THERAPIST THURSDAY: Does Someone You Know Have ADD/ADHD?

Unfortunately, for quite a few years, ADHD/ ADD seemed to be a catch-all diagnosis, often given to any child who seemed to have a lot of energy or was distracted or disruptive in class. There are some estimates that as many as one million children in the United States may be misdiagnosed with this disorder. This over-diagnosing has caused even more confusion about the diagnosis and have led many in the general public to be suspicious of the diagnosis as a real condition.

I often work with parents who, understandably, have concerns about the validity of this diagnosis for their child. They express concern that because it seems like “everyone” has the diagnosis, they have doubts about its existence and are often concerned it may be being used as an “excuse” or a way to not have to deal with a more challenging child in the school setting. Also, a misunderstanding of how ADHD presents often leads to confusion as well. For example, parents often tell me that their child could not have ADHD because he/ she is able to focus on video games for hours without attending to anything else. How can a person with such precise focus possibly have a diagnosis that involves impairment in focus? Let me explain. ADHD does not mean that a person is unable to focus. A brain without ADHD takes in stimuli and filters it similarly to a colander filtering spaghetti, holding in the noodles, and letting out the water. Our brains do the same thing with the wealth of stimuli it is taking in throughout the day. Our brain determines what information is relevant and needs to be noticed, and what needs to be filtered out. It knows all of the stimuli is there, and if something should change and that irrelevant stimuli suddenly becomes relevant, the focus can switch. For example, someone calling our name or a loud noise of some sort will cause a switch of focus. But for a brain with ADHD, that filter does not work in the same way. This brain over-focuses; it focuses on the stimuli at the expense of all other stimuli. So the video games may be focused on, but then the child may not hear their name being called or that loud noise that just happened near them. Their filter does not work properly. If they focus, it is more like a solid wall than a colander with holes in it.

DIAGNOSIS:

To fully understand the diagnosis, some basic information is helpful. ADD without hyperactivity is no longer an accurate diagnostic term. The correct term is ADHD. There are three presentations of ADHD: 1. predominately Inattentive, 2. predominantly Hyperactive-Impulsive, and 3. Combined (meeting the diagnostic criteria of both of the other presentations). To meet the diagnostic criteria for ADHD, the symptoms must be present in at least two settings and must interfere with or reduce the quality of the person’s functioning. A person can have ADHD without hyperactivity (this is the inattentive presentation). This child is more likely to be undiagnosed, because they don’t necessarily stand out in a school setting. They are not likely to be disruptive in school in the way that person with hyperactive-impulsive presentation can be. Their symptoms are more likely to be confused with laziness or lack of caring.

If you suspect that a child you know may have ADHD, here are a few things to ask yourself (this is not a comprehensive list by any means, rather a few things to consider to determine if a further assessment may be warranted):

· Is your child unorganized? A chaotic environment, disastrous backpack, a bedroom always in extreme disarray can be a sign of ADHD.

· Does your child seem to have difficulty understanding time (in a way that seems inappropriate for their age)? If a person is always late or the simplest tasks seem to take forever, this could be a sign of ADHD.

· Does your child seem to have difficulty following a list of things to do, even a simple list with only a few items on it?

· Does your child have difficulty transitioning from one task to another?

· Does your child do homework but then forget to turn it in?

· Is homework a daily struggle, with everything else seeming to compete for her attention?

· Does your child have issues with impulsivity? Does he seem to have difficulty keeping his hands to himself? Does he seem to need to touch everything or climb on everything? Does it seem that he does things without thinking about them first? Does she lie a lot, often without thinking first?

· Does your child lose things often?

· Is your child hyperactive? Does she fidget constantly and have difficulty keeping still?

If any of these issues seem familiar to you, it may be time for a thorough assessment. The sooner this issue is diagnosed, the better the prognosis. I often work with kids and teens who were not diagnosed until years after their symptoms became evident. I find this unfortunate, because then the person not only has to learn to cope with the challenges this diagnosis presents, but they also have to overcome the way in which this issue has impacted their sense of themselves. For example, it is very common for the person to believe they are not very smart, or that they are a problem child, or that they are “always in trouble.” This negative self-concept has then exacerbated the issue over time and now they have to learn to reconceptualize themselves and come to believe that they can be successful at meeting their goals. Because, when we believe something about ourselves, we tend to do things that reinforce that belief system. If a person with ADHD can get intervention as soon as possible, then they are able to learn the skills necessary to manage their symptoms and reduce the impact it has on their lives. And there are less negative self-image issues that need to be dealt with.

TREATMENT:

Once a thorough assessment has been completed and a diagnosis made, treatment needs to occur. The most effective treatment for ADHD is a combination of medication and psychotherapy. While some individuals elect not to medicate their child, the research is clear that the combination of the two treatments is the most effective treatment approach. Parents are often understandably very apprehensive to medicate their children. When this is the case, my approach is to use psychotherapy alone and see what progress can be made, and then evaluate if it has reduced symptoms enough to be effective. Sometimes the person is able to progress to the point where their symptoms are not very disruptive of their lives and they are able to meet the expectations of school and family. Sometimes there are still significant symptoms present even with psychotherapy, and then the parents must decide if they want to add medication to the treatment plan to create more effectiveness.

Personally, I see medication as a last resort and am not likely to take medication, even when sick, unless I really need to. But when it comes to ADHD, I explain it to parents this way: if your child had a physical illness or disease that required medication, that medication would be provided without hesitation. For example, if your child was diabetic and required insulin, there would not be a doubt as to what to do. ADHD is a physical ailment as well, it is just that the origin of it is in the brain, and the symptoms are behavioral. But it is just as real of a physical issue as another other physical issue. Your child can not decide to do it differently any more than they could decide to regulate their blood sugar if they had diabetes. Fortunately, our brains can change and make new neurological connections, and psychotherapy can create these changes. And there are situations in which the changes made by psychotherapy are sufficient to alleviate the symptoms for the person. In these cases, medication is not necessary. But if the change is not enough, rather than having the individual continue to suffer, not reach their full potential, and develop a negative self-image, it may be appropriate to consider adding medication to the treatment regimen.

It is my hope that this article provided some valuable information about what ADHD really is, what it looks like, and how it can be treated. Like most issues, if a person has a proper assessment and an appropriate treatment plan, the changes that can occur can be lifechanging. There have been so many advances in our understanding of the causes and treatments of ADHD that it is completely unnecessary for anyone to suffer in silence. If you suspect someone you know may have ADHD, I urge you to take the steps necessary to address the issue!

If you have a topic you would like addressed in our weekly Therapist Thursday column, please email Rochelle at meetme4therapy@gmail.com.

Rochelle Whitson is a psychotherapist in private practice in Temecula, CA. She is also the author of the blog www.meetme4therapy.com.