Gordon was on his way to give a talk about adolescents to a group of mental health professionals. Thinking about the many challenges that face kids this age, Gordon reflected upon his middle child, Zach, a gentle, dreamy teen who had struggled with symptoms of attention deficit hyperactivity disorder (ADHD) since he began school.

School was big trouble for Zach, who couldn’t focus on assignments or pay attention to the teacher for long. He was forever losing things, always needing reminders to finish projects. But his quick wit and playful attitude made him a favorite of teachers, despite these challenges. Gordon, a psychologist and Eastside father of three, thought about his son’s struggles and triumphs — as well as his own exasperation — and then it came to him in a flash: Zach is like a river otter.

“I just had this epiphany. A river otter — that was Zach,” said Gordon. “They’re in and out of the water, in constant motion, and there’s always this playful quality. I realized that I kept wanting Zach to be a beaver — build dams, get his homework done, hang his towel up — but that’s not a river otter. It was like that image, that metaphor somehow transformed this struggle for me.”

Zach is one of approximately 4.4 million kids between the ages of 4 and 17 who have been diagnosed with ADHD in the U.S. According to the American Academy of Pediatrics, ADHD affects between 4 percent and 12 percent of school-age children. In a classroom of 25 to 30 kids, chances are that at least one will have ADHD.

A misunderstood disorder

A great deal of attention — attitudes, opinions and controversy — has surrounded ADHD in recent years. So much so that CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder), a national nonprofit serving individuals with ADHD and their families, has a whole section on its Web site devoted to myths and misunderstandings about the disorder. Search “ADHD” on Amazon.com and you’ll get more than 7,000 hits.  

So how can you get clear, useful information if you suspect your child has ADHD?

Experts say you should ask for information and help as soon as you suspect your child has symptoms of ADHD. Keep an open mind about treatment options. And above all, keep your love for your child and his unique strengths paramount, as together you learn to navigate the world with ADHD.

What does ADHD look like?

According to the National Resource Center on ADHD, the hallmark symptoms of ADHD in children — inattention, impulsivity and hyperactivity — have been documented by medical science since the early 1900s. The condition has had many names over the years, but the causes of ADHD are still something of a mystery. ADHD runs in families, and so appears to be genetic. Some studies suggest excessive screen time or other behaviors might make ADHD symptoms worse.

So, what does ADHD look like? The classic case is the child who behaves as if his motor is always running — in constant motion and talking nonstop. This is the Hyperactive/Impulsive type, one of three types of ADHD, according to Dr. Frederic Provenzano, a Seattle-area family and school psychologist who tests children for a range of disorders. Kids with this type of ADHD are also highly emotional, often react without thinking, and can have trouble picking up on social cues.

But even kids who are outwardly quiet and calm can have ADHD. The so-called ADHD Inattentive kid has trouble focusing, can’t get his work done, even though he may be highly intelligent. He may be careless with details, forgetting to write his name on his paper despite constant reminders. It might not seem like he’s listening, even when you speak directly to him.  

Many kids with ADHD have a little of both types — both Hyperactive and Inattentive. This third type, Combined Inattentive/Hyperactive/Impulsive, is most frequently diagnosed.

A caution: All kids may sometimes leave a coat on the playground or have an off day with schoolwork, but children with ADHD are distinctly different, says Provenzano. “We look for these behaviors in multiple settings and under multiple conditions,” he says.  

When (not) to worry

Kids younger the age of 5 are often inattentive, impulsive and even hyperactive, and that’s normal and developmentally appropriate, explains Dr. Chris Varley, a professor in the Division of Child and Adolescent Psychiatry at the University of Washington School of Medicine. Varley is especially cautious in diagnosing children younger than the age of 5 with ADHD.

“Half of the parents of 4-year-old boys think their sons are hyperactive,” says Varley, who is also an attending physician at Children’s Hospital and Regional Medical Center. “These kids are enthusiastic and have a lot of energy, but by no means does that mean that anywhere near that number of kids would be diagnosed with ADHD.”

“We commonly see questions of ADHD come up in the second-grade classroom,” says Varley, “in situations where the student’s ability doesn’t seem to match a student’s potential. The student may have problems with academic activities such as reading and math, or problems with short attention and distractibility.”

