In this series of articles, we will discuss some of the most common questions parents ask about various additional needs. We’re going to start with ADHD.
ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children with ADHD may have trouble paying attention, controlling impulsive behaviors (may act without thinking about what the result will be), or be overly active.
There are three main types of ADHD…
•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., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive 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. A person with impulsiveness may have more accidents and injuries than others.
•Combined Presentation: Symptoms of the above two types are equally present in the person.
Usually a child will be diagnosed with one of these three types, according to the diagnostic criteria in the ICD-10 or DSM-5. However, the latest research shows that there are actually seven different types of ADHD and they all manifest in slightly different ways. To learn more about this, have a look at Dr Amen’s work with SPECT scans: a special kind of scan to see areas of brain activity.
what causes ADHD?
ADHD is caused by a variety of factors including genetics, neurotransmitter levels in the brain and the ‘wiring’ of the brain itself. It is not caused by bad parenting!
Usually a parent or close (male) relative has ADHD. Identical twins 90% chance of both having ADHD; this shows us that there is definitely a strong hereditary cause.
What about the neurotransmitters? What are they?
Neurotransmitters are the body’s ‘chemical messengers’; they pass information from one neuron to another. Two neurotransmitters are either imbalanced or reduced in children who have ADHD. These are noradrenaline and dopamine.
Noradrenaline affects behaviors including our levels of vigilance, arousal, attention, motivation, reward, and also learning and memory.
Dopamine is involved in reward, motivation, memory, attention and even regulating body movements.
When these two brain chemicals are unbalanced, or not being produced in the right amounts, it causes a lack of concentration, hyperactive behaviour and difficulties controlling impulses.
This is compacted by the way the ‘wiring’ is in the brain of a child with ADHD. On PET and SPECT scans, scientists can see that there is dysfunction in the frontal lobes-the part of the brain that says “hmm, is this a good idea?”- so the children can’t put the brakes on their behaviour
In addition, other areas such as the limbic area are under functioning which means the children are taking in lots more unnecessary information through their eyes and ears but they can’t filter the information. 70% of children with ADHD show ‘markers’ on brain MRIs which show their internal system is dysregulated: they are underactive when they should be busy, but hyper when they should be quiet. They also really struggle to monitor and regulate their behaviour.
All of these things added together obviously make a huge impact on their behaviour and emotions. Imagine how you would feel if you were in your car and had a near-miss. You’d likely have an adrenaline rush- the ‘flight-or-fight’ response- and would feel shaken up. Now imagine feeling like that for most of the day and being asked to sit down and write an essay or do some maths: it’s practically impossible.
What about girls with ADHD?
Girls with ADHD do tend to demonstrate slightly different behaviours and there is still a long way to go in researching why this is the case. However, some of the most commons signs of ADHD in girls are shown in the diagram below:
So how can I help my child?
As in the infographic above, the most effective behavioural treatments for ADHD involve living by routine, rewarding the good and taking a step back from confrontation.
Approximatly 50% of children with ADHD also have a Specific Learning Difficulty such as dyslexia, dyspraxia, slow processing speed or poor working memory. They need routine and structure in order to thrive. Children with ADHD often have mood swings and emotional variability so they need help regulating and expressing their emotions. Additionally, they can be very sensitive and suffer from cripplingly low self-esteem: they are ‘out of kilter’ with their peers, misread social cues and tend be treated as the annoying outcast who won’t calm down and keep up with the group. They put a lot of effort into their school work but achieve little because they are unable to focus and channel their attention. To help them we need to tackle the issues of emotional regulation, sensory processing problems and brain chemistry.
But how do i do that?
We need to make sure they eat and sleep well. Sugar crashes are far more severe in our children and they get ‘hangry’ quickly. They need a diet that helps to balance their noradrenaline and dopamine levels. This includes a protein heavy breakfast- turkey burgers are particularly good, but baked beans, boiled eggs and other sources of protein are excellent choices. Choose brown carbs over white carbs- they have a grounding affect and take longer to break down which means our children don’t suffer such extreme energy crashes. Iron, zinc and magnesium are essential in the production of neurotransmitters so a multivitamin is essential, along with green leafy veg (maybe in a smoothie with some orange juice to aid the iron absorption). Fortified bread and cereal are excellent choices too, along with bananas (which are an excellent source of B6- a vitamin that helps in neurotransmitter function). Zinc can be found in meat products, beans, chickpeas and nuts. A breakfast of baked beans or peanut butter on whole-wheat toast is an ideal way to get the day off to a good start!
Make sure the children are surrounded by positive social support. They may be left out at school, with friends pushing them to the side when they’ve had enough of the mood swings or inattentiveness. This really impacts our children’s mental health so we need to give them plenty of positive social interaction and specific praise from family and friends. They may find it easier to be friends with younger children who are at a similar developmental age.
Children with ADHD are very sensitive to stress and become overwhelmed very quickly. We need to find out what their triggers are, think ahead and plan ahead. Choose which aspect of their behaviour you’d like to work on and stick with just that to begin with. Don’t overwhelm them with lots of changes and punishments. Use a behaviour system such as ‘1,2,3…Magic’. It’s one of the most popular programs and really works well for children with ADHD because it gives them the chance to stop, think and make the right choice. We need to make sure we don’t ask too much of them; don’t expect the impossible. Keep distraction to a minimum as far as possible and have structures in place to help the child. This could be things such as having a place for everything in the home, getting them to count what they need in their school bag, repeating requests back to you. As they get older, organization and note apps are really helpful for them to keep track of their thoughts and their day.
Their body, mind and brain are all sending and receiving mixed signals due to their systemic dysregulation and sensory issues. We need to help their body and mind ‘tune in’ to each other and balance their neurophysiology as far as we are able to. This can be done by using grounding activities, mindfulness, and helping them to recognize what they are feeling. For a younger child, we might ask them to colour in on a picture of a body and point to “where they feel cross” or “where they feel sad”. We could then do some mindful breathing exercises and grounding techniques. Even just 15 minutes of mindfulness per day has been shown phenomenal improvements in attention, working memory, compassion and anxiety reduction. Apps such as Positive Penguins and Molehill Mountain are very effective. Another useful habit to start is journaling and using a diary to monitor their emotions. The one I recommend is the Happy Self Journal; it asks different questions every day and helps the children to process their feelings and events of the day. This is also so useful to us as parents because sometimes our children struggle to express themselves verbally and using the journal allows them the opportunity to share their feelings through writing or drawing.
What about medication?
There are quite a few options for medication in treating ADHD, and all are working towards the same end goal: adjusting the levels of brain chemistry and compensating for the brain wiring problems so that the child can focus. According to Childmind.org, “Stimulants are the best and most common type of medication used to treat ADHD. There are only two stimulant medications, methylphenidate (the active ingredient in Ritalin, Concerta and other formulations) and amphetamine (the active ingredient in Adderall, Vyvanse and other formulations). Both medications are available as short-acting medications and in longer acting preparations.
The two types of medications (methylphenidate and amphetamine) are equally effective and have the same benefits and the same risks. While most people will respond equally well to either medication, there are a few people who respond better to one versus the other. Typically, if you start treatment with one of these medications and it doesn’t work well or is not tolerated, you should probably try the other medication.”
Which books do you recommend?
Always a favourite point to end on, here are some of my favourite books for children with ADHD & their parents.
What do you find most challenging about being a parent of a child with ADHD? Have you noticed if you have ADHD traits yourself, or a diagnosis even? How do you manage your child’s behaviour? I’d love to hear your feedback.