Focusing on ADHD

Attention deficit hyperactivity disorder is a widespread issue for many Arkansas families.

By Dwain Hebda

Focus on ADHD

Scarcely even heard of 20 years ago, attention deficit hyperactivity disorder (ADHD) has grown to become one of the most commonly diagnosed conditions, towing with it an entire cultural shift in treatment, terminology, institutional awareness and accommodation.

“ADHD is sort of a diagnosis in self-regulation,” said Dr. Adam Benton, co-founder of Arkansas Families First in North Little Rock. “It’s the brain’s ability to regulate attention, behavior and other executive functioning skills.” Benton said common behaviors associated with ADHD include an inability to follow through on multistep tasks, distractibility and impulsivity. Diagnosis tends to be more common after a child starts school, as it is there they are being asked to sit still, pay attention and follow a fairly narrow set of behavioral rules.

“Most of the time that’s when it comes out. In fact, most people who evaluate for ADHD tend to delay diagnosis until kindergarten, first or second grade,” Benton said. “In severe cases, certainly, you can do psychological testing and have the diagnosis earlier but it’s not as likely.”

The Centers for Disease Control and Prevention reports 8.8 percent of U.S. children ages 4-17 had the condition in 2011, up from 7.2 percent just four years earlier. Arkansas’s diagnosis rates were considerably higher than the national average over that same period, growing from 10.9 percent in 2007 to 14.6 percent in 2011.

But the chasm between the state and national diagnosis rates has widened in recent years. Arkansas’s instance of ADHD was 3.7 percent higher than the national average in 2007; by 2011 that gap had ballooned to 5.8 percent and the state’s rank had risen from fifth in the country to second.

Yet despite the prevalence of the condition, science is still at a loss to explain exactly what causes it. Even the National Institute of Mental Health, a federal agency that is part of the U.S. Department of Health and Human Services, can only suggest contributing factors such as genetics, low birth rate, brain injuries and poor prenatal care.

Preliminary diagnosis can, and often is, made in the pediatrician’s office, commonly followed up by a formal evaluation by a psychiatrist, counselor or psychologist. In many cases children exhibit the classic fidgety, hyperactive symptoms, while others are more subtle.

“Inattentive-type ADHD is more commonly overlooked because it gets less attention in the classroom,” Dr. Benton said. “It is often discovered later when school is more difficult and the child can’t keep up with demand.”

Once a child is diagnosed with ADHD, parents should immediately work with their school administration to arrange for learning accommodations. Typically, a letter from the pediatrician, psychologist or psychiatrist verifying the diagnosis is required, and it has to be shown ADHD is disrupting the child’s adjustment in school, be it academic, behavioral or social.

“Children whose ADHD impairs their functioning, in a school that receives federal funds, have a legal right to academic accommodations through what’s known as a 504 Plan,” Dr. Benton said. “Once a parent requests that a child receive a 504 evaluation, the school is obligated to consider if the child meets criteria.”

School accommodation, while crucial for the student’s success, can be a double-edged sword. Preferential seating, alternate testing arrangements or reduced workload are essential for the child to succeed academically. But they also unavoidably shine a light on their condition, which some students may start to view as a crutch or excuse. Parents need to educate themselves, Dr. Benton said, to be able to walk the line between the two.

“There are still a lot of myths about ADHD,” Dr. Benton said. “A lot of times I’ll hear things like, ‘Why can my child pay attention to video games, but they can’t pay attention in class?’ Well, video games are really, really interesting. There’s lots going on, they’re constantly changing, they’re pretty stimulating. Parents need to be educated about what [the condition] really means.”

One local source for that education is the Centers for Youth and Families, which offers a class, “Parenting the ADHD Child.” Beth McAlpine teaches the six-hour course, spread out over three evenings. She said the range of those in attendance shows the scope of the issue in Arkansas.

“We have parents, grandparents, teachers, sometimes we have therapists and tutors that work with kids who have ADHD,” she said. “All sorts of people who want to come and get more information about what’s going on in the child’s brain, how to handle that, the ways that they’re thinking. They are looking for different techniques to make it easier to communicate, but also to give the child coping skills.”

“When a child has ADHD, their brain works 95 percent differently than their peers’ and probably from the way that teachers and other people are communicating with them. They process everything differently, they think about everything differently. They’re not using all the same executive functions, that impulse control, empathy and decision-making.”

When most people think of treatment options, they automatically think of medication and with good reason—almost 5 percent of all U.S. children were taking medication, for ADHD in 2007, a number that rose slightly by 2011. In Arkansas, 7.5 percent were taking ADHD meds in 2007, and just four years later, nearly one in 10 were.

While in many cases medication is the best course of treatment, McAlpine said behavior therapy can also be used effectively, depending on circumstances. Parents should be sure to examine all of their options and not automatically assume pills are the answer.

“There are seven types of ADHD and there are some other conditions that go along with ADHD,” she said. “If you walk into a doctor’s office and they want to immediately come in and put the child on medication before they give you all the information about what’s causing it, I tell parents to stop right there. Find some other resources, get a second opinion, go see a psychiatrist or a behavior therapist or a counselor that has more information and can take a better look and do some more diagnostic testing.

“Try some of these other things, because medicine only makes the behavior go away while you’re on it. It also takes a lot of repetition and a lot of practice, and these kids don’t have that. Plus, if you take the child off the medicine, the behavior comes back. So, along the way you have to be teaching them how to cope and how to find that self-control.”