Fidgeting, inability to focus, impulsiveness, restlessness, disorganization - I think we all have been there at times. But...

Fidgeting, inability to focus, impulsiveness, restlessness, disorganization - I think we all have been there at times. But for children or adults with ADHD (attention-deficit/hyperactivity disorder), these symptoms present a consistent pattern throughout all areas of their lives, including school, home and relationships.

Is it ADHD?

It can be challenging to determine if a child is truly struggling with ADHD. "Difficulties with paying attention or extremely active behavior often tell us that there is a problem, but it's not necessarily ADHD," said Kathryn H. Leugers, Psy.D., M.B.A., a counselor with Meers, Inc. Consulting Psychologists in Columbus. "These difficulties can also be due to other issues such as lack of sleep, stress, medical illness, or psychological conditions such as anxiety or depression."

Professionals utilize behavioral scales to determine if a child has ADHD. "Teachers and parents are asked to fill out questionnaires," said Shivani Gopal Edwards, director of clinical development at Buckeye Ranch in Columbus. "We are looking for patterns of behavior such as inability to sit still, running around all the time, touching other kids or getting in people's faces."

Four main characteristics

Earl Oremus, headmaster at Marburn Academy in Columbus, explained that ADHD is actually a "syndrome" with a number of identified characteristics, but that a diagnosed individual may not exhibit them all. They include:

Inattentiveness Impulsiveness Disorganization Hyperactivity


Oremus said that an ADHD student is often unable to control the temptation of distractions such as paying attention to another student instead of to what a teacher is saying. "Another type of distracted student may 'tune out' the teacher and begin focusing on their own internal thoughts and feelings," he said.

Oremus said it is a misconception that those with inattentive ADHD can't focus at all. "The problem occurs when the focused attention is required for activities the child views as boring or not fun, which, sad to say, is how ADHD students often perceive many of their classroom activities."

Impulsive ADHD students often blurt out their responses without waiting for the teacher to call on them. "This behavior often results in the impulsive child being punished as if they had done it on purpose as an act of defiance," Oremus said. "One study showed that impulsive ADHD school children receive correction, admonitions, criticism and punishments 17 times more each day than non-impulsive children. Such repeated negative feedback often has devastating effects on children's self-images and motivation."

Help for ADHD

June Richdale-Robb is the volunteer coordinator of the Columbus Satellite of CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder). Her son Brian was diagnosed with ADHD when he was in the third grade. "After Brian was diagnosed, we were able to look back and recognize some earlier behaviors that were probably linked to ADHD," Richdale-Robb said. "He had done well in school until third grade when the teacher had a more structured setting. Brian couldn't sit still and he became a behavior problem. We sought counseling to address these issues."

Richdale-Robb said that medication, along with counseling and switching to a different education environment, helped Brian. "We ended up putting him in a Montessori school for his fourth and fifth grade years where he flourished," she said. "When he hit the puberty years, his medications had to be adjusted to help with the additional chemical imbalance. It's important for parents to realize that the child's treatment may change as they grow. Parents often want to find the perfect thing to take care of the issue, but we have to be flexible."

Richdale-Robb said that kids like her son need a routine. "With Brian, I learned to become more organized. It's important as a parent of a child with ADHD to be specific and to be reasonable. The child needs to feel they can accomplish something well," she said. "Make simple requests and give them constant praise. This is important for these kids because they don't always feel equal to their peers."

Richdale-Robb established a routine for Brian that involved a balanced diet, medication and rest. "He would take his medication in the morning, at noon and again in the afternoon when he got home from school," she said. "He would usually need a bit of down time when he got home before he started on his homework. That was a good time for his snack. He wasn't a big breakfast or lunch eater, so it was important to offer him high-quality snacks like peanut butter and jelly on whole wheat bread, cheese and crackers, or yogurt."

Finding support

"As a parent of a child with ADHD, there is a point when you hit rock bottom and need help," Richdale-Robb said. "A child who has severe ADHD really stresses the family, the marital relationship of parents, and the relationships with siblings," Oremus said. "It is very important for both parents to become well educated on the issues and the interventions proven to be successful."

Experts recommend parents seek counseling and a support group such as CHADD. "We also recommend parents receive school advocacy for their ADHD child," Edwards said. "Not all these kids need special education. They may just need flexibility in how they receive their education and help with organizational skills. Medication is not always necessary, nor is it our primary focus. But it is often utilized as part of the treatment program."

