shorter instructions, more frequent breaks, moving their desk to the front of the classroom, minimizing distractions (such as unnecessary decorations and toys), altering how much time they have to complete a task, studying with headphones (with or without music), all of these interventions may allow the child to focus better in the classroom.
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