Saturday, March 29, 2014

ADHD: What Is It?

Everyone and their dog has an opinion about ADHD.  All of it negative.  All of it freely dispensed to the parents of kids with ADHD.  People don't realize how we've heard it all before.  I'm here to tell you it's time to listen up.

Some stuff we hear frequently:

ADHD is SO overdiagnosed

ADHD is a label that follows your kid for their entire school career

Kids who are labelled ADHD just need more exercise
                                          ...just need to sit at the front of the class
                                          ...just need more sleep
                                          ...just need more structured parenting
                                          ...just need fewer restrictions
                                          ...just need to be attachment parented
                                          ...just need to be held
                                          ...just need vision therapy
                                          ...just need a spanking
                                          ...just need a better diet with no food dyes, additives, or sugar
                                          ...just need to be fed gluten free
                                          ...just need to be fed gluten, caesin, and dairy free
                                          ...just need glasses
                                          ...just need tubes in their ears
                                          ...just need less time in front of a screen
                                          ...just need their parents not to get divorced
                                          ...just need time to develop at their own pace

All of this may or may not be true, or mitigating factors in some cases.  But if we can break down ADHD into its actual component parts?  I think we can spread some understanding and stem the flood of negative feedback us ADHD parents receive.  Here are the symptoms of ADHD:

-highly distracted unless doing something 'fun'
-commonly make many careless mistakes
-frequently lose things
-difficulty following directions

-problems sitting still

-highly impulsive
-hard time waiting turns and sharing
-very impatient
-frequently interrupts others
-frequently blurts out answers or statements
-difficulty discerning consequences for various behaviours
-difficulty with decision making even if able to discern consequences

It is normal for kids to experience some or all of the above, sometimes.  Especially when children are quite small.  Which is part of the problem with the negative stigma that everyone and their dog attaches to the ADHD diagnosis; it all sounds normal.  What pushes the ball over from normal kid behaviour into abnormal and hence a possible disorder, is the frequency, intensity, and persistence of these symptoms.  The above list sounds normal.  Until you live with it.  The intensity of the above list is magnified a thousandfold from normal, in my house, in my kid.  It absorbs all of the energy in the house, it puts every member of the family on edge, and it turns normal family interactions into a vast exercise in behaviour management.  Normal kids get rowdy sometimes.  My kid gets rowdy fifty times an hour.  Normal kids are impulsive sometimes.  My kid dashes across busy parking lots without looking, climbs roofs without thinking, snatches food out of other kids' hands at lunch hour and taunts them.  Blurts stuff out while others are talking.  Fifty times a day.  Normal kids are restless and need to move frequently.  My kid has movement compulsions.  He touches everything.  E.V.E.R.Y.T.H.I.N.G.  He picks his skin, fingers, and feet compulsively.  He rips apart school erasers, dismantles toys, taps surfaces, rocks in his chair, punches himself in the head, hums, sings, and breaths in loud, repetitive patterns, just to satisfy his compulsion to move.  Also in the fifty times an hour category.

The persistence element is twofold; first, it persists over time.  The symptoms must last far beyond the toddler and preschool years, when other kids their age have gotten a handle on impulse control and the basics of self organization.  These symptoms must be present for more than six months.  Secondly, the symptoms must persist in more than one setting; school, home, and extracurricular environments.

Hyperactivity, impulse control difficulties, and difficulty with paying attention can be symptoms of other disorders.  Allergies.  Fetal alcohol syndrome.  Vision or hearing problems.  Attachment disorders.  Emotional upset from divorce, illness in the family, separation, grief, or depression.  Anxiety, bipolar disorder, or a medication problem.  So, when a child is undergoing the process of diagnosis, these causes are investigated and ruled out.  Our pediatrician undertook months of tests, evaluations, questionnaires for us, teachers, friends, and support staff, full physical exam, in depth family and medical histories, and parenting technique evaluations before coming to the conclusion that Matthew has ADHD.
Because I'm naturopathic leaning, our pediatrician also sent Matthew for extra blood tests for heavy metal poisoning, vitamin deficiencies, and immunological disorders, allergy testing, and fielded many of my questions regarding alternative therapies and treatments.

