By Dr. Jane Hannah, Currey Ingram Academy Lower School Division Head
(originally published in the February 13, 2013, issue of the Currey Ingram Academy Lower School newsletter)

Over the last week while participating in ILP conferences, a number of questions were asked related to Attention Deficit Hyperactivity Disorder (ADHD).  While listening, a number of misunderstandings emerged.  A few of these are shared in this article.

 

Misunderstanding # 1: My child isn’t hyperactive; he can’t have ADHD.

Response: Often parents associate ADHD with only hyperactivity; however, hyperactivity is not the only symptom of ADHD.  There are actually three subtypes of ADHD, which include:

 

ADHD; predominately inattentive type:  The child with this subtype has among others symptoms poor sustained attention or persistence of effort when completing tasks, especially when the task is repetitive or boring. 

ADHD; hyperactive/impulsive type: The person with this subtype often demonstrates impaired behavioral inhibition, excessive activity, and struggles to delay gratification.

ADHD; combined type:  The individual with this subtype demonstrates symptoms associated with the subtypes above: inattention, hyperactivity and impulsivity.

 

Russell Barkley (1997) suggests that ADHD should be viewed as a deeper problem with how children are able to self-regulate their emotions, actions, attention and activity.  Self-regulation also involves the ability to think, plan and organize.

 

Misunderstanding # 2:  ADHD is caused by bad parenting.  All a child needs is discipline.

Response:  Frequently, I have shared that having a child with ADHD humbles you as a parent.  After having my first child, I thought parenting was very easy and frequently found myself being judgmental of parents who could not control their children in public.  Then, I had my second child, Thomas.  To say the least, it was humbling.  I actually learned better parenting strategies from Thomas because I could no longer parent on cruise-control.  While researchers may disagree on the exact cause of ADHD, most agree that there is a hereditary factor.  In fact, some research suggests that you are 25% more likely to have a child with ADHD if a family member has ADHD.  While ADHD is not caused by bad parenting, symptoms can be exacerbated by poor parenting.  Hinshaw (2006) found that punitive discipline will likely increase or exacerbate behavior problems in children; thus, punishment is not the answer.  All children need supportive discipline, but they don’t need excessive punishment.

 

Misunderstanding # 3: ADHD is caused by consuming too much sugar.

Response:  In 1985 and then again in 1994, Mark Wolraich, et. al published studies demonstrating that sugar plays no role in causing ADHD.  Since his article in the New England Journal of Medicine, similar results have confirmed this finding.

 

Misunderstanding # 4:  One way ADHD can be diagnosed is to give the child suspected of ADHD a psychostimulant, such as Ritalin, and if there is a positive effect, the diagnosis is confirmed.

Response: Research has repeatedly demonstrated that psychostimulants would have similar effects on children without ADHD; thus, medication is never recommended to confirm a diagnosis of ADHD.  

 

Misunderstanding # 5:  ADHD is always outgrown by adolescence.

Response: Research has found that some children do seem to outgrow many of the symptoms; however, the majority of individuals demonstrate symptoms into adolescence and some into adulthood.  As children get older, many are able to acquire strategies that seem to diminish the symptoms or impairments.

 

Misunderstanding # 6: My child can’t have ADHD.  He can play with Legos or Minecraft for hours. 

Response:  A child can still have ADHD and attend for hours when something is stimulating.  Individuals with ADHD can concentrate when something interests them.

 

Misunderstanding # 7: Children who take medication for ADHD are more likely to abuse drugs as teenagers.  

Response: Research shows that the opposite is true.  Wilen, Faraone, Biederman & Gunawardene (2003) found that people with ADHD who took stimulants as a child tended to have lower rates of substance abuse than those individuals with ADHD who did not take stimulants.  A 10-year study by Biderman, et. al (2008) also supports this finding.

 

Misunderstanding # 8: Medication is the only treatment for ADHD.

Response:  It has been said, “If you have seen one child with ADHD, you have seen one child with ADHD.”  Each child is different even though there are similarities.  Thus, a “one size fits all” treatment approach is not recommended.  While medication is not a cure, and it only treats the symptoms, research has found psychostimulants do have a positive effect for many children.  Psychostimulants are an approved treatment by the National Institute of Mental Health (NIMH) if carefully monitored by the child’s physician, but because of side effects, beliefs of a family, etc., other treatments may be warranted.  Other treatments that have been shown to be effective for many children include parent and teacher training in behavioral interventions, cognitive-behavioral therapy, and good educational interventions.

 

Misunderstanding # 9:  My child is doomed to a life of failure if he has ADHD.

Response: There is a great deal parents can do to help a child with ADHD.  First, educate yourself on ADHD and the symptoms that interfere with your child’s functioning. Second, learn and then practice positive-based parenting strategies.  While I know firsthand how frustrating it can be to parent a child with ADHD, I also know that yelling, lecturing and corporal punishment do not teach a child what you want him to do.  These punishment strategies may stop an unwanted behavior momentarily, but it will not change the behavior. Third, parent training provided by a therapist experienced with children with ADHD is often helpful.  Fourth, partner with teachers and other school personnel so that you and school personnel work together to help your son or daughter be successful. Fifth, implement several lifestyle changes that can have a positive effect on the symptoms of ADHD.  These include enforcing a digital time-out every day in your home.  It is thought that over-stimulating activities such as television or video games can increase inattention.  Other important changes include ensuring that your child eats healthy meals, gets sufficient sleep and exercises at least 60 minutes per day.  While some children can successfully participate in team sports, others benefit from more individual sports, such as swimming or Tae Kwon Do. There are many successful, well educated adults who continue to excel and have learned to use the symptoms of ADHD to their advantage.  Children with ADHD are not doomed to a life of failure.

 

References:

Barkley, R. A. (1997). ADHD and the Nature of Self-Control. New York: The Guilford Press.

 

Biederman, J., Monuteaux, M.C., Spencer, T., Wilens, T.E., MacPherson, H.A., & Faraone, S.V. (2008). Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: A naturalistic controlled 10-year follow-up study. American Journal of Psychiatry 165, 597–603.

 

Hinshaw, S.P. (2006). Attention-deficit/hyperactivity disorder: The search of viable treatments. In P.C. Kendall (Ed.) Child and adolescent therapy: Cognitive-behavioral procedures. (3rd ed.) New York: Guilford, pp. 82-113.

 

Wilens, T. E., Faraone, S.V., Biederman, J., & Gunawardene, S. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 111, 179–185.

 

Wolraich, M., Milich, R., Stumbo, P., Schultz, F. The effects of sucrose ingestion on the behavior of hyperactive boys. Pediatrics, 1985 Apr; 106(4):657-682. 

 

Wolraich, M.L., Lindgren, S.D., Stumbo, P.J., Stegink, L.D., Appelbaum, M.I., Kiritsy, M.C. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 1994 Feb 3; 330(5):301-307.