Tuesday, January 17, 2017

ADHD- Where Do Parents Start?

January 17, 2017
Sarah Danahy, LCSW 

ADHD- Where do Parents Start?

I think my very first 8 year old client in 2001 was diagnosed with ADHD. He came to me with the diagnosis and so I just kept it and wrote it into my progress note every week. I assumed that the provider who assigned him the diagnosis had made an accurate and thoughtful decision based on what parents and teachers reported: He was fidgety in class, he never looked at the board in front of the classroom, he was frequently staring off into space, he appeared distracted, and his grades were not reflecting his true abilities. He appeared to meet all of the criteria of Attention Deficit Hyperactivity Disorder.
Several months later, I attended a professional development training on the topic of ADHD. The training focused on all of the possible reasons a child looks like a child with ADHD. The very first item I learned to rule out: When was the last time the child had a vision screening? This is where my passion for accurate ADHD diagnosing began.
 I started pulling all of my Social Work 101 knowledge out of the basement of my brain…what if a child isn’t feeling well? He probably looks fidgety… what if he hasn’t eaten breakfast today? He is likely not focusing… what if her parents argued last night and she is feeling anxious today? She’s not going to want to learn about math. WHAT IF HE CAN’T SEE THE WHITEBOARD? He’s not going to look to the front of the class, or pay attention, or understand what is being taught, or receive grades that accurately reflect his true abilities!

These are the most frequent questions and statements I hear in my office on a weekly, sometimes daily, basis from parents:
·         We keep getting notes from the teachers about his behavior, but we don’t want to do medication.
·         Should we take red dye and gluten out of her diet?
·         Her cousin is on ADHD medications and he’s like a walking zombie
·         Should we try chiropractic?
·         My husband has ADHD and he never took medication and he turned out just fine.
What do these all have in common? They are questions and statements about treatment for ADHD. I rarely get questions about “What else could it be?”

My number one goal as a behavioral health provider assessing for ADHD is to thoroughly and comprehensively rule out as many disorders, medical issues, and environment issues that may be presenting as ADHD, as possible.

How is ADHD Diagnosed?
The American Academy of Pediatrics recommends that the necessary criteria be met per the Diagnostic and Statistical Manual of Mental Disorders.  Some of these criteria include: often fails to give close attention to details, often has difficulty sustaining attention, often does not follow through with tasks. Sound like every child you know? This is why the second part is so important: rule out other mental health disorders, medical issues, and other environmental factors. Otherwise known as (in my practice) CAN HE SEE THE WHITEBOARD?

Often, the pediatrician, or therapist will require checklists to be completed by parents and teachers in order to gain a broad perspective of the child’s behaviors. A physical, or other medical tests may also be ordered in order to rule out vitamin deficiencies, or vision problems.

Is ADHD Overdiagnosed?
Yes and No. There are many, many factors that I believe contribute to the increase in ADHD diagnoses- too many to list here. (maybe a future article?)
 A large factor, in my opinion, is the changing school curriculum for young children. Dr. Leonard Sax writes in his book Boys Adrift, “…“Kindergarten” isn’t kindergarten anymore….In 2008, the kindergarten curriculum at most North American schools..looks very much like the first grade curriculum of 1978.”

In addition to school curriculum, why are males diagnosed more frequently than females? Does the increase in video games play a role in our children becoming less active, and therefore, more fidgety when required to sit still and pay attention? Are classroom sizes too large to allow teachers to provide flexible learning? Are teachers offered the resources required to create flexible learning environments? The questions could go on forever and every expert has a different opinion on them.

Where to Turn for Help
If you are a parent questioning the possibility of ADHD in your child, or someone has said to you “maybe he has ADHD” and you immediately started googling every article on ADHD meds- Stop. Take a breath, and make an appointment with your pediatrician, or find a respected therapist who specializes in Attention Deficit Hyperactivity Disorder. Take your time on the front end of the diagnosis before you stress out about treatments.
I always suggest www.chadd.org as a wonderful resource for parents as well.

Lastly, don’t forget to ask your child the most important question:

Sarah Danahy is a Licensed Clinical Social Worker at Esprit Counseling and Consulting in Neenah, WI. Sarah graduated from The University of Michigan and has since worked in a variety of clinical and medical settings, specializing in the treatment of mental health disorders in children, adolescents, and families. She has a special interest in the diagnosing of ADHD and the impact of ADHD on children and their families. To make an appointment with Sarah, please go to www.espritcounseling.com