Maybe back in the 1990s, general practitioner physicians were hearing the words "hyper" and "inattentive" and prescribing medication and slapping a label on kids "just to get them to sit still."  But in my experience, that doesn't happen anymore (if it ever did at all).  We had to be referred to a special pediatrician who has specific training and experience with ADHD, undergo months of screening, and careful, many hours' long appointments discussing the symptoms, diagnosis, and treatment planning.  Nobody was proposing a laissez fair approach to my kid or his situation.

These things have been proven to help people with ADHD:

-Medication (specifically, stimulants like ritalin)
-Structured environment with lots of social support
-Omega 3 fish oils
-CBT (cognitive behaviour therapy)
-Active, healthy lifestyle
-Healthy diet

Those are in order.  Medication helps the most.
Medication is a sticking point for most adults.  We hate to medicate children.  We hate to dull their natural curiosity, exuberance, joi de vivre, creativity, and sparkle.  We hate to deaden their senses.  We hate to dull their eyes.  We hate to expose them to the chemistry and side effects of medicine just to make them sit still.  TRUST ME.  I GET IT.  I GET IT MORE THAN ANY PERSON WITH NO ADHD KIDS.  This was my kid we were talking about medicating, here.  The love of my heart.  Nobody knows this better than me (except other ADHD parents).

What helps is to understand a few basic things about ADHD.  First is the pathophysiology.  ADHD is a mental illness.  Russel Barkley is the leading researcher for ADHD and has done extensive research into neurological structure and ADHD symptomology.  There is no definitive cause of ADHD but there is evidence indicating that the prefrontal cortex of those with ADHD is smaller and receives less blood flow than in a non ADHD brain.  The prefrontal cortex houses what are called executive functions: working memory, reasoning, task flexibility, problem solving, impulse control, planning, and executing self organization and control.

Stimulant medication increases blood flow to the prefrontal cortex.  Therefore improving performance of the executive functions.  Blood flow.  To the brain.

Non ADHD brain                       ADHD brain

Another thing to understand is that kids who have ADHD and are not treated are at significantly increased risk of being in vehicle accidents when they are old enough to drive, becoming addicted to alcohol or drugs, being socially isolated, developing behaviour disorders, dying or being injured during high risk taking, and having difficulty having success in school or training programs.  It's not about getting them to sit still.  It's about blood flow to the parts of the brain that assess risk and make decisions.  It's about keeping them safe, and helping them thrive.

Also.  A trial run with medication was a life changing experience for us.  Rather than deaden Matthew's enthusiasm or dull his sparkle, it ignited a brilliance we always knew was there, under the surface, dulled by something.  His eyes sparkle more.  He is far more fully engaged, makes more eye contact, and is more creative when medicated.  His relationships flourish.  His schoolwork exploded with far more successes than with any other intervention to date.  And we have gone from a vast exercise in behaviour management to a fully functioning, happy, interconnected family that mutually enjoys each other's company.  (For the most part.  We are normal people, here.  We get on each others' nerves).

He no longer bullies kids.  He no longer climbs roofs.  He no longer snatches things.

He's not 'cured.'  He still picks his skin compulsively.  He still fidgets.  He still interrupts and blurts and gets distracted.  But he's far, far better than before.  And also, the medication is short acting so although he takes a pill after breakfast every day, it has completely worn off by mid afternoon.  So we still see some wild child in the later evenings, and especially first thing in the morning.  I often think to myself I could never forget to give you this medicine, because you so clearly drive me crazy in the mornings.

Some good resources on ADHD:

Kelty Mental Health 

The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance

Dr Russell Barkley

Here to Help

A Kelty Mental Health Accumulation of Resources and Links for parents.

You can see how well meaning suggestions, opinions, and statements from those who have not walked the ADHD path can be frustrating for us ADHD parents.  You can see how the fear of labels and misdiagnoses and dulled, overmedicated children can get in the way of really important treatment of an actual mental illness that impairs children's ability to flourish.  You can see how, at this moment in time, I had to stop and ask everyone to listen up to what I had to say about ADHD.

My kid is more than a label.  So much more.  But having a diagnosis and following a treatment plan for ADHD actually helps us unlock that brilliance that is inside him and go beyond a mental illness and deep into realizing his full potential as a human being.  A brilliant, wonderful, creative, funny, intelligent human being.  The end.

1 comment:

melissa said...

Thanks for taking time to share about this, Melissa. It's good information for us all.