ADHD: What Is It and What To Do If You Suspect Your Child Has It
Dr. Shereen Alavian discusses ADHD in children and when parents or teachers should be worried. She delves into symptoms, diagnosis, and treatment options.
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Learn more about Shereen Alavian, MD, MPH
Shereen Alavian, MD, MPH
Shereen Alavian, MD, MPH, is a Pediatrician with WakeMed Children’s.Learn more about Shereen Alavian, MD, MPH
Transcription:
ADHD: What Is It and What To Do If You Suspect Your Child Has It
Evo Terra (Host): Fortyish years ago, I was what you would have called an unruly child, or the class clown. And my report card always showed plenty of needs improvement markings. In hindsight, I probably had ADHD but instead of self-diagnosing, I’ll bring that up with Dr. Shereen Alavian, a Pediatrician with WakeMed Children's.
This is WakeMed Voices, the podcast from WakeMed Health and Hospitals. I’m Evo Terra. Dr. Alavian, how do you diagnose ADHD as a medical condition for these kids as opposed to just being a rambunctious child?
Shereen Alavian, MD (Guest): You know there are a couple of things that we look at when we are considering the diagnosis of ADHD. Because it’s true, there are kids out there that just have a lot of energy, sometimes get easily distracted. There are a couple of things that – the most important things to consider are how are these symptoms affecting your child’s function? So, are they so hyperactive to the point that they cannot sit still in school where they are able to learn? That they are constantly getting gup out of their chair, they are not listening to the teacher or are they so distracted that every time the teacher starts to talk, or they sit down to take a test; they kind of move off and are focusing on something else.
And so it’s really the degree to which their function is impaired. So, specific things we look out would be starting with the little ones getting kicked out of preschool or kindergarten. Issues with behavior on the bus that are threatening to get them removed from the bus. Starting to see decreasing grades or inability to learn what we would expect them to be able to learn.
Host: And that doesn’t sound like me, so maybe I was free of that particular diagnosis back in the day. You mentioned several different symptoms that could crop up. Are there other mental health or developmental problems that might be associated with this behavior?
Dr. Alavian: There are other mental health or developmental problems that actually can look just like ADHD as well which is one of the reasons it’s important not to just label every kid who is hyperactive or impulsive or has trouble with attention as having ADHD. Things like learning disorders can look like ADHD. Things like anxiety or depression can absolutely look like ADHD in children. And difficulty with vision or hearing can look like ADHD. It’s hard to pay attention or learn when you can’t hear, and you can’t see.
And then we also know that along with ADHD we tend to see a lot of other kind of behavioral or developmental problems. Kids who have family stress can look like ADHD and often those symptoms are worse when we have family stress, stressors at home, things like that. Lack of sleep can look like ADHD and also make those symptoms much worse. And then for some kids either they are inappropriately placed in schools or we have unrealistic expectations of them based on their age and where we thing they should be.
Host: So, this definitely sounds like something where self- diagnosis is not recommended. Can you walk us through the process of how you make a diagnosis?
Dr. Alavian: Yes. Absolutely. And through the American Academy of Pediatrics, there are some pretty standard guidelines in terms of diagnosing ADHD. So, it is a clinical diagnosis. There’s no lab test that we do. There’s no imaging that we do. We bring a patient in and the most important information is kind of their history and what’s going on. And we like to hear it from multiple sources. So, children who have these symptoms in just one setting, it tends not to be ADHD. And that’s kind of something that we see across multiple settings.
So, the parents will come in explain their concerns sometimes on their own initiative sometimes at the prompting of the schools or teachers. We will then kind of document what behaviors they have that are concerning related to problems with attention, problems with hyperactivity and problems with being impulsive. And then to what degree those affect their function and then typically, the parent will be sent home with some forms that have standardized questions that ask about these symptoms as well as things that could look like ADHD but are not. And so we have family members or caregivers fill forms out. We also have teachers fill forms out. Because we want to see what they are seeing in the school related to these behaviors.
And there’s along list of them on these forms. When the family comes back and we have information from them and from the teachers; we can then look and if the kids tend to have a certain number of these main criteria in either the category of difficulty with paying attention or difficulty with being hyperactive or impulsive and it’s affecting their ability to learn or function; then that’s what would make us lean towards a diagnosis of ADHD. Assuming that we’ve ruled out any of these other or considered some of these other things like a learning disorder, anxiety and depression which you certainly can have together with ADHD; but also could be the explanation alone.
