Imagine that you are watching an elementary school classroom while a lesson is in progress. Many children are sitting quietly in their seats, facing forward, with their eyes on the teacher. There may be one or two who are fidgeting in their seats, calling out responses without raising their hands, making comments to their neighbors, or dropping their pencils and other belongings. The teacher pauses to give these children a little more attention, reminding them to wait their turn, stay seated, and not talk to nearby classmates. There may be another child who is sitting quietly, facing forward. She appears to be present and focused, but she is in fact lost in her thoughts and has missed much of the lesson. Though her learning may be as strongly impacted as that of the other students described above, she is much more likely to go unnoticed in the busy classroom setting.
ADHD, which stands for Attention-Deficit/Hyperactivity Disorder, is one of the most common behavioral disorders in children. It is a neurodevelopmental condition, which means that it starts in childhood and affects brain development, particularly in the prefrontal cortex. Individuals with ADHD struggle with executive functioning skills, which are higher-order cognitive skills that include the ability to focus and sustain attention, inhibit impulses, initiate, plan, organize, and prioritize, and complete tasks and activities in an efficient manner. There are three main symptoms associated with ADHD, and these must be observed in more than one setting (e.g., both at home and at school). These include difficulty focusing/sustaining attention (particularly on non-preferred activities), and/or difficulty inhibiting impulses, and/or difficulty regulating physical restlessness. While the challenges related to hyperactivity and impulsivity are often most salient, there are in fact three different subtypes of ADHD:
● Predominantly inattentive presentation (sometimes known colloquially as ADD), which refers to individuals who have significant challenges with attention/distractibility, but not with hyperactivity or impulsivity.
● Predominantly hyperactive/impulsive presentation, which refers to individuals who have significant challenges with hyperactivity and impulsivity, but not with inattention. This is not a common subtype.
● Combined presentation, which refers to individuals who have significant challenges with both inattention and hyperactivity/impulsivity.
Boys are diagnosed with ADHD almost two times as often as girls, although research suggests that ADHD affects boys and girls at similar rates. As such, many girls with ADHD are not being identified. Girls with ADHD are more likely to have the predominantly inattentive presentation, which is less readily detectable, especially in settings such as the classroom (where the squeaky wheel is often more likely to get the grease). Teachers are less likely to notice the more subtle difficulties that these girls experience, and even if these students start to fall behind academically, they are often misdiagnosed, most commonly with anxiety and/or mood-related issues. While these girls may in fact be experiencing emotional difficulties, the cause may be rooted in their undiagnosed and untreated ADHD. Girls with ADHD are also vulnerable to executive functioning challenges, such as weaknesses with prioritizing, time management, planning ahead, and organizational skills. These difficulties may go unnoticed until academic
demands increase in middle school and later in high school, and it is not uncommon for girls with ADHD to elude diagnosis until they are older.
Other common misconceptions related to ADHD may also affect diagnosis. For example, ADHD refers more aptly to a “dysregulation” of attention than to an attention “deficit.” As such, individuals with ADHD have much more difficulty focusing/sustaining attention and persisting with tasks that are not intrinsically interesting to them and/or are perceived as difficult or stressful. However, many individuals with ADHD can hyperfocus on areas of interest. Parents may wonder how their child who spends uninterrupted hours reading graphic novels or playing video games could possibly have ADHD.
If you suspect that your daughter may have ADHD, we encourage you to consult with an appropriate professional (e.g., a pediatrician, psychiatrist, psychologist, or neuropsychologist). In addition, we recommend that you speak with your daughter’s teacher, to ask about the sorts of subtle issues that may be occurring in the classroom. We also encourage you to speak with your daughter herself. She may be able to share her experience with you, so that you can learn about her perception of the situation and her potential symptoms. Once a diagnosis is made, a treatment plan can be put in place to support your daughter at school, at home, and in other settings. This may include speaking with your medical doctor about medication management, talking to school staff about accommodations to support attention in the classroom (e.g., preferential seating, frequent breaks, checking in for understanding), as well as supporting any emotional sequelae that may arise (e.g., individual therapy to help with anxiety symptoms).
Remember that while difficulties with attention, hyperactivity, and impulsivity can result in challenges, there are also advantages to having a different thinking style. Individuals with ADHD are often excellent at creative thinking, can focus passionately on preferred topics (which can be a great advantage when channeled into vocational endeavors), are generally more spontaneous and willing to take risks, and are often very resilient. Different thinkers can and do make wonderful things happen!
ABOUT THE AUTHORS
Dr. Katia Fredriksen received a bachelor’s degree in psychology with a certificate in French language and culture from Princeton University. She went on to earn her doctoral degree in clinical psychology from University of Massachusetts Boston, and her clinical training included inpatient and outpatient psychotherapy and assessment with children, adolescents, and adults. Her graduate research focused on health behaviors, including sleep and substance use. Dr. Fredriksen completed her post-doctoral training at a private practice in the Boston area, where she focused on autism, genetic disorders, learning disorders, and attention and executive functioning in a pediatric population.
She has published several articles in peer-reviewed journals and presented at national and international conferences. Dr. Fredriksen continues to lecture to parent groups and professional organizations.
She was born in France to a New Zealander mother and a Norwegian father, and she moved with her parents to Norway and then to the Washington, D.C., area, where she grew up. Returning to her roots, Dr. Fredriksen spent a year studying and working in Norway and New Zealand. She now lives in the Washington, D.C., metro area with her husband, two children, cat, and parakeet.
Dr. Yael Rothman was born and raised in Michigan. She attended the University of Michigan where she earned a bachelor’s degree in biopsychology and cognitive science. Following college, she had the privilege of spending a year in Cambridge, United Kingdom, doing research focused on autism spectrum disorder and tuberous sclerosis complex. She then spent a year in New York teaching young children with autism before earning a doctoral degree from the Ferkauf Graduate School of Psychology at Yeshiva University. Dr. Rothman completed her internship at Children’s Hospital Colorado and her postdoctoral fellowship at Children’s Hospital in Washington, D.C. She spent four years working as a pediatric neuropsychologist and was an assistant professor in the Department of Psychiatry and Behavioral Sciences and the Department of Pediatrics at the George Washington University School of Medicine.
Dr. Rothman currently works at the Stixrud Group in Silver Spring, Maryland, where she completes comprehensive evaluations for children, adolescents, and young adults who have a wide range of conditions that impact learning, behavior, and/or socioemotional functioning. In addition to her clinical work, Dr. Rothman also has been involved in clinical research, with a primary focus on autism spectrum disorders. She has presented at several national and international conferences, published more than a dozen articles in peer-reviewed journals, and given lectures to parents and educators.
Check out their Instagram page @neuropsychmomdocs and learn more about Different Thinkers: ADHD at www.boystownpress.org.
No comments:
Post a Comment