ABCs of ADHD: Diagnosis on the rise

Many childhood challenges may escape notice, but children with attention deficit hyperactivity disorder (ADHD) often can be the subject of great concern to parents and teachers.

"It's normal for children to have trouble focusing and behaving at one time or another," states Dr. Cecelia Horan, director of child and adolescent services at Alexian Brothers Behavioral Health Hospital in Hoffman Estates. "But children with ADHD don't necessarily grow out of the behaviors. Symptoms can continue and may cause difficulty at school, at home, with friends and later, in the workplace."

There are many theories about the cause of ADHD - a term coined in the early '70s to describe the condition, according to experts at the Centers for Disease Control and Prevention. Children with ADHD - one of the most common neurodevelopmental disorders of childhood - may have trouble staying on task, often can't sit still, are easily distracted, daydream, forget or lose things, make careless mistakes or take unnecessary risks, have trouble taking turns, may be unable to pay attention, frequently jump from task to task, have a hard time resisting temptation, and can have difficulty getting along with others.

In most cases, Horan says, ADHD is best treated with a combination of medication and behavior therapy. "Diagnosis is a multi-stepped process and there is no single test to diagnose ADHD. Likewise, no single treatment is the answer for every child," she notes.

Incidence on the rise

Dr. Horan points to a 16 percent increase in the number of children ages four to 17 being diagnosed with ADHD since 2007. "There's lots of speculation about this increase, resulting in 11 percent of our children being labeled with an ADHD diagnosis," admits Dr. Horan, who says both today's parents and primary care pediatricians are much more attuned to symptoms.

There are distinct types of ADHD including:

• Predominantly inattentive presentation: Individuals often can't pay attention to details, find it hard to organize or finish a task, and have difficulty following instructions.

• Hyperactive-Impulsive Presentation: Typified by fidgeting, individuals often have difficulty sitting still, are restless and have difficulty controlling impulses leading to more frequent accidents and injury. Smaller children may run, jump and climb constantly, and older children may find it nearly impossible to sit down for a meal or to complete homework.

• Combined Presentation: Includes equal symptoms from both categories.

Causes

No single cause has yet been identified for ADHD, however, a number of risk factors are noted. ADHD is a complicated disorder, with strong genetic links. According to Horan, it can be very much a "family affair" with a strong correlation among family members.

Close relatives have a five times greater than random chance of having ADHD themselves and also are at increased risk for things like anxiety, depression, learning disabilities or conduct disorders.

"Boys have a four times greater chance of having ADHD," according to Horan, who notes the ages of 7 to 12 seem to be the prime time for diagnosis as symptoms become more pronounced.

In addition to genetics, researchers are taking a close look at environmental factors, brain injuries, nutrition and how the social environment might contribute to ADHD.

Debunking myths

Horan stresses that a number of factors can cause increased challenges for children with ADHD, but things such as too much or too little sugar, lack of vitamins, television and video games, food sensitivities, fluorescent lighting, food additives and food coloring, poor home or school life and allergies are not root causes.

ADHD At School

While not necessarily seeing an increase in the diagnosis of ADHD, school administrators are reporting an increase in teachers and parents referring children for concerns related to ADHD.

"These are most often difficulty listening in class, staying focused to complete work, behaving impulsively, and/or difficulty sitting still in situations where most children can sit still," explains Todd Huenecke, a school psychologist working with elementary school students at Benjamin District 25 in West suburban Carol Stream and West Chicago.

What can parents and teachers do?

Educators have become much more savvy in the last 10 to 15 years, according to Huenecke, who notes that teachers and parents seem to be more open to problem-solving strategies.

"Some of the strategies target sensory needs of children," states Huenecke, who explains that simple steps like wrapping surgical tubing around the leg of their desk can allow students to kick or press against something that will not be distracting to others, but which gives sensory feedback.

"Another common strategy is to allow students to stand at a table in the back of the class while working," he says. "Some teachers do movement breaks or classroom yoga-type stretches between lessons. Some children have individualized strategies, like taking a two-minute walk break to the office and back. Some children sit near the front to decrease external distractions in between them and the teacher."

Teachers also use nonverbal cuing systems, such as stickers on the desk that they can touch to give a child an unobtrusive prompt that they need to refocus or use a strategy that the child has been taught to use. Children can be taught to use sensory strategies, help-seeking strategies, and focus questions like, "When the teacher points to the sticker, I am supposed to ask myself 'What I should be doing?'"

He adds that active strategies for older children might be to take notes to sustain focus, or use an assignment book to maintain organization. Younger children can be taught to look around the room and figure out what most other students are doing if they realize they have been daydreaming.

A link to screen time?

One area of increasing concern is "screen time," according to Huenecke, who points to the work of several researchers, such as Yang, F., Helgason, A., Sigfursdottir, I., and Kristjánsson, A. (2013) or Christakis, D., (2009), which shows an association between early exposure to TV and/or electronic media, and later difficulties with sustaining focus.

"One thing parents can do, is to decrease 'screen time,' especially for very young children," he states. "In our society, this is becoming an increasing challenge. This can be replaced with other activities that require concentration, sequential planning, interacting with others, and are known to be beneficial for brain-growth, such as reading, construction-toys like Legos, playing musical instruments, or playing imaginatively with other children."

Family impact

"ADHD can have a profound effect on children and families," says Dr. Huenecke, who notes children with ADHD are more likely to struggle in school.

"They are at increased risk for other learning difficulties, like reading problems," he notes. "In social settings, they are more likely to miss social cues or blurt out inappropriate comments. With adolescents, one of our greatest concerns is that they will impulsively engage in risky behaviors like drugs or sexual behavior. Children with untreated attention problems, are by definition, more likely to behave impulsively. Parents of children with ADHD struggle more with discipline, because the child's behavior is often less predictable and thus can be more frustrating."

He notes it is important for parents to know that there is hope and help. Behavioral strategies, cognitive thinking-based strategies, environmental changes and medical help all are available.

Tips for success

Andrea Sagel, a licensed occupational therapist at Easter Seals DuPage and Fox Valley, an accredited outpatient pediatric rehabilitation center in Villa Park, suggests a few simple steps to help improve or maintain your child's attention.

"For example," she says, "use visual supports to assist with attention and performance of activities such as visual schedules of tasks broken down using pictures as well as words for each step."

Sagel adds that receiving an occupational therapy evaluation may be beneficial to support family education and increasing the child's self-awareness and self-management abilities.

Other suggestions include:

• Give frequent short movement breaks between activities in school and at home during homework time.

• Animal walk races (crab walk, frog jumps, snake slithers) down the hallway at home or around the classroom.

• Stretching activities using big movements (arms over your head reaching to the sky, arm circles, give yourself a big hug)

• Push-ups in the chair or wall push-ups

• Jumping jacks at your desk

• Allow for more lengthy breaks throughout the day and before beginning a period of time of seated activities.

• Lying on stomach on scooter board and using only hands to pull body along the floor

• Pushing laundry basket down hallway

• Help move furniture for vacuuming or sweeping

• Make an obstacle course out of household items and furniture

• Pull things in a wagon or push in a wheelbarrow

• Use sensory tools to support continued attention that allow for small movement input.

• Move n' Sit Cushion

• Hand fidgets (stress balls, stretchy balls)

• Therapy ball chair versus a regular chair

• Exercise bands tied in a loop to chair legs for feet movement input

• Crunchy or chewy snacks

• Keep a water bottle with high suction at the desk