How is ADHD actually diagnosed? And what are the most effective treatment approaches?

Attention Deficit Hyperactivity Disorder or ADHD can look different. Perhaps your teenage son’s bedroom looks like a Category 3 hurricane blew through it and he has a magnifying lens on all his emotions. Or your 4th grade daughter seems like she is always daydreaming and needs constant reminders to complete even simple tasks. And of course there could be your middle school son who simply cannot sit still and blurts out information like Alexa on auto repeat, even when not asked.

October is ADHD awareness month (though if your child has it you are probably aware of it 12 months a year!), so Engage the Brain is focusing on sharing some facts, debunking some common myths, and detailing some typical – and not so typical – treatment options.

Dr. Ned Hallowell, a well-know psychiatrist who specializes in ADHD, says, “The ADHD brain is like a Ferrari engine with bicycle brakes.” If your child is like the active – and verbose – child described above, clearly you can relate to this quote. The thinking, processing and output cycle in individuals with ADHD can be disrupted and often times yield undesired consequences.

Types of ADHD/ADD and statistics

According to the CDC, there are three different ways ADHD presents itself, depending on which types of symptoms are strongest in the individual:

• Predominantly Inattentive Presentation: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

• Predominantly Hyperactive-Impulsive Presentation: The person fidgets and talks a lot. It is hard to sit still for long (e.g., while doing homework). Younger children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. They may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions.

• Combined Presentation: Symptoms of the above two types are equally present in the person.

According to CHAAD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), ADHD runs in families with a heritability chance of 57% for a child if a parent has ADHD and a 70%-80% chance for a twin if the other twin has ADHD. The Centers for Disease Control estimated the number of children aged 3–17 years ever diagnosed with ADHD, according to a national survey of parents, is 6 million (9.8%) using data from 2016-2019. This number includes:

• 3–5 years: 265,000 (2%)
• 6–11 years 2.4 million (10%)
• 12–17 years: 3.3 million (13%).

Additionally, according to a national 2016 parent survey, 6 in 10 children with ADHD had at least one other mental, emotional, or behavioral disorder:

• About half of the children with ADHD had a conduct problem.
• About 3 in 10 children with ADHD had anxiety.

Myths about ADHD

Like so many conditions and diseases and maladies, there is a plethora of information available just a few finger clicks away on the internet. Hello, Dr. Google! While some of that information is truthful and perhaps even helpful, much of it is wrong and can be even dangerous depending on the disorder. To help parents sort through what information belongs in which category, what follows are several common myths about ADHD and related facts.

Myth: A child’s environment is the main cause of attention deficit disorder. If you make changes to the home environment, the condition will solve itself.

Fact: ADHD is a legitimate brain processing condition. The environment could be perfectly set up to support a child with ADHD and there could still be challenges.

Myth: ADHD is not a real medical condition.

Fact: Understood states that The National Institutes of Health, the Centers for Disease Control and Prevention, and the American Psychiatric Association all recognize ADHD as a medical condition. Imaging studies show differences in brain development between people with ADHD and people who don’t have it.

Myth: All children with ADHD are hyperactive.

Fact: As referenced above, there are three ways the condition can present itself. One is predominantly inattentive. Think of the daydreamers or child who needs multi-step directions repeated numerous times.

Myth: Children with ADHD will outgrow it.

Fact: According to the Child Mind Institute, about two-thirds of kids with ADHD will continue to meet the criteria into adulthood. But the symptoms can change. Often the hyperactivity component can lessen as a person matures into an adult.

Myth: Only boys have ADHD.

Fact: Twice as many boys are diagnosed with ADHD than girls. That typically is attributed to girls not being hyperactive, which tends to be more visible – and disruptive – in childhood. Often with girls the symptoms are missed or overlooked by classroom teachers who are not trained or experienced in working with students with ADHD. 

Diagnosing ADHD

There’s no single test to diagnose ADHD. A psychologist or psychiatrist or a primary care provider such as pediatrician can diagnose the condition. According to Wedmd, doctors rely on several things, including:

• Interviews with the parents, relatives, teachers, or other adults
• Personally watching the child or adult
• Questionnaires or rating scales that measure symptoms of ADHD
• Psychological tests

ADHD ratings scales are commonly utilized during the diagnosis process. Parents and teacher(s) will be asked to fill out a questionnaire. Healthline has some great information about the rating scales and what to expect when completing them.

Treatment options for ADHD

Just as no two people with ADHD share the exact same symptoms, there is no universal treatment perfect for all. According to Nemours Kids Health, treatment for ADHD usually includes:

• Medicine. This activates the brain’s ability to pay attention, slow down, and use more self-control.
• Behavior therapy. Therapists can help kids develop the social, emotional, and planning skills that are lagging with ADHD.
• Parent coaching. Through coaching, parents learn the best ways to respond to behavior problems that are part of ADHD.
• School support. Teachers can help kids with ADHD do well and enjoy school more.

While medicine, therapy, and coaching are the most common approaches to addressing ADHD, there are alternate treatment options.

• Diet: The Feingold Diet is an elimination diet, which strives to remove certain foods to help reduce hyperactivity and increase focus.
• Exercise: CHAAD states that 30 minutes of aerobic work: running, biking, swimming can be as effective as taking medication. 
• Yoga: My Yoga Teacher shares ten poses to help with focus and attention.  
• Meditation: Five techniques to get started by Choosing Therapy.

Final thoughts

ADHD is a legitimate brain condition which can present in three different ways: predominantly inattentive, predominantly hyperactive and impulsive, or a combination of the two. Diagnosing it requires a medical professional such as a pediatrician or psychiatrist who will use a variety of techniques including observation, interview, and rating scales. Treating ADHD is most effective when employing a holistic approach, using a combination of tools including medicine, diet, and exercise. Perhaps the most important action to take when a child has ADHD is to surround them with the right support system. Dr. Hallowell, the psychiatrist who focuses on ADHD, says, “You need to give what’s best in you a chance to grow with the right gardener, one who sees that you’re a special plant, not a weed.”

If your child has been diagnosed with ADHD or you believe your child is struggling with symptoms similar to it, please contact Jennifer Disch at Engage the Brain to discover how a Learning Specialist may be able to help provide your child with strategies and techniques to help them thrive in the classroom and life and blossom into the best versions of themselves.