This is the first in a series of three articles aimed at educating parents on ADHD. In Part 1, we’ll explore some of the issues associated with accurately diagnosing ADHD in children. We’ll also explain some of the theory behind what we believe is happening with people who have ADHD as well as discussing some of the latest research.
Part 2 will focus on providing characteristics and insights related ADHD in children. Part 3 will then wrap up the conversation with some teaching tips for parents in order to support your child’s learning.
Let’s start off by explaining why it isn’t always easy to accurately identify ADHD.
Issues Associated with Diagnosis and Theory Behind ADHD
“Jose, why are you running across the tops of the desks? Susie, why can’t you … ever … be … QUIET!?! Tommy, how is it you can get distracted if the wind blows sideways?” If you’ve seen the Disney movie Up, I’m always reminded of the dog Doug whenever I think about this disorder — Squirrel! . . . Where was I?
Oh yeah, I was talking about Attention Deficit Hyperactivity Disorder (ADHD), which just so happens to be (in my opinion) one of the most misunderstood diagnoses out there.
To begin with, it’s important to understand that most clinicians recognize there are two general types.
The first type is Attention Deficit Disorder (ADD, also known by clinicians as Inattentive Type) which refers to a pervasive problem with paying attention and maintaining focus.
The second type (the most commonly known one) involves all of the problems associated with ADD, with hyperactivity and impulsivity thrown in (ADHD).
Personally, I have often wondered whether or not we can truly classify ADHD as a “disorder” at all. I’m not the only one who feels that way, either, as others including Dr. Edward Hallowell (one of the foremost experts on ADHD), believe it’s much more of a trait. Others have thought perhaps it should actually be placed on the Autism Scale.
During my time as a professional, I’ve known a lot of children (and adults) who havethought they have ADD/ADHD. I’ve known a lot of children (and adults) who’veactually had ADD/ADHD as well. This article will chronicle signs and symptoms as well as little known facts and clinical insights surrounding this mysterious diagnosis.
Exactly how prevalent is ADD/ADHD?
That really depends on who you ask. According to the CDC, approximately 11% of children 4-17 years of age have been given the diagnosis of ADHD at some point in their lives.
The DSM-5, on the other hand, states that about 5% of children have ADHD, although other studies in communities throughout the U.S. have generated higher estimates.
In children, the gender ratio for ADHD tends to be 2:1 (2 boys for every 1 girl).
Problems Associated With Diagnosing ADD and ADHD
A lot of factors today really muddy the waters and make a definitive diagnosis challenging.
Psychologist Bob Brown, who has ADHD himself, explains part of the problem with getting a definitive diagnosis, especially today:
“Part of the issue is that especially since the 1970s and Children’s Television with images changing every 15-20 seconds, kids have increasingly become wired to a higher level of stimulus. If I were to take 100 kids who were diagnosed with ADHD and take them out in the woods for a week, removing them completely from technology, about 95% of them would begin to look normal.”
Just how much has today’s high stimulus technology affected us? In the 1950s and early 60s, the average attention span was around 1 minute.
Microsoft recently conducted a study and found that today’s average American now has an attention span of roughly 8 seconds. To put that in perspective, your average goldfish has an attention span of about 9 seconds. Yikes! That reality sure makes the job of your average middle school teacher a real challenge.
In the minds of many of today’s students, if things aren’t blowing up every two seconds, if teachers aren’t doing Jet Li Flips, or classroom aides aren’t shooting force lightning from their hands, they are finding school borrrrrring.
During my time in graduate school, it was stressed to us that a Medical Doctor is really the best person to make a true definitive diagnosis of ADHD. Why? Because there are so many other things that can cause inattention and hyperactivity (some of which once they’re addressed, the symptoms tend to greatly diminish or even vanish).
Below are a few of what I would call “False ADHD Factors.”
False ADHD Factors
High Stimulus Video Games, Computers, Movies, Media
As mentioned above, these are wiring our brains to a higher level of stimulus than ever before.
Abuse or Neglect
Studies have shown links between ADHD symptoms and Abuse and Neglect. Now, are kids who actually have ADHD at higher risk for abuse? The research clearly says, “Yes.” But some experts also believe that children who grow up in chaotic environments and experience ongoing trauma and environments can display hyperactivity, disruptive and inattentive behavior as well.
Their constant hypervigilance (due to abuse) can be mistaken for inattention. Since chaos is normal and actually feels normal for them, they may look to recreate chaos in places like school classrooms where none is supposed to exist.
Another thing that was always stressed to me in my graduate studies was that depression can look like virtually anything. People who have experienced trauma related to a recent death, divorce, or some other significant life event can become quite depressed.
As a result, they may find paying attention to things or being able to follow through on tasks quite difficult. Their lives and their living space can look quite disorganized. Depressed people may have a hard time being able to listen to others. If it’s depression alone that a person is dealing with, many of these symptoms will start to disappear once the depression is treated and starts to lift.
Traumatic brain injuries and seizures are among the other physiological issues that can cause ADHD-like symptoms. If, for example, your child has had a recent car accident, bike accident, or suffered a serious blow to the head, a medical appointment to rule out possible injury or other physiological causes is probably warranted.
