Transcription:
ADHD in Children: Signs, Diagnosis and Treatment

Prakash Chandran: Today, we're talking about ADHD in children and joining me is Dr. Colby boots on she's a licensed Labban children's psychologist who sees patients at pediatric associates in Memphis.

This is the peds pod by Labar children's hospital. I'm your host pre Cron. So Dr. Boots on really appreciate your time today. Thank you so much for joining us.

Let's get started with the basics. What exactly is a D.

Dr Colby Butzon: Well, ADHD stands for attention deficit hyperactivity disorder. It's a neurodevelopmental disorder that we typically see in children. And it's characterized by difficulty paying attention, trouble, controlling, impulsive behaviors, and being overly active.

Prakash Chandran: Okay, understood. Now, is this ADHD related to D or is that completely separate?

Dr Colby Butzon: Well, that's a great question. We often think of those two things as two different things, ADHD being attention deficit, hyperactivity disorder, and a D being attention deficit disorder with the current diagnostic tools and diagnostic standards we use today. We lump all of those conditions under the umbrella term of ADHD, attention deficit hyperactivity disorder.

But we do specify what type of presentation a person has based on their symptoms. So there's ADHD, predominantly inattentive presentation, which is what a lot of times people will refer to as a D D because there isn't the hyperactivity piece, So there's also the predominantly hyperactive or impulsive presentation, which is characterized by hyperactivity and impulsive behavior. And then finally, there's a combined presentation that has characteristics of both the in presentation and the hyperactive impulsive presentation.

Prakash Chandran: Okay, that's helpful. And do we know yet what actually causes ADHD?

Dr Colby Butzon: We really don't. There does seem to be a genetic component because we see ADHD that runs in families a lot of times, but we don't know exactly what causes ADHD. We know that it's not related to things like eating too much sugar or watching too much TV or poor parenting or environmental factors or things like that.

We know that those are not the causes of ADHD, but we don't know exactly what does cause.

Prakash Chandran: So you talked about different presentations, but just broadly speaking, what are some signs to look out for that parents should be aware of and how does ADHD present itself?

Dr Colby Butzon: So a lot of times we'll see difficulties with concentrating and focusing. We'll. A short attention span. We might see a child who's really active. Very fidgety has a hard time sitting, still hard time sitting in their seat. We might see kids who play really noisily. They make a, they're kind of a big personality, make a lot of noise in their play and in their activities.

We might see kids who have a hard time interrupting others, or have a hard time waiting their turn either in a game or waiting in line or things like that. We might see kids looking out the window, being distracted, having a difficult time, focusing on something that isn't interesting. We might have. We might also see that they kind of keep a messy space.

They have a hard time organizing their space. Their backpack might be a mess. Their room might be a. And they also might have a difficult time organizing their activities. So they might kind of get the steps to a process out of order, or they might seem forgetful. You might give a child three steps of something to do, and they might remember the first and forget the other two.

And so sometimes people think it's a memory problem, but it's, more of an attention problem. Maybe the second and third command never made it into their brain. They heard the first one. And then didn't pay attention to. So those sorts of really active behaviors, impulsive behaviors, difficulty with attention.

Those are some of the common early signs that we might see that would suggest that a parent would wanna talk with their pediatrician about possible.

Prakash Chandran: So at what age can you actually start diagnosing ADHD? Because I imagine, for example, if you have a toddler, some parents might say, Hey, you know, they're just naturally fidgety and they wanna play a lot, so they don't necessarily seem focused because they're a toddler. So how do you I guess start thinking about what age you should really start being concerned and maybe going to seek.

Dr Colby Butzon: Well, you make a really great point there that younger children do have a shorter attention span and are a lot more active. So we don't want to be putting a label on somebody who's doing something that's really developmentally appropriate for their age. So as children get older, They do develop a greater ability to focus and pay attention for longer periods of time.

They also develop some increased self-regulation. They can have improved organization and planning for what they wanna do long term. So if we're looking at a child who's, you know, kind of past those toddler years and is still having a lot of trouble compared to their peers, with things like paying attention or activity level, then we might wanna.

Start talking with our healthcare provider about what could be going on as far as. Young a child can be diagnosed with ADHD. There's some variability on that. I tend to want to wait and see how a child does in a structured school setting. So that might be kindergarten, first grade, second grade. One of the big things that's important to know when we're looking at a diagnosis of ADHD is we wanna see difficulty in more than one setting.

So if they're at home, And that's the only setting. We really don't have information about how they do in different settings with different behavioral expectations. So we wanna see them often in another setting, like a school setting, even though a child might be in daycare, we typically don't see the demands of focus and attention that.

Lead to a diagnosis of ADHD until they're in a more structured school environment. And for me, a kindergarten diagnosis is pretty young. Still. I tend to wanna see how a child is going to do with the structure of things like reading instruction and the expectations of. A first or second grade classroom, there is a lot of variability, however, and some providers might pick up on some symptoms or feel comfortable diagnosing ADHD at a younger age.

But I tend to look to those kids who are beyond kindergarten for an initial diagnosis.

Prakash Chandran: Yeah, that's very helpful. Thank you for that clarity. So when it comes to that initial diagnosis, how is that typically done? Does the parent kind of notice some of the things that we were talking about earlier do they approach the pediatrician talk a little bit about that?

