The ADHD Child: What You Need to Know

What Is ADHD?

ADHD is not simply an inability to stay focused. Attention-deficit/hyperactivity disorder (ADHD) is a chronic condition that affects millions of children and often persists into adulthood. The ADHD child may have a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. They also have poor executive functioning, which impacts them academically, socially and at home.  1 in 10 children will be identified with ADHD, and it is the second most common children's mental health issue.

Many people assume that the ADHD child cannot focus, but not only can they focus, but they may also have hyperfocus when they are interested. So parents think, “This kid can focus, so he doesn't have ADHD!” The reason why they can hyperfocus is that when they are excited or interested, their brain is getting the stimulation to keep them engaged.

This is the reason they can play with  LEGO or do Minecraft for hours and have an inability to transition from the activity. Their brain is in a happy place. This also makes them more easily understimulated which makes focusing more difficult when the task is boring, repetitive, or mundane. This makes sitting for hours at school, brushing teeth, or remembering to flush the toilet a challenge, causing parental frustration.

The terms Attention Deficit Disorder and Attention Deficit Hyperactive Disorder are often used interchangeably. In the most recent version of the Diagnostic and Statistical Manual (DSM), the manual reclassified ADHD into three subtypes, Predominantly Inattentive Presentation, Predominantly Hyperactive/Impulsive Presentation, and Combined Presentation.

A predominantly inattentive presentation is often less disruptive than the other presentations. Symptoms of the inattentive ADHD child might include missing details, being easily distracted, having difficulty focusing, becoming easily bored, becoming confused, seemingly not listening when spoken to directly, having a hard time following directions, or processing information slowly. These are the kids that typically “zone out” or daydream.   They are generally compliant; however, they need a lot of reminders or support with getting started or finishing work or tasks.

Predominantly hyperactive/impulsive presentation includes the need to constantly move. The hyperactive/impulsive ADHD child may fidget, talk nonstop, be constantly in motion, and be impatient. These children may have difficulty transitioning, have high error rates, or avoid academics, especially reading. They tend to interrupt conversations, are highly emotional, have problems with group sports, are often be socially inappropriate, and may have friendship issues.

Research shows that these children are often identified earlier in life because their behaviors disrupt classroom activities.. Teachers tend to express concern as early as preschool due to behavioral and social issues. The earlier the onset, the greater the severity of the disorder. The greater the severity, the greater the impact the disorder has over the course of one's life. Even though these children have greater behavioral issues, adults are often drawn to the high-level verbal skills and quick thinking these kids have. These verbal and cognitive skills may lead them to be missed until later elementary when work requires them to organize their thoughts and put pen to paper.

The Combined presentation ADHD child is the one who comes with a full buffet of all the symptoms listed above.

What Causes ADHD?

The medical community is not sure exactly what causes ADHD. They have concluded that there are genetic and environmental factors involved. In addition, there are structural and functional differences in the brain of the ADHD child. Structurally, the ADHD child will show delayed cortical development, cortical thinning, reduced grey and white matter volume, and reduced volume in other brain regions. Functional differences include reduced connectivity of neurons in the prefrontal cortex, basal ganglia, and cerebellum. The frontal brain waves of the ADHD child has too much slow wave activity and not enough fast wave activity to allow them to stay engaged.* 

But, People Told Me ADHD Is a Hoax?

The hardest part of being the parent of an ADHD child might be the way other parents treat you and your child. Over the years, myths about ADHD have arisen. Dispelling these myths is important to help you approach the diagnosis in a healthy way.

ADHD is a real disorder, not something made up. Diagnosing ADHD is not simply a reaction to a child who cannot meet social behavioral norms. As science evolves, more information about how ADHD is connected to genetics and brain function is being discovered.

ADHD is not overdiagnosed as an attempt to get help for kids who misbehave. While diagnosis rates for ADHD have increased 5% every year from 2003-2011, the likely explanations are improved awareness and better ability to diagnose or fewer stigmas attached to ADHD.

Poor parenting is not a cause of ADHD. Despite every eye roll from those playground parents about your child's behavior, ADHD is not a result of how well you discipline or how much you spoil your child.