Can food actually cause ADHD symptoms? Interestingly enough, we are finding out the answer to that is, “Yes.” The top 8 common food allergies that can cause ADHD like symptoms are: wheat, milk, peanuts, soy, eggs, tree nuts, fish, and shellfish.
Additionally, Salicylates, which are naturally found in red apples, almonds, tomatoes, grapes, cranberries, as well as some medications like aspirin, Alka-Seltzer, Pepto-Bismol, and other places, can cause those same symptoms as well. Here is a list of products that contain Salicylates. I’d recommend working in conjunction with your doctor, naturopath, and/or dietician to rule this one out.
You know how parents have forever complained about how candy made their kids hyperactive? The expert response to that had pretty much been, “Pfft! Sugar doesn’t make kids hyperactive.” Well, not so fast. It may not have been sugar itself causing hyperactivity, but rather artificial food dyes in candies that are to blame.
Artificial food dyes (such as FD&C Blue No. 1 and 2) and artificial preservatives (like BHT, BHA, and Sodium Nitrate) are now being targeted by many experts as having negative behavioral effects (including hyperactivity). In fact, 11 of the artificial food dyes regularly found in foods that we as Americans eat are banned in Europe.
Will the Real ADHD Please Stand Up?
[Which they probably will and may even do a little dance for you]
If all of those things can cause ADD/ADHD like symptoms, how can you as a parent honestly know if your child may have it?
When you’re trying to figure out the answer to that question, you have to look at theentire picture. All of the above factors need to be considered and ruled out. But let’s say you happen to be one of those highly motivated parents who has chosen to attack this issue with a vengeance. You eat organic food, you’ve eliminated all genetically modified and processed foods, you’ve done your allergy testing (so you’ve eliminated that variable), artificial food dyes are nowhere to be seen, and you’ve basically killed your TV and are putting severe limits on your kids’ exposure to electronic stimuli. Now what?
Allow me to explain the theory behind what we believe is happening with this disorder, provide some factors to consider, and paint a portrait of what a child with actual ADHD might look like.
What must first be fully grasped is the fact that the brains of children (and adults) whoactually have ADHD honestly workdifferently from those who don’t have it.
How exactly? Let me explain:
In the past, one theory that has been postulated is that with people who have ADHD, their midbrain (the limbic system) is operating faster than their cerebral cortex’s (that’s the outer “gray matter” layer of the brain which is responsible for thinking and reasoning) ability to process information.
That’s been the overall theory behind understanding why medications like Adderall and Ritalin are often prescribed and work for ADHD. Doctors and scientists haven’t known fully why they work — all they know is that they do.
Those medications are stimulants and the thinking is, “We can’t slow the midbrain down, BUT we can speed UP the outer reasoning centers of the brain.” The idea there is to get those two centers in sync with one another (get them working at the same speed).
A new study, published inThe Lancet Psychiatry in February 2017 involving more than 3,200 people, used MRI scans to demonstrate that people diagnosed with ADHD showed significant differences in the sizes of five different regions of the brain in comparison to those without ADHD.
The five regions of the brain that researchers found were smaller in people with ADHD were:
The Caudate Nucleus — which appears to be involved in our response to stimuli, arousal, and the formation of repetitive, learned behaviors (habits).
The Putamen — Again, scientists believe this area to be involved in movement as well as our response to stimuli and our learned habits.
The Nucleus Accumbens — appears to play a role in our reward cycle, that is, our feelings of desire and satisfaction. For example, our desires for food, sex, etc. and our feelings of satisfaction once those desires are met. It also appears to be involved in inhibiting desires (a major problem with ADHD).
The Amygdala — is responsible for or involved in regulating emotion.
The Hippocampus — is involved in the formation of memory.
In that study, the size differences were found to be much more prominent in children than adults. If those regions honestly tend to be smaller (particularly the Caudate Nucleus and the Nucleus Accumbens), that might make sense for why kids with ADHD are always on the lookout for high levels of stimulation, have great difficulty inhibiting negative desires, and have trouble learning from their past mistakes.
Scientists do not fully understand the causes of ADHD or how exactly the operation of a person’s brain who has ADHD specifically differs from someone who doesn’t have it. Suffice it to say, they are starting to recognize that the brains of children and adults with ADHD are honestly wired differently from those who don’t have it.
As you can begin to see, ADHD is a subject which is quite complicated given today’s culture. Although it is a real disorder that has definite features and real life stumbling blocks for the person who has it as well as for their family, friends, and community, accurate diagnosis is difficult without the aid of a professional such as an experienced Christian Clinician.
In Part 2 of this 3-part series, we will continue by discussing characteristics and tendencies of children with ADHD, provide parents with insights in understanding how their minds work, and explain a bit on how clinicians arrive at a diagnosis.
Special thanks to Bob Brown, Ph.D for his amazing knowledge, experience, and insights in helping to write these articles.
“ADHD Scrabble Tiles,” courtesy of PracticalCures.com, Flickr Creative Commons 2.0, CC0 License; “Running through the Sprinklers,” courtesy of Mi Pham, unsplash.com, CC0 License; “ADHD,” courtesy of Jesper Sehested, TheDyslexicBook.com, Flickr Creative Commons, CC0 License; “Brain diagram,” courtesy of Free-Vector-Images, pixabay.com, CC0 License