Dr Colby Butzon: So the parents are one of our greatest sources of information about their child, because they're the expert on their child. Any diagnosis of ADHD is going to start off with a really comprehensive interview with the parent. To get some background information about the child, the behaviors that they're seeing, how long the behaviors have been going on.

We also wanna look at family history to see if ADHD or other diagnoses run in the family. It's important to also rule out any possible medical causes. So often the first step in the ADHD evaluation process is to go to the pediatrician, have a comprehensive medical evaluation to make sure there's not a medical diagnosis that could be affecting attention or behavior.

And. Moving forward with a more specialized evaluation, the evaluation will include that comprehensive interview. It will also look for information and data about the child's behavior in more than one setting. So usually that comes in the form of a rating scale completed by their parents or caregivers as well as rating forms completed by a teacher or multiple teachers at school.

Prakash Chandran: You know, one of the things that I've heard is that autism or a spectrum of autism can actually represent very similarly to ADHD. what might you tell parents that are trying to figure out whether their child has autism or ADHD?

Dr Colby Butzon: That's an excellent question. And as we learn more and more about various forms of neuro divergence, people do have questions about, is this ADHD, is this an autism spectrum disorder? What is going on with. My child. So typically just from a strictly diagnostic perspective, ADHD is characterized by problems with attention and focus.

And then with the hyperactive piece there's problems with hyperactivity and impulsivity. Autism spectrum disorder is also a neurodevelopmental disorder, but it is characterized by delays or impairments in social communication, as well as repetitive behaviors or restricted interests. So the diagnostic criteria are very different and very distinct.

There are some children who have coexisting, ADHD, and autism spectrum disorder. Two diagnoses can be made in the same person, but they really have very different diagnostic criteria and an evaluation for each of those diagnoses would have different components. A psychologist who is trained in both types of evaluation could do a comprehensive evaluation, looking at both diagnoses and being able to provide a differential diagnosis of one or the other, or in some cases, both.

Prakash Chandran: Okay, thank you. That's very helpful. If a parent has a child who's been diagnosed with ADHD. What tips can you give to that parent around helping them manage it?

Dr Colby Butzon: Behavioral therapies and parent training around behavior therapy is a very effective treatment for ADHD. There are lots of great books and websites available for parents dealing with an ADHD diagnosis. There's also several providers in our community and in communities. The country and around the world who can teach parents how to structure their home and their environment in a way that can best support their child with ADHD.

Some of the things that are really important to consider are things like having a consistent, predictable routine and following through with that routine, having a consistent discipline system, that all caregivers who are working with the child follow which would include ways that we're going to.

Children appropriate behaviors as well as ways that we're going to have consequences for behaviors. We don't wanna see children with ADHD are often, much more sensitive to rewards than to punishment, especially if a punishment is given after the fact. So for example, if a child misbehaves at school and they're punished three hours later, when they come home, that's not going to be as salient as if they receive an immediate reinforcement for appropriate behavior or an immediate consequence for inappropriate. I do always encourage parents to lean towards the reinforcement of appropriate behavior in teaching new behaviors and in encouraging children to do the things we want them to do because having the reliance on punishment is often, much less effective than reinforcing and rewarding or praising appropriate behaviors that we wanna see.

Prakash Chandran: yeah, that completely makes sense. One thing that I wanted to cover before we close is, you know, I know a few parents whose child have been diagnosed with ADHD, and sometimes I feel like there's a feeling of sadness or, just concerned that their child won't live a complete life that their child might be labeled.

That something that you see as well? And what might you say to those parents?

Dr Colby Butzon: Of course. I definitely understand where parents are coming from with the thoughts and the wishes and the ideas that they have about what a child's life is going to be like and getting. Information about a diagnosis can be hard to take. Sometimes. However, people with ADHD are very successful.

There are people in this world who are in the highest levels of power and influence who have ADHD and ADHD is not a diagnosis that is going to preclude anyone from reaching their goals. So there's a lot of positive things that can come with that diagnosis of ADHD. In addition, sometimes. Kids who have the diagnosis of ADHD might be having a difficult time following the rules.

And before we know that they have a diagnosis of ADHD, sometimes people think that's willful disobedience or they're just misbehaving. And once we have that information, that there's a diagnosis going on. We can understand those behaviors in a different context and approach them in a different way.

And I think that's really helpful and useful, particularly for students who are in school, because it can allow them to have protections for their behaviors that are part of a diagnosis rather than a behavior that is willful or. Acting out for the sake of acting out. So children who are in school might be eligible for special education services in the form of, of an I E P or they might be eligible for supports through a 5 0 4 plan, which is part of civil rights law.

And those are wonderful supports to have available, to make sure that their needs are being met in the educational setting, the best way they need to be met. But I think the take home message for me is that children with ADHD can do just as many things as children, without ADHD. And this is not a diagnosis that tells us anything about the kind of person they're going to grow up to be.

Prakash Chandran: Well, Dr. Boots on. I think that's the perfect place to end. Thank you so much for your time.

Dr Colby Butzon: Thank.

Prakash Chandran: That was Dr. Colby boots on a licensed psychologist and behavioral health consultant at lab pediatrics. For more information regarding ADHD in children, you can visit lab.org that is spelled L E B O N H E U r.org.

Thanks for listening and make sure to subscribe to the Petes pod by LaBauder children's hospital on apple podcast. Google podcasts or wherever you listen to your podcasts, you can also check out the lab.org podcast page for the entire podcast library. This has been the Petes pod by lab or children's hospital.

I'm your host pre thank you so much for listening.