Host: That’s very helpful. What about treatment? Medication only, therapies; what can we do?
Dr. Alavian: So, the AAP recommends kind of the first line treatment in any kid over about 6 is – especially if their function is considerably affected, is medication. And we have a couple different types of medications. The most commonly used is a stimulant. People who have heard of things like Ritalin, Focalin, Adderall, Vyvanse; those are kind of some examples. There are two main classes of stimulants as well as some nonstimulants that are kind of second line use in children.
For the very young children, the four and five year olds; behavioral therapy is actually what we recommend first to get started and you can work with families as well as even with teachers in terms of how can we manage this child’s behavior and redirect them and keep them focused. Once we get to the older kids; we know that the medications work really, really well once you have found the right medicine and the right dose. And behavioral therapy is recommended as well because it can help the children develop some of those skills to overcome the impulsiveness that’s associated with the hyperactivity or not paying attention.
Host: And once a child is on medications, is this a condition that can be cured or is this something that is managed forever?
Dr. Alavian: So, we look at ADHD – it’s a change in the brain. And so the brain patterns and the way the brain works. So, we look at it as a lifelong chronic condition. Now that doesn’t mean that you are on medicine for the rest of your life necessarily. Many kids within a few years can come off of medication as their brain develops and they develop the capacity to overcome those impulses of let me look away, let me be distracted, get out of my chair and not learn.
There are many children at the same time, that we do continue medication through school. Whether that be high school and college; some by the time they get to college and it’s things they are interested in need less help with overcoming those impulses to be distracted or to not pay attention. And then for some people in order to function well within their jobs do need to be on a medication. By the same token, there are some people who can go into a field of work or a job that’s really exciting and stimulating for them and in fact, the way that their brain functions is an asset and they actually don’t require medication because they are in an area where they don’t have the need to constantly be distracted or kind of not paying attention because they’re constantly engaged.
Host: Great information Doctor, thank you. Thanks once again to Dr. Shereen Alavian a Pediatrician with WakeMed Children's in Raleigh, North Carolina. And thanks for checking out this episode of WakeMed Voices. Head to www.wakemed.org/childrens to get connected with Dr. Alavian or another provider. And if you found this episode helpful, please share it on all your social media channels. And be sure to check the entire library of past episodes for topics that might interest you.
ADHD: What Is It and What To Do If You Suspect Your Child Has It
Evo Terra (Host): Fortyish years ago, I was what you would have called an unruly child, or the class clown. And my report card always showed plenty of needs improvement markings. In hindsight, I probably had ADHD but instead of self-diagnosing, I’ll bring that up with Dr. Shereen Alavian, a Pediatrician with WakeMed Children's.
This is WakeMed Voices, the podcast from WakeMed Health and Hospitals. I’m Evo Terra. Dr. Alavian, how do you diagnose ADHD as a medical condition for these kids as opposed to just being a rambunctious child?
Shereen Alavian, MD (Guest): You know there are a couple of things that we look at when we are considering the diagnosis of ADHD. Because it’s true, there are kids out there that just have a lot of energy, sometimes get easily distracted. There are a couple of things that – the most important things to consider are how are these symptoms affecting your child’s function? So, are they so hyperactive to the point that they cannot sit still in school where they are able to learn? That they are constantly getting gup out of their chair, they are not listening to the teacher or are they so distracted that every time the teacher starts to talk, or they sit down to take a test; they kind of move off and are focusing on something else.
And so it’s really the degree to which their function is impaired. So, specific things we look out would be starting with the little ones getting kicked out of preschool or kindergarten. Issues with behavior on the bus that are threatening to get them removed from the bus. Starting to see decreasing grades or inability to learn what we would expect them to be able to learn.
Host: And that doesn’t sound like me, so maybe I was free of that particular diagnosis back in the day. You mentioned several different symptoms that could crop up. Are there other mental health or developmental problems that might be associated with this behavior?
Dr. Alavian: There are other mental health or developmental problems that actually can look just like ADHD as well which is one of the reasons it’s important not to just label every kid who is hyperactive or impulsive or has trouble with attention as having ADHD. Things like learning disorders can look like ADHD. Things like anxiety or depression can absolutely look like ADHD in children. And difficulty with vision or hearing can look like ADHD. It’s hard to pay attention or learn when you can’t hear, and you can’t see.
