ADHD: What Parents Need To
Know To Help Their Children

by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist
Article Last Reviewed: Sept. 9, 2006

Stacey Rial describes her youngest daughter as her “live wire”.

“She was always active. She never crawled or walked-just ran!” Rial never considered her daughter’s behavior to be abnormal. She noted that this child had difficulty following rules and resolving conflicts with her siblings. She was much more impulsive, fidgety and prone to outbursts. The Rials did their best to direct their young daughter’s energy but were frequently unsuccessful. In kindergarten, the teacher noted the same challenges and related them to Rial at a parent/teacher conference. Rial began to research her daughter’s symptoms and her search led her to Attention Deficit Hyperactivity Disorder, ADHD. Initially, the Rials refused medication due to their daughter’s young age. A later trial of medication significantly reduced their daughter’s symptoms. The Rials eventually developed a plan of medication and structured lifestyle for their daughter with the help of teachers, a specialists and their pediatrician

Attention Deficit Disorder, (ADD), was initially defined by psychiatrists in 1980. According to the American Academy of Pediatrics an estimated five to ten percent of school-aged children are affected. In 1987 the term was modified to Attention Deficit Hyperactivity Disorder to include the inability to regulate energy levels in a given situation. There are several manifestations of ADHD. It most commonly manifests as inattentiveness alone, a form commonly seen in girls, and inattentiveness with the hyperactivity and impulsivity, the most common presentation.

For any child exhibiting symptoms of ADHD, the first step is to properly identify and diagnose the disorder. If parents suspect ADHD they should consult with their child’s pediatrician. Current diagnoses of ADHD are based on subjective questionnaires obtained from parents and teachers combined with a comprehensive history, physical exam and diagnostic interview performed by a trained clinician. Other disorders and medical conditions must be excluded as the cause of the child’s behavioral symptoms.

Children and adults with ADHD tend to be very sensitive, bright, and creative individuals. They are not brain damaged, emotionally disturbed or learning impaired. They are not stupid. The configuration of their brains renders them unable to control their behavior and manifest their sensitivity, intelligence and creativity. Instead of labeling these individuals as “problem children” the focus has rightfully shifted to ways to help them constructively demonstrate their creativity and intelligence.

Research into the origins of ADHD has progressed significantly in the past ten to fifteen years. Alan Zimetkin, M.D., a researcher for the National Institutes of Mental Health, published data in 1991 showed that individuals with ADHD have physiologic differences in the front part of the brain. It was unclear whether these changes "cause" one to have ADHD, are the result of ADHD or are just normal variants. Since that research was published many other researchers have conducted studies of children with ADHD using Positron Emission Tomography scans and Magnetic Resonance Images and have consistently noted these subtle differences in the structures of brains of individuals with ADHD. Yet researchers still cannot definitively state that the changes cause ADHD or are a result of ADHD. Xavier Castellanos, M.D. reported in the October 2002 Journal of the American Medical Association that these changes are fixed, not progressive and not due to stimulant medications such as Ritalin.

There is also conclusive evidence that there is a genetic component to ADHD. Children with ADHD usually have at least one close relative with ADHD. One third of fathers with ADHD have children with ADHD. Twin studies confirm the genetic predisposition of ADHD. In studies of identical twins reared separately, when one twin was identified as ADHD the other twin was usually also affected. To date three genes have been identified that may be partly responsible for ADHD. The complexity of ADHD leads researchers to believe that many more genes may be responsible for ADHD and its various manifestations.

Researchers are also exploring how environmental factors are affecting children during prenatal development and how such factors may affect the early stages of the child’s development. Clearly there is much more to be learned about ADHD, how it develops, who gets it and why.
Byron Kocen, M.D. is a pediatrician who specializes in ADHD. He believes that children with ADHD are in fact more creative and the disorder should really be called, “Attention Creative Difference.” He is the only physician in the Austin area utilizing a computerized test called the McLean Motion Activity Test to evaluate a child’s body movements and concentration. A band with a small ball attached to the back of it is placed around the child’s head. While sitting in front of the computer and performing the test, an infrared camera is detecting the motion of the small ball. The data is immediately transmitted to the McLean Institute Child Development Center computer at Harvard University, analyzed and sent back for printout by Kocen in his office. The actographs are compared to standards for children of the same age. A printout with more scattered points per unit of time indicates increased head and body movement and is indicative of ADHD. Kocen uses the actographs as part of his assessment along with the information gathered from parents and teachers to make the diagnosis and to develop a treatment plan. He offers a plethora of information on ADHD for parents, educators and other interested parties on his website www.BeyondADD.com.

Teachers are invaluable for helping to diagnose ADHD. They can offer parents insight into their child’s interaction with other children as well as any difficulties with schoolwork or classroom activities. Teachers are able to share with parents what has been effective in helping their children learn and adjust to the school environment.

Joan Altobelli, the director of special education for the Austin Independent School District (AISD) states the policy of AISD is for the parents to direct the course of the child's diagnosis and treatment. We try to teach the children as they come to us. Educators help develop accommodations to address learning differences. When teachers utilize a combination of methods the children are less likely to end up in disciplinary situations and are more likely to succeed academically.

Not long ago, parents were forced to make decisions about ADHD diagnosis and treatments for their children. Teachers could request that a child be evaluated for ADHD. If an evaluation by the school psychologist or an outside psychologist or clinician determined that a child did have ADHD, the school officials could demand that the child receive medical treatment. The problem with these evaluations remains that much of the information gathered is via subjective questionnaire and there is no one standard against which the child is evaluated. Yet Schools could refuse to let children enroll or could enroll the children in special education classes if they weren’t treated. Some parents were told they were “negligent” if they did not place their children on medication for ADHD and could risk having their child removed from the home by Child Protective Services.

John Breeding, Ph.D, an Austin psychologist, was troubled by this coercion of parents. Many parents in his practice were very anxious over their “rambunctious” children. Some did not want their children tested and labeled, yet were afraid of the consequences if they did not go along with the program. In response to this dilemma, he became an advocate for children with ADHD and their parents starting Texans for Safe Education. He lobbied the Texas House of Representatives and helped to pass House Bill 1406 making it illegal for school employees to recommend a child be tested for ADHD or be placed on medication. He also lobbied for House Bill 320 making it illegal to threaten parents with a charge of negligence and the threat of having their children removed from the home if they don’t place their children on medication for ADHD. Both bills passed in the Legislature in 2003 and the complete documents may be viewed at www.capitol.state.tx.us.

His belief that children have different ways of learning prompted Breeding to write a book titled, “The Wildest Colts Make the Best Horses”. He too delivers the message that children with ADHD are very creative. Yet he believes that this creativity is what makes it so difficult for children to learn in the traditional school setting. If adults as the teachers and advocates for children focused more on what the child needs in order to learn instead of enforcing a particular curriculum or standardized format he believes that we could eliminate the need for medication. Dr. Breeding said,

"It is important for parents to understand that diagnoses like ADHD are entirely subjective, and that the prescribed drugs are addictive and dangerous."

Parents, teachers and other interested parties can learn more about Breeding and “Wild Colts” at www.wildestcolts.com.

Though complicated and often frustrating, ADHD can be diagnosed and treated. Parents must take the initiative and work with teachers and physicians to develop the best treatment plan for their child.