Many parents may suspect that something is up, but for most the first suggestion that a child has “attentional needs” comes from school. It starts out simply enough; a phone call or email from your child’s teacher, or maybe the conversation at a parent-teacher conference turns to phrases like; “…doesn’t always think before he acts,” “…struggles to pay attention,” or “…can’t follow directions.” Words like “impulsive,” “inattentive,” and “hyperactive” are not far behind. While these phrases and words are relatively common in the lexicon of education, they can be heartbreaking to the parents of a first or second grader. Parents react in many ways; from tears to denial, anger to despair, from frantic Internet searches to (eventually) a visit to the pediatrician. It can be overwhelming to get and then accept a diagnosis of Attention Deficit Hyperactivity Disorder.
There are three types of Attention Deficit Hyperactivity Disorder. ADHD-Predominantly Inattentive Type is diagnosed when there are six or more symptoms of inattention (e.g., difficulty sustaining attention, often distracted by extraneous material) and less than six symptoms of hyperactivity or impulsiveness. ADHD – Predominantly Hyperactive-Impulsive Type is diagnosed when there are six or more symptoms of hyperactivity (e.g., fidgets with hands or feet, talks excessively) or impulsivity (e.g., often blurts out answers before questions have been completed) and less than six symptoms of inattention. ADHD – Combined Type is diagnosed when there are more than six symptoms in each category (inattention and hyperactivity-impulsivity). Symptoms must be present in at least two settings (e.g., school and home) and there must be evidence of some impairment before age 7. Essentially a problem in self regulation, ADHD can present significant challenges to a child’s ability to do well in school, make friends, and develop a positive sense of self.
Effective treatment of ADHD follows four interrelated pathways; medication, behavioral interventions, counseling, and executive functioning training.
- There are many more medications available to treat the core symptoms of ADHD (inattention, impulsiveness, hyperactivity) than can be listed here. Many physicians begin with a trial period to determine the most appropriate medication and dosage, as well as to monitor for side effects. While parental resistance to beginning a regimen of medication is perfectly understandable, it is important to appreciate that this is medicine that is generally effective in treating a real disorder. (If the diagnosis was diabetes, would there be any question about using insulin?) This is a conversation to have with your pediatrician or whoever is prescribing treatment for your child’s ADHD.
- Behavioral Interventions:
- Behavior plans have been very effective in reducing undesirable behaviors (e.g., blurting out in class) and increasing desirable behaviors (e.g., increased time attending in class). These plans generally involve an incentive/reward and can be developed for use in the classroom, at home, or both. Dr. Willis has years of experience in developing and implementing behavioral management plans.
- Part of any effective behavior plan is regular counseling with the child to review and record his/her progress. Additionally there are a number of social and emotional issues that may arise for a child with ADHD, such as adjusting to the diagnosis, developing better social skills, coping with academic difficulties, dealing with behavior and discipline problems, and developing a positive sense of self. Counseling may be provided in an individual, group, or family context. Counseling interventions are available through Pathways to Success in School.