Leugers agreed. "There are several treatments for ADHD, including medication, psychotherapy, cognitive behavioral therapy or behavioral therapy for individuals and their families, and cognitive training (using computer training to build attention and decrease impulsivity). I believe that these adaptive cognitive and emotional skills, which help the child focus in a classroom and with other social situations, will help children and teens with ADHD have the most likelihood of a healthy development in childhood and in transitioning to adulthood."

"We are living proof that as parents we did survive having a child with ADHD," Richdale-Robb said. "Brian is doing well and is now a sophomore at Case Western University."

Jan Myers is a freelance journalist from Coshocton. She has a degree in psychology and natural health. She and her husband Alan have a son, Maxx, 16, and a daughter, Maggie, 11. Myers enjoys writing about parenting, travel and natural health. Visit her website at www.mylifetransformations.com.

ADHD developmental stages

Earl Oremus, headmaster at Marburn Academy in Columbus, said that hyperactive and impulsive characteristics of ADHD are usually very evident in toddlers. "The disorganization and lack of focus

are usually somewhat visible before school-age, but become much more visible when school expectations of managing focus and organization become important," he said.

During ages 3 through 6, children begin to slowly increase their attention spans and ability to sit still for short to moderate periods of time. Kathryn H. Leugers, Psy.D., M.B.A. with Meers, Inc. Consulting Psychologists in Columbus, said that hyperactive and impulsive symptoms often become apparent in early childhood during pre-school, kindergarten or early elementary school, while the inattentive symptoms sometimes are not noticed until elementary school or middle school years. "Sometimes children or teens that are either strong academically or struggle academically due to learning differences or other psychological issues may have ADHD that is not detected until a bit later on in development."- Earl Oremus

Medication and ADHD Is medication always necessary?

Not always, said Earl Oremus, headmaster at Marburn Academy in Columbus. He said the more severe the symptoms and the greater the problems they are causing the child in school, socially, or in the family, the more likely it is that medication will be needed. Medication is used to diminish the symptoms enough for the behavior modification and coaching to take hold and produce improvements.

Shivani Edwards, Director of Clinical Development at Buckeye Ranch in Columbus, said that medication is not their primary focus, but is often utilized as part of the treatment. "Medication is not always necessary," she said.

Kathryn Leugers, Psy.D., M.B.A., counselor with Meers, Inc. Consulting Psychologists in Columbus agreed. She said that although research supports the use of medication as an effective treatment for ADHD, sometimes it's not appropriate due to other medical issues or it's not effective with a specific individual. "Most professionals strongly recommend that therapy and support are important components of treatment in addition to medication," she said.


Are we overmedicating our kids?

Oremus said that in his experience the vast majority of decisions about utilizing medication for ADHD are very pragmatic: if it isn't needed it isn't tried. And if it is tried and it doesn't work, it is not continued. "Almost every one of the hundreds of parents of ADHD kids I have discussed medication with have been very reluctant to consider medication," he said. "They only seem to get to the point of trying medication when all of the other ideas fail to work and the child seems to be getting into ever greater difficulty. And if they try medication and it doesn't seem to work, almost all of them are very quick to discontinue it. They don't just keep doing it for the sake of medicating the child."


Are the medications harmful?

Medication used to treat virtually any condition produces both desired and undesired effects side effects. The medications used to treat ADHD are no different. "The question then becomes, 'Are the side effects serious?'" continued Oremus. "Countless studies have reported that the side effects of the common ADHD meds are among the most benign of all widely-administered drugs."

Stimulants and non-stimulants are used to treat the inattention, hyperactivity, and impulsivity symptoms of ADHD. "With stimulants, an increased heart rate and lowered appetite are more commonly reported," Leugers said.

Recommendations for the ADHD child

Parents typically manage stresses and challenges best if they have access to an expert support system.Earl Oremus, headmaster at Marburn Academy in Columbus, recommends parents find support in the following areas:

(a) A school such as Marburn that specializes in working with ADHD children and helping parents.

(b) An advocacy and training support organization such as CHADD. CHADD is a superb, highly knowledgeable and credible national organization devoted exclusively to ADHD issues, and I recommend that as the first point of contact as they then can lead parents to many other resources.

(c) A psychologist, psychiatrist, counselor, or coach who is highly skilled with ADHD issues.

