By Dr. Noel Swanson
I have had a number of people asking about ADHD (attention deficit hyperactivity disorder).
Not surprising, really, since it is such a common concern.
So what is it, when should you be thinking about it, and what do you do about it?
First of all, just as I discussed in my article on Asperger’s, it is not particularly useful to think about it as an ‘it’.
Just as children range from short to tall, skinny to fat, so they also range from placid to hyperactive.
Since there is such a wide range, at what point to do start to say there is something ‘wrong’ with the child?
There are only two ways we can define “wrong”.
Either there is a clear, biological, problem that is qualitatively different from normal. Not just a matter of degree, but of something being broken or disordered (like asthmas is different from just being short of breath).
Or the degree of “abnormality” is so great that it causes problems of its own accord. Thus being too tall causes problems (hitting heads on door frames, joint and back problems, possibly). Being too fat causes problems (diabetes, heart problems, etc). And being too active causes problems (people don’t like the things you do!)
So, let’s look at these two types of definition. First, is there any evidence of something biological being “broken”?
That is a difficult question. There is evidence that hyperactive children have different brains than placid children. Just as there is evidence that tall people have longer bones than short people. There is even evidence that taxi drivers have different brains to non-taxi drivers. But that still does not answer the question as to whether there is something “broken”, or if it is again, just a matter of degree.
In the old days ADHD used to be called “minimal brain dysfunction” because people assumed there must be something wrong with the brain that they just hadn’t yet been able to identify. Many scientists still believe that.
Either way, it is actually pretty irrelevant, as we shall see when it comes to deciding what to do about it.
The second question is whether being hyperactive causes problems beyond that of placid children. The short answer is “yes”. And typically, the more “hyper” you are, the more trouble you get into.
So, at the extreme end of the scale, the kids that are really climbing the walls, it is pretty easy to say that they have a “disorder” and to give it a name such as ADHD.
But where is the line between normal and ADHD? Come to that, where is the line between normal and fat, between normal and too tall (or too short). And does it depend on whether you live among the 7ft Masai warriors, or the 4ft pygmies?
The line is, of course, arbitrary. We put the line where it seems to be “about right”. Usually there is some statistical reason for it – e.g. being more hyper than 95%
of the population. But it also depends a lot on what society is happy, or not, to consider as “normal” childish behavior.
And on that we, as a society, have probably become less tolerant in the last couple of decades. We now want all our children to sit still and pay attention in class, whereas in past decades, if they didn’t get on with school, then they didn’t go!
Now, if your child is getting into problems at school or home, you usually want to know why? One of the questions you might ask yourself, and others, is “is there something wrong with my child”.
The reason you would ask that, is because of the assumption (from the rest of medicine) that if you know what is “wrong” with him, you will then know how to cure or treat him.
Hmmm. Let’s see how that plays out…
So you go to an expert to get a decision as to whether or not he has something wrong. The doctor has no fancy tests, as there is nothing physical to look for. So she asks some questions about what, exactly, it is that he does. She may also ask the school and other carers for their observations.
Then she feels she has to come up with an answer for you.
But what does she say?
If she says, “Yes, he has something wrong. It is called ADHD”, you are then going to want it treated and fixed.
But if she says, “No, there is nothing wrong with him”, you are going to assume that he is just playing up and needs “more discipline” (ie more punishments).
Not only that, but suppose he is just on that arbitrary borderline between “having” it and “not having” it? Which way should she jump?
Both answers cause problems and, really, both answers are wrong.
Instead, let’s tackle it from a different perspective. Your son is constantly having problems. Everyone can agree on that. The problems are similar to the list of problems
in the “diagnostic criteria for ADHD“.
Everyone can probably agree on that, to a greater or lesser degree.Okay, so now the REAL questions is not “does he have ADHD”, but “WHAT DO WE DO TO HELP HIM?”
Now that takes us much further!
Here is what you can do:
1. Learn all you can about ADHD – whether or not he has been given the diagnosis. Why? Because you will then better understand why he does the things he does (my book will also help with that).
2. Hyperactive children benefit from calm, consistent, firm but fair management. They don’t need different discipline than placid children, but they do often need it to be enforced much more consistently. Sorting out your parenting techniques will definitely help. The best way to do that is to use the strategies in my book.
3. The same applies to school. Working closely with teachers is vital, and finding the right teacher for your child is equally crucial. School can definitely make or break these children.
4. If doing the above is not enough, then it may be time to consider medication. The most common ones are the stimulants (Ritalin, Dexedrine, Adderall). The doctors will
probably require a “diagnosis” before they will prescribe.
That’s okay – you know that the diagnosis doesn’t really mean anything, but it does give them permission to prescribe for you.
You have not failed if you take the medication route. Just as you have not failed if your child has to take an inhaler for asthma. It is just one of those things, and if it helps, then use it.
But, remember that the medication is NOT a cure. It is NOT a replacement for proper parenting and schooling, and it does NOT mean you child does or does not have ADHD – since it has exactly the same effect on any child (it is simply more dramatic the more extreme the child is).
You can find more info about the stimulants here
As you can see, the real key is to assess your own child’s unique strengths and weaknesses, and to work on these, in conjunction with the school, to achieve the best outcome.If you do that properly, then a formal diagnosis becomes quite irrelevant.
HOWEVER, we live in an imperfect world, and some people are just unable to think in these terms. This is particularly true of formal systems such as health and education who will want a “label” in order for them to decide whether or not they are going to help you.
If that is the case, and the label “fits”, then don’t be afraid to use it. But it can cut two ways – once you child starts to think that he “has” ADHD, this, in itself, may undermine his confidence, as he feels that he is damaged or disabled in some way.
On the other hand, the label might be just the thing he needs to boost him. Knowing that it is not his fault that he is so hyperactive may release him from his guilt and sense of failure, and allow him to try again, perhaps, this time, with medication to help. Either way, hold the diagnosis lightly, and recognize it for what it is – just a convenient shorthand for a bunch of behaviors.
SO: As with Asperger’s, think carefully before you go the route of looking for a label and a diagnosis. It may just open the doors your child needs. Or it may shut them in his face. You know your child best. Now read up as much as you can, and then YOU take charge of helping him to achieve the very best future. And if that involves doctors and medicines, well, so be it.
Dr. Noel Swanson, Consultant Child Psychiatrist and author of The GOOD CHILD Guide, specializes in children's behavioural difficulties and writes a free newsletter for parents. He can be contacted through his website on Expert Parenting Advice.