Most healthy children are busy, active and constantly running around. But if your child has been given a diagnosis of ADHD, you’ll be looking for answers. Understanding your child and what is behind the symptoms of ADHD is the first step to helping her. Get to know your child and explore ADHD treatment options. There is no ‘one size fits all’ solution
What does ADHD look like?
Attention-deficit hyperactivity disorder (ADHD) goes hand in hand with behavioral problems caused by impulsivity, difficulty regulating emotions and an inability to delay gratification – or wait for something that is desperately desired. When your ADHD child falls apart every time she can’t get what she wants, it’s because she can’t tolerate frustration. She needs help in developing this and other skills that rely on mature brain functioning.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes ADHD as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Children with ADHD often produce schoolwork that is incomplete and below the expected standard. They are forgetful, distractible, they often lose things and struggle to concentrate on a task for longer than a few minutes. Characteristically, children with ADHD can’t sit still and they are extremely active, fidgety and busy. It can be hard for them to focus, which makes reading, writing and listening to instructions very difficult for them. This can cause problems academically, socially, behaviorally and emotionally. Impulsivity can cause the ADHD child to lash out and hurt others.
What the professionals say
The outcome of an informal survey I did amongst colleagues around the globe was that there is a belief amongst mental health practitioners that these days ADHD can be over-diagnosed and over-medicated. The colleagues I asked recognize that when ADHD does occur, it needs to be effectively managed. The current edition of the DSM-5 classifies ADHD as a Neurodevelopmental Disorder. It usually begins early in life and it can impact on everyday functioning. The DSM-5 suggests that across many different cultures, ADHD affects about 5% of children. When the numbers of children diagnosed as ADHD in a particular group are much higher, it raises questions about who is making the diagnosis and for what purpose. It could also indicate an unrealistic expectation of childhood or an environment that is not child-friendly or age-appropriate. Healthy children tend to be exuberant, excitable, energetic, unruly and impatient. There is nothing pathological or abnormal about that.
Evidence-based research has found medication and psychotherapy to be the appropriate treatments of choice for children with ADHD. According to Clinical Professor of Psychiatry at Columbia University, Karen Gilmore, ADHD is a puzzling diagnostic entity, which is estimated to account for up to fifty percent of child referrals. She and other authors have noted that although pharmacology (ADHD pills), possibly with cognitive behavioral therapies as an adjunct, are commonly regarded as preferable methods of addressing the ADHD symptom profile, a psychoanalytic perspective helps us to understand the meaning of the symptoms of each child’s ADHD.
Your mental health and medical team can advise you about whether or not medication is indicated for your child. The possible risks of ADHD medication on a child’s developing brain need to be weighed up against the effect of ADHD on your child’s life. As is often the case with medication, it should be given when it is the lesser of two evils. Find a child psychotherapist that you trust for your ADHD child. Regular psychotherapy can be extremely beneficial and for children below puberty age this usually involves the medium of play. Psychoeducation for parents, teachers and caregivers, parent guidance consultations or psychotherapy with parents, aim to help you to help your child and provide a supportive, containing environment for her. Sometimes dietary adjustments, supplements and lifestyle changes can make a difference.
Adjustments to your child’s world
Consider your ADHD child’s school environment carefully, with a view to maximizing her learning potential in whatever way works best for her. Some ADHD children make better progress if a facilitator works alongside them at school. Others do better in smaller classes with more individualized attention. Some children learn better using a visual medium and others find it easier to learn if they are moving around – perhaps even sitting on an exercise ball rather than a chair. Some children focus better when they are close to a beloved pet, others are distracted by animals. Music and songs can help children to concentrate and learn – other children are over-stimulated by music. Try to ascertain what environment is more conducive to learning for your child.
Your ADHD child needs physical space to be energetic and active. Create opportunities for her to develop certain skills. Team-sport, ball-sports, after-school activities, art classes, creativity workshops, martial arts, learning a musical instrument and participating in group activities can all be helpful and therapeutic. If any of these are extremely challenging for your child to the extent that she hates and dreads them, the destructiveness may outweigh the benefits. Find an activity that is best suited to her abilities, her current functioning and be mindful and realistic about her limitations. If your child is very young, one of the most therapeutic things you can do is to spend time playing with her or watching her play.
The benefits of play
Jaak Panksepp was a neuroscientist and psychobiologist who researched the associations between the brain and emotions. He argued that ADHD symptoms could be alleviated if young children were given more opportunities to engage in social play – especially with other children. His research suggests that abundant play during early childhood stimulates brain development, especially in the crucially important frontal lobe. Today’s children might be less playful because of their preference for digital devices and electronic games. Some children are not allowed to play outside because of safety and security concerns. If you can, whenever possible, give opportunities for your child to play with other children of a similar age. Free, unstructured play is important but so is play that involves rules and the learning of skills The benefits of play are often invisible but they are many and varied. These skills include:
- social skills
- fine-motor skills
- gross-motor skills
- delayed gratification
- frustration tolerance
- attention and concentration skills
- learning through failure
- balance and co-ordination
- cognitive functioning
- visual perceptual skills
- numerical reasoning
- spatial reasoning
- visual tracking
- eye-hand co-ordination
- personal and psychological growth
- short term memory skills
The defensive function of ADHD symptoms
ADHD, as in many other psychological disturbances, often has its roots in a young child’s attempt to protect herself from being emotionally hurt. That is, the symptoms (such as high levels of activity) may be the child’s adaptation to something that is troubling her. Like adults, children who are highly stressed are often much more impulsive and they struggle to concentrate. They might also make themselves frenetically busy in order to shut out mental distress that would otherwise be intolerably disturbing for them. So think about and talk to your therapist about what your child could be trying to protect herself against. There is wisdom in mental illness and symptoms are not meaningless. Parenting your children in a conscious way allows you to process their distress and this in turn can reduce their symptoms and bring mental relief.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Arlington, VA: American Psychiatric Association, 2013
Gilmore, K. (2016). A Psychoanalytic Perspective on Attention-Deficit/Hyperactivity Disorder. Journal of the American Psychoanalytic Association, 48(4), 1259–1293. https://doi.org/10.1177/00030651000480040901
Caye, A., Swanson, J.M., Coghill, D. & Rohde, L.A. (2019). Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Molecular Psychiatry, 7, 390-408
Panksepp, J. (2007). Can PLAY diminish ADHD and facilitate the construction of the social brain? Journal of the Canadian Academy of Child and Adolescent Psychiatry, 16 (2). 57-66
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