FIDGETY PHIL AND THE ESSENTIALS OF ADHD: PART 1

"Let me see if Philip can – Be a little gentleman;
Let me see if he is able – To sit still for once at table"

Thus begins “Fidgety Phil,” Dr. Heinrich Hoffman’s early 19th Century ode to children with attention problems. The tale is sadly familiar to frustrated parents today, more than 170 years later.

ADHD remains one of the most misunderstood and challenging issues for both adults and children although today there is hope for treatment and much better understanding. We know that kids won’t just outgrow ADHD but the good news is that ADHD can be treated.

HOW DO YOU DIAGNOSE ADHD?

Most people know that ADHD is the acronym for Attention Deficit Hyperactivity Disorder. Attention is the ability to focus or filter information. Psychologists are uniquely qualified to diagnose ADHD using standardized tests in addition to observation and parent or teacher reports. Too often, ADHD is inaccurately diagnosed based exclusively on symptoms.

Using neuroimaging studies, we know that children with ADHD have physical brain differences in numerous areas. The outcome of this new knowledge is an understanding that children with ADHD typically lag 2-3 years behind neurotypical children in the development of the brain’s prefrontal cortex, the area associated with higher-level skills of planning and impulse control.

For instance, it is not until adolescence that the prefrontal cortex becomes more active. Individuals with ADHD lag behind their typical peers in this process and therefore are more likely to exhibit difficulty with problem-solving, anticipating consequences, inhibiting responses, and impulse control

The prefrontal cortex is associated with executive functioning, which is the ability to plan out strategies make a goal, and anticipate outcomes/consequences. The prefrontal cortex plays a role in the ability to differentiate between conflicting thoughts and emotions i.e. decision-making.

It’s rare that someone only has ADHD; this much-maligned illness is often accompanied by a learning disability or a mood disorder. Adding to the difficulty, there is a significant overlap between the symptoms of ADHD and other disorders, known in psychology as ‘comorbidities’.

Family dysfunction, parenting issues and low self-esteem are frequent co-conspirators in ADHD. Any of these issues may lead to depression, a frequent co-occurring condition. So, clearly, ADHD has a serious impact on kids, families, and schools.

WHO IS AFFECTED?

ADHD is known to affect more boys than girls, and although the prevalence rate is thought to be no more than 10%, roughly 50% of children referred to mental health clinics have ADHD-related problems. The societal cost of ADHD is estimated to be between $12,005 — $17,458 annually per individual, or a whopping $36 – 52 billion in total.

The worst impact of ADHD is in school, where the kids typically show:

  • High rates of disruptive behavior;
  • Low rates of engagement with academic instruction and materials;
  • Inconsistent completion and accuracy on schoolwork;
  • Poor performance on homework, tests, and long-term assignments, and
  • Difficult getting along with peers and teachers.

Socially, there is also an impact. ADHD can impact peer relationships; while eager to make friends, kids with ADHD often have difficulty keeping them. In fact, some might feel ignored but other kids insightfully know they are actively being rejected. They may sense that they are deficient in the mechanics of friendship, what we in the clinical world call appropriate social behavior.

Even team sports may be challenging, as the kid with ADHD may become too easily frustrated and show poor emotional regulation. Their friends may find them annoying or impatient, inflexible or bossy, none of which bodes in school or at play.

CAN ADHD BE TREATED?

It’s clear that children with ADHD confront significant issues at a young age. How can we expect a ten year old with ADHD and the brain development of an eight year old (or younger) to behave beyond his capability? As parents, we want to help our children build character and self-discipline and to lay cornerstones in executive functioning.
Therapy can help our children develop these necessary skills for success. Stay tuned for details in my next post!