Marburn's program is founded on the belief that ADHD characteristics or behaviors result when children fail to learn and employ the effective self-management strategies that other kids use to manage their attention, their impulsivity, their spatial and temporal organization, or their anger about all the punishments they receive.

Marburn overtly teaches these strategies and then cues, coaches and rewards children for employing them over a long enough period of time that they become automatic.
Aside from identifying and teaching the strategies themselves, the most critical element of this system is to work with the children in a positive, supportive, encouraging manner.

One study showed that impulsive ADHD children receive correction, admonitions, criticism and punishments 17 times more each day in the typical classroom than non-impulsive children. This eventually leads most ADHD kids to believe that they can't succeed in that system, so they may wonder, "why try?"

The response to ADHD behavior in most schools is to administer a consequence or punishment for the behavior (e.g.: lower the grade for forgotten homework, stay in from recess for impulsively talking after being told to be quiet). The assumption is that the ADHD behavior is willful or volitional and that the punishment is well deserved and will "teach" the child not to do that again.

But we at Marburn believe that the behavior is neurologically based, not volitional. Piling up consequences on an impulsive kid doesn't address the neurology that makes him impulsive, it only hurts him, damages his faith in himself, and eventually makes him angry or depressed -- none of which provides the retraining needed to establish the new circuitry that allows the kid to 'self-manage' by pausing, reflecting and predicting the outcome before acting.

The minority of ADHD kids who survive school with their self-image intact often turn out to be highly productive and leaders in their field. They have great energy, great powers of concentration when they are engaged, are often very engaging and personable, and often are very creative and innovative thinkers. They have a lot to offer our society, but the way we typically respond to them in school often dents them up so much that their potential is not realized.

More recommendations for the ADHD child and ADHD resources Read reliable resources such as those found on the national CHADD website or at the Columbus Metropolitan Library. It's not uncommon to feel totally overwhelmed. Seek out a support group such as CHADD. Take time for yourself to exercise or just have some time to recuperate. Establish routines for your child. Work with the school to find ways to help your child succeed. Be sure your child gets plenty of sleep. Allow them to have the down time they need. Be sure your child eats a balanced diet and has high-quality snacks. You may want to get them involved in a sport or other activity they enjoy. Help your child map out her schoolwork on a calendar or list so she can visualize what needs done when. Check your child's book bag to be sure he or she is bringing home schoolwork. Communicate with teacher regularly. Work on some behavior modification techniques at home. Forgetfulness is a big issue, so lists can help kids feel more in control. Have patience with and compassion for your ADHD child. When a situation arises, step back and try not to respond with an instant reaction. What you see on the outside when your child is having some kind of 'spell,' may not be the actual issue. There is usually another underlying reason for what is going on. Talk with your child about it later when he has calmed down. Remember, you can't do it alone. Be sure to accept help and support from others. Let your child know she's important and very special. Remember to tell your child that some behaviors aren't his fault. Sometimes he can't control himself. ADHD books

ADD/ADHD Drug Free
By Frank Jacobelli and L.A. Watson. If you're the parent of a child with ADD or ADHD, you know just how much it affects his or her life - and yours. This book offers natural alternatives and practical activities to help kids improve learning and behavior effectively and without medication. $10.20 on amazon.com.



Michael
By Tony Bradman and Tony Ross. Michael was different. His teachers said he was the worst boy in the school. He was always late and he was a little scruffy. Is there no hope for him at all? This is a tale of a child whose teachers dismiss him as different and hopeless, but who goes on to reach heights no one imagined were possible. Michael is a touching and whimsial story that celebrates differences of all kinds. $9.99 in bookstores.


Overcoming ADHD: Helping your Child Become Calm, Engaged and Focused Without a Pill
By Stanley Greenspan, M.D. Greenspan's view of ADHD is that it's not a single problem, but a set of common symptoms that arise from several different sensory, motor and self-regulation problems. He demonstrates how children can confidently learn to engage with others, attend to what they see and hear, and maintain their focus on the problems at hand. $16.50 on amazon.com.


AD/HD Success! Solutions for Boosting Self-Esteem: The Diary Method for Ages 7-17
This practical workbook is full of non-technical questions, prompts, strategies and gentle assessments that include parent involvement. It features over 50 reproducible diary pages, parent and child questionnaires, self-esteem logs and scales, an AD/HD overview, and much more. Parents will find valuable information, guidance and insights that will enhance communication for the whole family. Available on amazon.com for $19.95.