Girls are just as at risk as boys for ADHD. Research indicates that girls may present inattentive ADHD more often than hyperactive/impulsive or combined type ADHD. This often means that girls have gone undiagnosed since they were not causing behavioral problems. Early on,  girls often rely on their intellect at school; however, when upper grades require work that requires executive function skills, they have trouble meeting expectations. As clinicians know more about ADHD, more girls are being diagnosed with the disorder.

What Other Problems Might Be Causing My Child's Behavior?

Before diagnosing a child with ADHD, it's important to understand that many different factors can cause the behaviors. Unfortunately, many of the reasons that children present ADHD symptoms are also a result of comorbid, or simultaneously occurring, conditions.

Some of these conditions include depression, bipolar disorder, anxiety/PTSD/OCD, learning disabilities like dyslexia, CAPD, sensory integrations dysfunction, ASD/Autism, metabolic issues/nutrient deficits, chronic medical conditions, or Lyme/tick-borne illnesses.

Before being able to diagnose your child with ADHD, you need to have these ruled out as being primary conditions. While the ADHD child may also present these conditions, the difference between the ADHD being primary and secondary is the way to effectively target treatment. For example, if the primary problem is anxiety and not ADHD, then the typical pharmacological treatment will often exacerbate the problem

How Do You Diagnose the ADHD Child?

The main keys to diagnosis are that the symptoms occurred prior to the age of 7, the symptoms interfere with academic or livelihood, and the symptoms are seen in two settings.

Diagnosing the ADHD child will often start by going to your pediatrician and asking for referrals. Some pediatricians can make the diagnosis themselves with a clinical intake alone or in combination with a behavioral rating scales. ADHD is a psychological and biological condition. A diagnosis cannot be made without a professional.

Unfortunately, until recently, the majority of the measurements were subjective. In order to diagnose the ADHD child, teachers, caregivers, and parents are asked to complete behavioral rating forms, such as the BASC, BRIEF, Connors, or Vanderbilt. These checklists ask adults to look at the child and rate their behavior on a scale of 0 (never) to 3 (very often). These scales can be problematic because they come with an inherent bias. If a teacher has no patience for your child, the ratings may be skewed. Similarly, if you are unable to see flaws in your child, the ratings may be skewed. This bias is one of the reasons that the forms are only 47%-58% accurate in diagnosing the ADHD child.

If a case is more complex, a physician or provider may recommend a comprehensive neuropsychological or psychoeducational evaluation. This evaluation gives more specific details about how attention is breaking down at home and school. These types of comprehensive evaluations are especially helpful for school program planning.

Why Do I Want to Use a QEEG To Diagnose My ADHD Child?

Despite the naysayers, science proves the type and severity of a child's ADHD better than rating sheets.* Certain brain wave patterns are associated with certain symptoms or conditions. For example, too much delta wave in the frontal lobe is often associated with “brain fog” or difficulty concentrating.

A QEEG allows you to compare slow wave (known as Theta) and fast wave (known as Beta) activity. The ADHD child will have “cortical slowing” which is characterized by an elevation of the low-frequency theta waves and a reduction of the higher frequency beta waves in the prefrontal cortex.

Computers can score digitized EEG data and compute an individual's theta/beta ratio. This ration can then be compared to the ratios considered typical for individuals of a similar age. If this ratio is higher than average, usually 1.5 standard deviations, the individual is considered to have the EEG marker for ADHD.

This is specifically important because it compares individuals within an age range. The EEG information compares seven-year-olds to seven-year-olds. This removes the doubt that comes from people saying, “oh but the kid is just immature! They'll grow out of it!”  

Research notes that QEEG offers an 89% accurate diagnostic rate compared to the 47%-58% accuracy for rating scales.

Will the EEG Hurt My Child?

No. An EEG is painless. It involves putting on a cap with sensors and then applying gel through the cap. The EEG process takes about a half hour. First, the technician measures the subject's head to mark where the electrodes should be placed and may need to scrub them to improve recording quality. Then, the electrodes are attached with a special adhesive. In some cases, a cap may be used to hold the electrodes in place. Next, the person just hangs out comfortable. In the case of ADHD QEEGs, there will be one done with eyes open and one done with eyes closed. As noted previously, it is an accurate way to analyze one's brain functioning and assess if one has ADHD or not.*