Diagnosing ADHD

If you think your child has symptoms of ADHD, Varley suggests you start by talking to your pediatrician. “Most pediatricians or PCPs have some measure of familiarity with ADHD,” he says. “Not all have special expertise, but most diagnose ADHD and prescribe the majority of medications for ADHD.” Your doctor will talk to you about your child’s history of behavior and may survey other adults, including teachers, who have been able to observe your child. ADHD sometimes comes hand-in-hand with other troubling symptoms, such as fatigue, anxiety and depression, and your doctor will also keep these factors in mind.

If your child has ADHD, it’s important to get help early, says Varley, because without diagnosis and treatment, he runs the risk of having low self-esteem and other problems that can hinder him throughout his life. Studies show that people with ADHD tend to have trouble with substance abuse, maintaining relationships and keeping jobs. As many as 70 percent of children with ADHD will still have symptoms into adulthood, according to the National Institute of Mental Health, so it’s important to learn coping skills early in life.

Treatment options

According to the National Resource Center on ADHD, it’s best to treat ADHD from several sides; besides medication, both parent and child can learn techniques to manage ADHD behaviors.

The drugs that are available to treat ADHD in children are effective for about 90 percent of kids with ADHD, according to the Surgeon General’s Report on Mental Health. There are also alternative therapies available, including (EEG) biofeedback, megavitamins, diet manipulation, attention training, visual training, traditional one-on-one psychotherapy and more. For some families, it may be worth looking into alternatives to drugs, says Varley. “Parents ought to be skeptical about putting their kids on medications,” he says. “So for some parents, doing something like employing a tutor or looking at a biofeedback plan and other types of strategies along those lines makes some sense as an initial step, as long as parents are critical about whether or not that intervention actually helps their child.”

A success story

Jackson started kindergarten in Seattle with what seemed like a normal measure of rambunctious enthusiasm. But soon his teacher noticed that Jackson had more trouble than other kids focusing on and finishing classroom activities. Jackson would be up and out of his seat and looking at the work of other kids, unable to settle down.

“It got worse the more that was expected of Jackson as he moved through first grade,” said Jackson’s father, Jon. “We would talk to the teacher two or three times a week about concerns with Jackson’s behavior.”

At Jackson’s annual check-up the pediatrician suspected ADHD. Specialists at Seattle’s Children’s Hospital confirmed the diagnosis through a course of testing, questionnaires and observation of Jackson in the classroom. Jackson’s parents wanted to avoid drugs, so they started a treatment program of behavior therapy and other exercises. But Jackson’s most difficult issues persisted. He still couldn’t sit still, study or focus on his work like the majority of his peers.

Late in second grade, with advice from their physician, Jackson’s parents decided to try him on a dose of Ritalin, a common drug for treating ADHD.

“I went to pick him up after the first day on medication, and his teacher came up and met me and said, ‘Jackson was a different kid today — you started the medication, didn’t you?’” says Jon. “For the first time ever, Jackson was able to work all the way through an exercise in the classroom. His teacher was excited and I was excited, and from that point on he has been a 100 percent better student. It was immediate and almost overwhelming.”

Jon says parents who have concerns about their own kids shouldn’t wait to get help. “Don’t wait, especially if your child is young, because they are starting their academic careers and they can get discouraged,” he says.

“You don’t want it to be coded into their neurons that learning is bad.”

A special school

For years, Kent mother Linda Smith tried numerous treatments for her daughter Taylor. The medications available at the time were ineffective and the 504 plan — a specialized education plan for Taylor in her public school — just wasn’t working.

Smith hung in, often relying on support from her local CHADD chapter, but was frustrated with the long haul to success for Taylor. Taylor’s ADHD behaviors zapped Smith’s energy and detracted from her relationship with her other two children.

Taylor seemed poised on a downward slope in seventh grade. Her grades were slipping, and she was having trouble making healthy friendships. Her parents decided it was time for a change, and enrolled her in a school that specializes in helping children with ADHD and learning disabilities, New Horizon in Renton.

