January 17, 2017
Sarah Danahy, LCSW
ADHD- Where do Parents Start?
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:
CAN
YOU SEE THE WHITEBOARD?
