I'm thinking about ADHD....wait..what was I thinking about??

I  LOVE ADHD!!! Really..this is the best time of my practice. The first few weeks of school, I have so many patients come in for evaluation of "attention issues"..

A child doesn't ever develop ADHD in kindergarten. Now, preschool is available at 4 years of age. Children also don't develop ADHD in preschool.

Children are BORN with ADHD.

First time parents sometimes don't know any better. They have no comparison. Second time parents are aware that there are differences but can allow for other reasons...." He is acting out...he is stubborn...he is bad...".

The first time that parents observe that their child has trouble with following directions like...staying on task...sitting quietly at a table with peers...waiting their turn... is usually noticed in the day care, pre-k or kindergarten environment.

They come to me in the first weeks of school saying that the teacher thinks there is a problem. The teacher tells them that their child is disruptive...can't pay attention..talks out loud..is fidgety..can't keep his hands to himself..can't sit in circle time...annoys others kids...can't follow directions...talks incessantly...

WOW.

Where are the parents? Where are the grandparents? Where is the babysitter? Where is the daycare?

I'll tell you. All of the above have noticed. The problem is that no "program" will recognize ADHD until the child gets to school and is singled out for his/her behavior.

By then it is harder to help the child in question.

That is where I love the chance to help.

The earlier the better. This gives me more chance to evaluate the child and set him/her up for testing.

The first thing I ask of the parent(s) is if the child met developmental milestones appropriately.

I ask if they can see and hear. Most people know...even without testing. If there is a question, then I set them up for evaluation with audiology and ophthalmology.

I then interview the child. If the child isn't able to sit still or engage in a task or answer questions or play or interrupts or climbs everywhere...etc.........then I get started.

I am amazed at how many K- 3 kids, with ADHD, when asked if they like school, say " NO"! I'm even more amazed that when I ask them if they have any friends..they say "NO". 75% of kids cry when I ask them if they feel welcome and loved at school. This always blows away parents ....and they usually cry too. I think because the parents ache for their child and they feel guilty or responsible. Which parent doesn't want their child to feel as special as we know they are?

The child with ADHD can't help behaving in a manner that is irritating. There is no regard for personal space, their thoughts race, they can't help yelling out, they fidget, they can't follow directions, they are disruptive, they act as if driven by a motor, they miss the innuendo and social cues that other kids have naturally.....they are obnoxious to teachers and fellow students.

The child hears, " Sit down...keep your hands to yourself..stop running around..pay attention..stay in line....focus...stay in your seat...stop talking...take turns...don't shout out loud..."

Then, the child gets a "note" for mom as he watches the rest of the "well behaved" kids get rewards for good behavior.

He goes home and hears..." You're bad..another note? ...Sit down...EAT!! Do your homework...stop wiggling...be like your sister...Wait 'til your dad gets home...etc..etc...

Pretty soon the child just tunes out and resolves himself to being the "bad egg".

This is where I step in.

I only wish that I had an hour with every child.

First, if I'm thinking that the child really has ADHD, I ask that the school test the child.

As I've been doing Pediatrics for 14 years, I have a good idea who is really ADHD. Not that I'm so smart, but  I am really willing to listen to teachers and parents.

I start meds at once if I'm convinced that the child is ADHD. I still put in the EVAL for development but I'm unwilling to let a child suffer when he or she could benefit from therapy.

I also tell the child that it is not a magic pill. It won't make their parents nicer or the teacher more lenient.
I tell them that it will only help them concentrate a bit longer. The rest , I tell them is up to them.

I also tell the parents that this child will need to be parented differently than most. I stress a highly structured environment.


Those of you that know me ...know I'm about as structured as a glob of silly putty. My kids just don't need rigid structure. In fact, they NEED to be flexible.

ADHD kids need structure. The meds ONLY help them concentrate a bit longer. Long enough to not do impulsive things... long enough to listen to and follow directions...long enough to regard a friend...long enough to form a bond...long enough to understand and feel empathy...

If the meds offer this "bit more" of focus, then the parents and teachers need to know what to do with that moment more.

Kids don't WANT to have ADHD. They want to be successful in kindergarten and 1st grade and 6th grade and 8th grade and 11th grade and college. If you asked your child in kindergarten if she wanted to drop out of school......she would LAUGH at you. The world is their world. It only takes a few months to take the wind out of their sails.

Don't be that parent that says, " There is NOTHIN wrong with my kid".

Teachers know. Doctors know. Most parents know.

I love ADHD kids because I can help change their lives if the parents and the teachers are on board early.

So, what was I thinkin about?