“I am very good at forgetting”. . .”I get angry because I try so hard”. . .”I get overwhelmed and can’t ask for help”…are typical frustrated statements from individuals with attention deficit hyperactivity disorder, according to psychologist Saline (2018).
ADHD: What it is–and isn’t
Children with ADHD struggle academically, socially, and psychologically. They forget things; can’t slow down; can’t focus; are disorganized; can’t control emotions, and are often unable to sustain peer relationships.
Author Saline recognizes that ADHD kids can be exceptionally creative; they are ashamed of having a disorder; and it is difficult for them to cope with symptoms (as it is for parents, all family members, teachers, and peers). ADHD kids do the best they can with problems of working memory, concentration, and impulse control.
Many children with ADHD experience emotional over-arousal and demonstrate aggressive behaviors, creating relationship difficulties. As ADHD children become adults, many continue to have symptoms. But, symptoms may tend to change. Hyperactive and impulsive symptoms may fade—and inattention remains.
The prevalence of ADHD, as noted by psychologist Phelan (2017), averages in children between 5 and 7 percent. In adults, it is about 3 to 5 percent. ADHD is seen worldwide. More than two-thirds of children and adults with ADHD have other psychiatric disorders. These include oppositional defiant disorder, substance abuse disorders, anxiety, and depression. Individuals with ADHD are also prone to learning disabilities and motor incoordination problems.
ADHD appears genetic. Author Phelan refers to current research that indicates that ADHD has something to do with a predominately inherited inability of the prefrontal areas of the brain to do their job of self-regulation correctly.
The DSM-5 (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) defines ADHD. It looks at persistence (symptoms have lasted for at least six months); number of symptoms (persistence of six or more symptoms for children through sixteen-year-olds; five or more symptoms for age seventeen and up); early onset prior to age 12; symptoms inconsistent with developmental level; evidence of impairment; symptoms in two or more settings; and symptoms are not due to another mental disorder.
Additionally, DSM-5 classifies according to inattention, hyperactivity, and impulsivity. The DSM-5 describes presentations, rather than types—for fluid conditions that may change over time.
A diagnostic evaluation can take hours of time, carefully examining the pattern of inattention and/or hyperactivity/impulsivity; difficulties with development; and symptoms that interfere with home, school, or work functioning.
The encouraging news, according to Phelan, is that information about ADHD has become more widespread. More classroom teachers and therapists are trained to understand and manage ADHD. ADHD is better understood as a neurological, genetic, and treatable condition. It is not caused by neglectful parenting. Some parents of children with ADHD and adults with ADHD now face the diagnosis with some relief.
Mental health experts now know more about symptoms, treatments, and accommodations.
ADHD Specialist: Dr. Nicolle Bugescu
This writer had an opportunity to interview Fullerton, California pediatric psychologist and ADHD specialist Dr. Nicolle Bugescu (February 2019).
Dr. Bugescu asks parents if they want to consider medication for ADHD. She indicates extensive research that demonstrates significant positive attention/concentration abilities with medication. Some parents are apprehensive about the long-term effects of medication. Research, again, is beneficial. Children who are on medication for ADHD are actually less likely to abuse drugs and alcohol as teenagers because they tend to feel that the medication is addressing their attention challenges, rather than using drugs or alcohol to cope with their challenges.
Because parents want to know about non-medication options, Dr. Bugescu recommends regular, intensive exercise. The frontal cortex of the brain has control over executive functions, including attention and concentration. She recommends 30 – 60 minutes of daily exercise to increase blood flow to the frontal part of the brain. Exercise is most beneficial before school, if time allows, or right after school, before beginning homework.
In regard to ADHD behavioral problems, such as throwing objects, hitting, and spitting, Dr. Bugescu has a valuable message for parents. Children with ADHD want to be good and please parents. She encourages parents to have empathy for their child—and provide praise for tasks done well. “Catch your child doing well”, is emphasized by Dr. Bugescu.
Five C’s of ADHD Parenting
Psychologist Saline (2018) has designed and recommended her “Five C’s of ADHD Parenting”: Self Control, Compassion, Collaboration, Consistency, and Celebration. Dr. Saline explains that her Five C Model uses strength-based thinking and identifies behaviors in which ADHD children excel—and nurtures those skills.
With Self Control, parents first learn to manage their own emotional feelings, so they can teach their child with ADHD to do the same.
With Compassion, parents try to “meet” a frustrated child where they are, not where one expects them to be.
With Collaboration, parents work together with a child and others in their life to find solutions to daily challenges, instead of imposing rules on them.
With Consistency, parents do what they say they will do. Aim for staying steady, not for perfection.
With Celebration, parents notice and acknowledge what is working by continuously offering words and actions of encouragement, praise, and validation. An ADHD child describes the “Five C” experience with, “ I was taught to think positively, and to think what I was doing right.”
Another means of promoting a positive ADHD result is with rehabilitation therapy.
Occupational Therapy Rehabilitation for ADHD
Occupational therapy practitioners have a long history of helping pediatric clients develop sensory, cognitive, and life skills.
In an occupational therapy study (Kelsch, Miller, Nielsen, 2016), ADHD children were described to demonstrate executive functioning impairment, to include working memory, planning, and emotional regulation. This study recommended the use of weighted vests, as their use tends to decrease anxiety, increase attention, and increase stay-on-task abilities. Large, sit-on stability balls also increase the ability for an ADHD child to remain seated and increase work productivity.