Taylor thrived at her new school, Smith says, thanks to smaller class size, targeted curriculum and extensive counseling services, along with new and better medication. “She had the lead part in a drama, took archery and got a gold medal,” Smith says. “Her grades were all A’s and one B — something that has never happened before.”

Learning to let go

When her son Simon was diagnosed with ADHD in sixth grade, Peggy Vance dove right in to help. She read every book on the subject, set up special organization systems for Simon and even formed a group for parents with children with ADHD. She also tried different medications for Simon, who was struggling as a student at an exclusive Seattle private school.

Help for Simon came unexpectedly in the form of a middle-school project. As part of an assignment, Simon bused tables and acted as “gofer” for two weeks at a neighborhood restaurant, succeeding — and even thriving — alongside adults in the hectic scene. Suddenly, Simon fit in, and even had fun. The experience gave Peggy a breakthrough insight.

“I realized I could have a kid who accepted my color-coding system, or I could have a kid who would come home and want to be with me,” Peggy says. “I told Simon, ‘However you do in school is not as important as you knowing how much I love you.’”

Peggy ratcheted back her involvement, leaving more of Simon’s coaching to an excellent tutor. As Simon was entering high school, the family moved to New York City. Simon insisted on enrolling in a public school, where he plugged right into the chaotic, diverse urban school environment, eventually joining the school’s leadership team and graduating as one of 17 kids on the honor roll. Simon was accepted at nearly every college to which he applied.

“These kids [with ADHD] don’t know how capable they are, they don’t know how smart and creative they are, and I wonder if how I was dealing with the ADHD, in what I thought was a really responsible way, never really helped Simon learn that,” says Peggy.

“When we talk about making life easier for our kids, I really wonder if we are talking about making it easier for us and for the teachers. This is still a big question mark for me.”

Rhonda Aronwald is parent, freelance writer and owner of the communications consulting practice, RKA Communications.

What to watch for

The National Institute of Mental Health (NIMH) lists the following as symptoms of ADHD. Keep in mind that diagnosing ADHD is not simple and should be done by a qualified professional. Many normal children have these symptoms at a low level; the ADHD child will have them to a degree that is “excessive, long term, and pervasive.” According to the NIMH, the behaviors must appear before age 7 and continue for at least six months. Above all, they must create a real handicap in at least two areas of a child’s life, such as at school, on the playground, at home or in social settings.

Symptoms of hyperactivity/impulsiveness:

• Feeling restless, often fidgeting with hands or feet, or squirming while seated
• Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
• Blurting out answers before hearing the whole question
• Having difficulty waiting in line or taking turns
• Often becoming easily distracted by irrelevant sights and sounds

Symptoms of inattentiveness:

• Often failing to pay attention to details and making careless mistakes
• Rarely following instructions carefully and completely losing or forgetting things such as toys, or pencils, books and tools needed for a task
• Often skipping from one uncompleted activity to another

Source: the National Institute of Mental Health


Web sites

• Children and Adults with Attention Deficit Hyperactivity Disorder: www.chadd.org
• National Resource Center on ADHD: www.help4adhd.org
• American Academy of Pediatrics information on ADHD: www.aap.org/healthtopics/adhd.cfm
• Seattle Children's Hospital and Regional Medical Center's information on ADHD: www.kidshealth.org/PageManager.jsp?dn=seattlechildrens&article_set=21612&lic=57&cat_id=142
• The HANDLE Institute, which provides non-drug alternative treatments for identifying and treating neurodevelopmental disorders: www.handle.org
• Information on academics and ADHD: www.teachAD/HD.ca
• Web site of Dr. Russell A. Barkley, ADHD authority: www.russellbarkley.org


The Gift of ADHD: How to Transform Your Child's Problems into Strengths, by Lara Honos-Webb, Ph.D.
How to Reach and Teach Children with ADD/ADHD: Practical Techniques, Strategies, and Interventions, by Sandra F. Rief, M.A.
Making ADHD a Gift: Teaching Superman How to Fly, by Robert Evert Cimera
Driven To Distraction : Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood, by Edward M. Hallowell and John J. Ratey


ADDitude: www.additudemag.com

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