And then we also know that along with ADHD we tend to see a lot of other kind of behavioral or developmental problems. Kids who have family stress can look like ADHD and often those symptoms are worse when we have family stress, stressors at home, things like that. Lack of sleep can look like ADHD and also make those symptoms much worse. And then for some kids either they are inappropriately placed in schools or we have unrealistic expectations of them based on their age and where we thing they should be.
Host: So, this definitely sounds like something where self- diagnosis is not recommended. Can you walk us through the process of how you make a diagnosis?
Dr. Alavian: Yes. Absolutely. And through the American Academy of Pediatrics, there are some pretty standard guidelines in terms of diagnosing ADHD. So, it is a clinical diagnosis. There’s no lab test that we do. There’s no imaging that we do. We bring a patient in and the most important information is kind of their history and what’s going on. And we like to hear it from multiple sources. So, children who have these symptoms in just one setting, it tends not to be ADHD. And that’s kind of something that we see across multiple settings.
So, the parents will come in explain their concerns sometimes on their own initiative sometimes at the prompting of the schools or teachers. We will then kind of document what behaviors they have that are concerning related to problems with attention, problems with hyperactivity and problems with being impulsive. And then to what degree those affect their function and then typically, the parent will be sent home with some forms that have standardized questions that ask about these symptoms as well as things that could look like ADHD but are not. And so we have family members or caregivers fill forms out. We also have teachers fill forms out. Because we want to see what they are seeing in the school related to these behaviors.
And there’s along list of them on these forms. When the family comes back and we have information from them and from the teachers; we can then look and if the kids tend to have a certain number of these main criteria in either the category of difficulty with paying attention or difficulty with being hyperactive or impulsive and it’s affecting their ability to learn or function; then that’s what would make us lean towards a diagnosis of ADHD. Assuming that we’ve ruled out any of these other or considered some of these other things like a learning disorder, anxiety and depression which you certainly can have together with ADHD; but also could be the explanation alone.
Host: That’s very helpful. What about treatment? Medication only, therapies; what can we do?
Dr. Alavian: So, the AAP recommends kind of the first line treatment in any kid over about 6 is – especially if their function is considerably affected, is medication. And we have a couple different types of medications. The most commonly used is a stimulant. People who have heard of things like Ritalin, Focalin, Adderall, Vyvanse; those are kind of some examples. There are two main classes of stimulants as well as some nonstimulants that are kind of second line use in children.
For the very young children, the four and five year olds; behavioral therapy is actually what we recommend first to get started and you can work with families as well as even with teachers in terms of how can we manage this child’s behavior and redirect them and keep them focused. Once we get to the older kids; we know that the medications work really, really well once you have found the right medicine and the right dose. And behavioral therapy is recommended as well because it can help the children develop some of those skills to overcome the impulsiveness that’s associated with the hyperactivity or not paying attention.
Host: And once a child is on medications, is this a condition that can be cured or is this something that is managed forever?
Dr. Alavian: So, we look at ADHD – it’s a change in the brain. And so the brain patterns and the way the brain works. So, we look at it as a lifelong chronic condition. Now that doesn’t mean that you are on medicine for the rest of your life necessarily. Many kids within a few years can come off of medication as their brain develops and they develop the capacity to overcome those impulses of let me look away, let me be distracted, get out of my chair and not learn.
There are many children at the same time, that we do continue medication through school. Whether that be high school and college; some by the time they get to college and it’s things they are interested in need less help with overcoming those impulses to be distracted or to not pay attention. And then for some people in order to function well within their jobs do need to be on a medication. By the same token, there are some people who can go into a field of work or a job that’s really exciting and stimulating for them and in fact, the way that their brain functions is an asset and they actually don’t require medication because they are in an area where they don’t have the need to constantly be distracted or kind of not paying attention because they’re constantly engaged.
Host: Great information Doctor, thank you. Thanks once again to Dr. Shereen Alavian a Pediatrician with WakeMed Children's in Raleigh, North Carolina. And thanks for checking out this episode of WakeMed Voices. Head to www.wakemed.org/childrens to get connected with Dr. Alavian or another provider. And if you found this episode helpful, please share it on all your social media channels. And be sure to check the entire library of past episodes for topics that might interest you.