As a student in a Marriage and Family Therapy program, you cover a wwwwiiiiiiddddddde range of topics in your studies.  One of the topics covered is attention deficit/hyperactive disorder–or ADHD for short.  You may know someone personally who has ADHD.  I’m also willing to bet many people out there have some traits of ADHD at least some of the time.  Who hasn’t felt unable to focus or hyper on occasion?

The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) labels ADHD a neurodevelopmental disorder.  The DSM-5 is what many mental health practitioners use as a reference in their practices to diagnose mental disorders.

Diagnostic Features

• ADHD begins in childhood.
• Its symptoms must be present in more than one environment (home, school, playground, etc.).
• As the name implies, ADHD is a persistent pattern of lack of attention and/or combined with hyperactivity-impulsivity behaviors.
• This inattentiveness and/or hyperactivity affects development or functioning for the individual.
• Inattentiveness can be seen as manifesting, for example, as a person being disorganized, wandering off the task at hand, having difficulty focusing, and having a lack of persistence.  These behaviors are not due to the individual’s lack of comprehension or defiance.
• An excess of motor activity describes the hyperactivity aspect of ADHD.  For example:  restlessness, fidgeting, tapping, or talking that is excessive.  Think of a kid running around and around when it is not appropriate.
• The impulsivity aspect of ADHD is marked by an individual’s inability to delay gratification.  Some behaviors may look like inappropriate social intrusions or maybe they’re engaging in behaviors that are not thought through: for example, running out into traffic.
• Impulsivity may be hard to ascertain in children and may later be diagnosed in adults (lots of kids are impulsive because they just don’t know any better).

Making the Diagnosis

Sometimes normal behaviors of children are mistaken for ADHD.

Symptoms often appear early in childhood, usually between 3 to 6 years old.

Symptoms vary, making diagnosis hard.

Teachers may notice the signs of ADHD first and report the child “spacing out” or following the rules in the classroom and out on the playground.

Parents may notice their child is out of control on a regular basis or loses interest in things more than other children.

There is no test currently that can diagnose a child with ADHD.  Instead, a licensed health professional like a mental health practitioner or pediatrician, will meet with the child and their parents to determine whether they have ADHD. Many pediatricians now will refer the child to a mental health practitioner who has more experience with ADHD. The professional will ask questions of the family about their child, their behaviors, and the environments they are in—like school and home. Through questioning, they will attempt to rule out other causes for the symptoms.

What Else Could It Be?

Are there other medical issues occurring that are mimicking or causing ADHD-like symptoms?

It could also be:

Depression
Anxiety
Learning disabilities
Major life change
Hearing loss
Vision problems
Seizures
Other medical issues yet undetected

To determine if a child has ADHD or not, the health practitioner might ask parents if depression or anxiety, learning disabilities, or medical issues affecting their child’s behavior or thinking might be causing the symptoms. Has there been a major life change? For example, has the child been experienced divorce, the death of a loved one, or financial hardship which is causing the family stress? Maybe the child has hearing issues, problems with their vision, or they are having seizures that are as yet undetected. Are there other medical issues occurring that are mimicking or causing ADHD-like symptoms?

Assessment

To determine if it is ADHD, the clinician will check medical and school records looking for clues. Are there environments your child is in where it is disruptive or stressful? Consulting with their babysitters, athletic coaches, or other adults who are in contact with them can also be helpful.

The clinician might ask questions such as:

Do the behaviors affect all facets of this child’s life?
Are they long-term behaviors and are they excessive?
Compared to other children, do these behaviors happen more often?
Do you think the behaviors are in response to something that is temporary or do you see them as a continual problem?
What kinds of settings do they occur in or do they occur in all of them?

The clinician observes the child in different scenarios—some structured, others less so—paying attention to their behaviors. They might be observed in social situations and/or given for learning disabilities.

After the clinician has gathered all of this data and has ascertained whether the child meets the criteria for ADHD, then they will be diagnosed. Co-occurrences with other conditions or illnesses is a possibility. These include a learning disability, oppositional defiant disorder, conduct disorder, anxiety and depression, bipolar disorder, or Tourette syndrome. Other disorders could include bed-wetting, substance abuse, sleep disorders, or other co-existing disorders.

Causes of ADHD

Researchers not sure about what causes ADHD, but many studies do point to genes as a potential factor. Children diagnosed with ADHD have been shown to have thinner brain tissue in the brain area known for attention. The good news is that research has found that as the child grows, the brain developed alongside their growth, a normal thickness level in this area. As this occurred, their ADHD symptoms abated. Additionally other factors such as the social environment, nutrition, and brain injuries might contribute to ADHD in children as well.

• Genes
• Environment
• Injuries to the brain
• Sugar
• Additives to food

ADHD Statistics

• The average age ADHD is noticed in a child is 7 years old
• ADHD is one of the most common disorders in childhood
• Boys are4 times more likely to be diagnosed with ADHD than girls
• ADHD varies by ethnicity and race
• The percentage of children diagnosed with ADHD has risen 7% from 1998-2000 to 9% for the years 2007-2009

Treatment

Possible treatments include:

Stimulant medications
Parent training
Counseling
Parent Education

If you think your child has ADHD, it is important to have their symptoms checked out by a pediatrician and/or licensed mental health practitioner.

Many parents and families are turned upside down by the effects of ADHD.  That’s why it’s important not only to receive help for your child, but for yourself and the family, too, if they’re feeling stressed.

Resources

American Psychiatric Association (2013). Neurodevelopmental disorders. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Retrieved from http://dx.doi.org.proxy1.ncu.edu/10.1176/appi.books.9780890425596.dsm01

Mayo Clinic (2015). Attention deficit/hyperactivity disorder (ADHD) in children. Retrieved from http://www.mayoclinic.org/diseases-conditions/adhd/basics/definition/CON-20023647

National Institute of Mental Health (NIMH) (n.d.). Attention deficit hyperactivity disorder. Retrieved from http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml#part_145444