Because play is a major life skill for a child, occupational therapists can facilitate appropriate behaviors. By including the child with ADHD in play activities with other children, an occupational therapist is able to promote/encourage social skills and cooperative play.
This occupational therapy study detailed the use of therapy as a co-treatment with medication for ADHD children.
Medications for ADHD
According to author Phelan, stimulant medications are usually first considered with ADHD children.
The two most common are methylphenidate (such as Ritalin) and amphetamine. They have been prescribed for over fifty years. Side effects may include headache, abdominal pain, decreased appetite, sadness, irritability, and drowsiness.
A non-stimulant, Stattera (Atomoxetine), is approved for children. This medication has a low potential for abuse. Positive effects may not maximize for weeks. Clonidine, a blood pressure medication, has been approved for use with children ages six to seventeen. Like other medications, Phelan indicates it may be used with stimulants.
Off-label medications, often antidepressants, such as Wellbutrin (bupropion) and Tofranil (imipramine) may also be prescribed.
Phelan has expressed that medications should be tailored to meet the needs or demands of each ADHD child. He has documented that stimulant medication is remarkably effective and safe. Stimulants for ADHD produce positive results about 75 percent of the time, with a decrease of impulsivity/hyperactivity—and an increase of concentration/attention span.
As there has been much opposition to medications for ADHD children, there are many proposed alternative approaches, according to Phelan.
Alternative ADHD Approaches
There has been an interest in alternative treatment approaches, to include vitamins, chiropractic treatment, yoga, meditation, acupuncture, and massage. There is also a mixed interest about the use of caffeine, as it has the potential to act in a manner similar to methylphenidate.
It is possible that some may benefit from a diet that eliminates certain foods or additives. These may include dairy, gluten, sugar, processed foods, and artificial food colors.
In addition to alternative possibilities, factors in the school environment have an excellent potential to provide positive results.
School Accommodations for ADHD
With the Individuals with Disabilities Education Act, Amendments of 1997, conditions included attention-deficit disorder and attention-deficit/hyperactivity disorder as two conditions that may render children eligible for special education services. With the reauthorization of IDEA in 2004, a greater emphasis was placed on early intervention and high-quality instruction for disabled students.
Teachers, support personnel, and therapists may help ADHD children. Classroom interventions and individual sessions can help achieve academic, social, and peer relationship goals.
Dr. Bugescu has added specific, valuable information for successful ADHD functioning in the school setting. Her suggestions include:
Provide seating near the front of the classroom, to avoid distraction.
Give tests and important assignments in a quiet room.
Present directions in a clear manner (using auditory, verbal, and written combinations).
Provide small amounts of information at a time to avoid over-stimulation.
Give frequent, short breaks.
Present challenging tasks with breaks for other, more enjoyable tasks.
Give folders for assignments to promote organization and decrease over-stimulation.
Teach mnemonic devices to assist short term memory.
Because memory difficulties and other symptoms may persist for an ADHD child beyond his/her school years, an understanding of adult ADHD is essential.
Adults with ADHD
About 60% of children with ADHD may carry some symptoms into adulthood.
Adults with ADHD may be more likely to experience accidental injuries; may have been fired by an employer—or impulsively quit a job; at greater risk for money management problems; and more likely to have marital problems/parenting problems, according to Phelan.
Support groups and ADHD education may be needed. ADHD adults may wish to contact CHADD, a national association for children and adults with ADHD at (800-233-4050) or visit the website at www.chadd.org.
Many adults will take antidepressant medication in addition—or instead—of stimulants. As with children, adult medications must be carefully selected and adjusted.
With support, many students can be successful in college, as expressed by Phelan. With earlier counseling and special school services, an ADHD student may gain the self-confidence to even consider attending college.
College accommodations can include extra breaks or time taking tests; early registration for classes; preferential seating in classes; audio textbooks; modified assignments; support groups; and individual coaching. Students can be coached when and how to ask for help.
As workers, employers with ADHD may be eligible for accommodations to increase work functioning. Job modifications may include a less distracting work area; working at home; flex time, and getting instructions in writing.
Toward a Positive Conclusion: ADHD
Saline offers a note of acceptance from a 13-year-old ADHD client. “I guess what has helped me accept my brain is my meds, my therapy, and my parents. My parents are good…and the meds help with focusing. The best thing I can do is laugh at myself—and my mistakes!”
Phelan indicates, with optimism, that many men and women with ADHD handle life well.
Some continue with treatment throughout childhood, teenage, and adult years. Many have acquired good social skills. Others indicate they have used their extra energy to good advantage—as outstanding achievers!
Saline, Sharon, Psy.D. (2018). What Your ADHD Child Wishes You Knew. Working Together to Empower Kids for Success in School and Life. Penguin Random House, LLC., N.Y.
Phelan, Thomas W., Ph.D. (2017). All About ADHD. A Family Resource for Helping Your Child Succeed With ADHD. Sourcebooks, Inc., Illinois.
Kelsch, Kamela, MOTS; Miller, Kaci, L.,MOTS; Nielsen, Sarah, Ph.D, OTR/L. (May, 2016). Occupational Therapy Interventions for ADHD: A Systematic Review. University of North Dakota. In https://pdfs.sematicscholar.org/7041/95047d75ae86409eDef774ea6cb04566d9ab.pdf.
Bugescu, Nicolle, Ph.D. (February, 2019). Fullerton Neuropsychological Services, Fullerton, California. Interview with Dr. Bugescu.
This writer wishes to express appreciation for Dr. Bugescu’s time, ADHD information, concern for ADHD clients, and assistance in the writing of this article.