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ADHD
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It is now November and the holiday season is just around the corner. School has been in session for three months and as far as you can tell, all is well. Then there is that unexpected and dreaded call from the teacher asking for a special meeting to discuss your child's progress, or lack of it. For some parents, this will be the first time they feel their hearts sinking into their stomachs. For others, the hope of a better year has now been shattered. You ask your child what might be the problem and you get the usual, "I don't know!" or in the older child, "The teacher just doesn't like me!" So you make the appointment as soon as possible. The teacher states that your child is having trouble completing assignments and paying attention in class. Homework has been late or not handed in at all. (By the way, you know the homework gets done because you spend time with your child but after that you are not quite sure.) The teacher may suggest that your son or daughter gets out of his/her seat and may be having social problems or getting into fights on the playground. Then it hits. The teacher states that your child may have ADHD. Not my child At first, you say it can't be true and that you just need to be a little more diligent in helping with homework and making sure the work gets handed in. Of course, as a parent, you feel you must have failed somewhere. Maybe a cold or not enough iron during pregnancy caused this. Then it even gets worse. You leave the conference in a daze and head to the library or the Internet and find out that ADHD is a brain disorder. What have you done to your child? You must have done something wrong! What are you going to do? This scenario is not an unfamiliar one in today's society and schools. Once a parent has eased past the initial shock and upset, what can be done? The first thing is not to panic and take it out on the teacher, the messenger. In most cases, the teachers will and should be your greatest ally in figuring out what's best for the child. Teachers are with your child five days a week for five to six hours. They are objective observers. Teachers want your child to learn and they are there to help determine what might be getting in the way of that process. It is their daily work. A definition Now that the teacher has mentioned it, what is ADHD? Attention Deficit Hyperactivity Disorder (ADHD) is a diagnosis characterized by hyperactivity, impulsivity and inattentiveness. Any combination of these symptoms may exist to further sub-classify the disorder. Diagnostic criteria published by the American Psychiatric Association exist as well as guidelines for diagnosis and management by the American Academy of Pediatrics. These classifications can help the school psychologist or your physician in determining whether this diagnosis should be considered and how to intervene to best help your child. Some people feel that ADHD has been overdiagnosed and children too often are treated and labeled. Whether this is the case or not, it will ultimately be the parents' decision to determine treatment. A parent must be the child's advocate as well as protector from false information and miracle treatments. Therefore, a systematic approach to evaluation can be helpful. Think of your child as a complex mix of psycho-emotional, intellectual and biochemical factors. Any one of these components or combination may interfere with the ability to learn. Simultaneous evaluation of these areas will help lead a family to the best intervention. What to do next Once all the information is compiled, a joint conference or communication among the school, the psychologist, the physician and family can be helpful. The diagnosis and specific intervention for children with learning problems must be a combined effort of all involved and a specific, individualized education and treatment plan should be developed. Treatment options may include medication, tutoring, special classes or therapies. Try to keep a reasonable attitude weighing all the available information before intervening. Since the brain is not stagnant but dynamic, monitoring and re-evaluation are essential to good care for a child with learning problems. Do not hesitate to get a second opinion about treatment options but beware of unproved therapy. Ask for references and the research available to support the intervention. Use the available science and evidence in making your decisions. Finally, take the time to properly evaluate your child avoiding a rapid and hasty misdiagnosis. Dr. Clyde Wesp is a pediatrician with Southern Orange County Pediatric Associates with offices in Lake Forest, Laguna Hills, Rancho Santa Margarita and Ladera Ranch and is affiliated with Saddleback Memorial Medical Center, Mission Hospital and Children's Hospital of Orange County. He is a member of the American Academy of Pediatrics and the MemorialCare Physician Society. Questions? E-mail to: askdrwesp@netscape.net. Keep the following points in mind Do not underestimate the effect of family stress on a school-aged child. New jobs, family illness or death and divorce are only a few of the potential stresses that influence learning. Do not deny that the family needs help and you may even think of this news as a "wake-up call" that the family needs some help. A child's ability to learn can be dependent upon many factors in the learning process. If a child has a learning disability, such as dyslexia, visual motor discrepancy or auditory discrimination difficulty, learning can lead to disinterest and inattentiveness. Therefore, educational testing to determine if a disability exists is important. Also, don't forget that if a child is having trouble seeing or hearing, they may not be able read all the assignments or hear directions. Testing of vision and hearing may be needed. Attention Deficit Hyperactivity Disorder has its basis in the biochemical transmission of neurotransmitters in the brain. There are a few tests that may be helpful, but making this diagnosis is based upon the clinical symptoms. There are some psychologists and pediatric psychiatrists who object to the current classification system in that it forces children into a diagnostic box. However, the classification can be a starting point for physicians and families to discuss the diagnosis and potential treatment. |
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