10-year old blue-eyed Michael executes the kata with surgical-like precision. He has earned his orange belt, he informs me, as he gets down from the exam table and circles the room for the sixth time in fifteen minutes. He then sits on the floor, jiggling and squirming, talking nonstop about a wide-range of topics. Flashing a heartwarming smile, Michael then tries to access the desktop in Exam Room 8; thankfully, there are passwords. A gifted math student, Michael’s desk in school is an unmitigated disaster of disorganization as is his knapsack which stinks of forgotten, rotting food. And his room, his parents say, looks as though a Level-4 hurricane has just passed through.
Michael’s parents have brought him in because they don’t know what to do to help their son. And his school, reporting that Michael has problems transitioning from one task to another, insists that he must have Attention Deficit Hyperactivity Disorder (ADHD). “Help us to help our child,” his parents plead.
Children with ADHD show signs of inattention, hyperactivity, and/or impulsivity in specific ways. These children are in constant motion, squirm and fidget, do not seem to listen, have trouble playing quietly, often talk excessively, interrupt or intrude on others, are easily distracted, and do not finish tasks.
How is ADHD diagnosed?
Though your child may have some symptoms that seem like ADHD, it might be something else such as anxiety or depression. That’s why you need your doctor to check it out.
Sorry but there is no specific or definitive test for ADHD.
Diagnosing ADHD is a multi-step process and involves gathering information from you the parent, your child’s school and others.
There will be a physical exam together with a complete medical history. Your pediatrician should ask what symptoms your child has, how long ago those symptoms started, and how the behavior affects your child and the rest of your family.
Doctors diagnose children with ADHD after a child has shown six or more specific symptoms of inattention or hyperactivity on a regular basis for more than 6 months in at least two settings. The doctor will consider how a child’s behavior compares with that of other children the same age.
Is ADHD the “disorder” of the 21st Century?
Often attributed or fueled by the hi-tech age with life speeding past. However, this is rubbish! A bit of history to understand more.
In 1763, Sir Arthur Crichton, observing patients unable to focus, wrote that “the barking of dogs, an ill-tuned organ, or the scolding of women, are sufficient to distract patients of this description to such a degree, as almost approaches to the nature of delirium.” Those patients, he wrote, referred to their own symptoms, including anger “bordering on insanity,” as “the fidgets.”
The good news is there has been progress in diagnosing and treating ADHD since Sir Crichton penned his words. Let’s start with the big white elephant in the room – the big question:
Do you medicate your child who has ADHD?
For a child struggling with ADHD, medication is a must.
ADHD is a brain issue, meaning it’s how the brain is wired, so therapy alone is generally not enough to help a child to sit in class and pay attention.
My friend and colleague, Dr. Barry Holzer, emphasizes that medication makes the ADH manageable for the child, rather than struggling against it. He adds that ADHD meds have been around for over 50 years and have some of the longest follow up studies with good safety records.
Sleep can be a game changer for children with ADHD:
As little as 30 extra minutes can be a game changer. Be consistent about bed time. Also, eat a balanced diet which includes whole grains, fish and plenty of fruits and vegetables. Cutting down on sugar and processed foods will help all children.
Behavior Therapy Options
Setting the Table
For example, start with small manageable goals such as sitting at the dinner table for 10 minutes and then rewarding your child. Within behavior therapy, there is a growing area called Executive Functioning (EF). Teachers trained in EF work with your child, teaching them how to organize a binder and/or use a homework planner together with colored pens. Generally speaking, EF teachers are more efficacious than parents because your child may perceive you as the nagging parent.
Bake in the Kitchen
A child who has ADHD loves to be involved with an activity. You read this correctly – as messy as this might be to bake in the kitchen, this works!
Have your child choose a (simple) recipe. Set a date or occasion for the dessert to be enjoyed. Write the date in the calendar. Together, choose a recipe. Your child should list out the ingredients needed and then check the cabinets, making a shopping list of missing ingredients. Schedule a trip to the grocery store, diarizing it in the planner or calendar. On the day of baking, your child should line up the ingredients and utensils needed. Then he can follow the recipe, step-by-step. If you get your child to clean up, call me: I want to know how you accomplished that.
The key is to keep it simple, fun and not to have high expectations!
Michael now has 30 milligrams daily of Vyvanse. He works weekly with an EF teacher at home. His teachers report that he’s able to transition between tasks more easily. Michael’s room might need reorganizing, but I hear he’s on his way to earning his green belt!
If you are concerned with your child’s behaviors and would like to schedule a consultation with our experienced team at Total Family Care, please contact us via email at email@example.com
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Dr. Hylton I. Lightman is a senior statesman amongst pediatricians, an internationally-recognized authority and diagnostician, a public speaker, expert witness and go-to resource for health issues in the Orthodox Jewish community.