At every moment of every day, the human brain processes a constant, and natural, barrage of stimuli. At multiple levels, including below consciousness, our brains constantly filter through these competing stimuli to prioritize those that help us respond, begin a task, take steps toward a larger goal and behave in socially appropriate ways.
For people with attention deficit hyperactivity disorder (ADHD), something is amiss in the brain pathways that filter through these competing impulses. Those affected with this neurological condition have difficulty sorting out relevant stimuli from non-relevant stimuli, and may respond impulsively or not respond when a quick response is required. In the classroom, children with ADHD have difficulty focusing on school or homework, sustaining their attention for things they are not interested in, and some (especially younger children) have difficulty sitting still.
Between 9 percent and 11 percent of school-aged children (4 to 17 years of age) in the U.S. have been diagnosed with ADHD – about 13 percent of boys and 5.5 percent of girls.
Though people with ADHD can be very successful in life, without proper diagnosis and treatment, this condition can have serious consequences, like:
- School failure and greater risk of dropping out
- Difficulty making and keeping friends
- Demoralization and low self-esteem related to underachievement
- Increased family stress
- Greater risk of accidents
- Higher likelihood of smoking and substance abuse
ADHD: Symptoms and needs change over time
A month to six weeks after returning to school is a great time to reassess the treatment needs of kids and teens who have previously been diagnosed with ADHD, says Mark Stein, PhD, ABPP, who leads Seattle Children’s PEARL Clinic (Program to Evaluate and Enhance Attention, Regulation and Learning).
It’s also a time when previously undiagnosed ADHD symptoms begin to flare – especially when a child or teen is making a significant developmental leap in academic or social responsibilities, notes Stein. Critical periods include:
- Starting fourth grade, middle school, high school or college
- A change in school setting at any age
- Starting a new job or an unfamiliar activity
Now that school is in full swing, here are some signs that a child might need to have their treatment plan and medication reassessed, or be evaluated for the first time:
- A drop off in academic, social or extracurricular success or participation as demands for independent work and expectations increase
- A lowering of self-confidence or self-esteem
- Onset of new or different behavioral problems (e.g., lying about homework completion, not following through on home responsibilities or poor listening)
- Emergence of ADHD symptoms, like:
- Difficulty organizing tasks and activities
- Not understanding what is expected of them
- Forgetfulness or day dreaming
- Interrupting or intruding on others
- Moving, fidgeting or talking excessively
According to Stein, ADHD is not a slam-dunk diagnosis. Although the symptoms are readily recognized in 7 year olds, they are more subtle in females and adolescents or may be overshadowed by other psychiatric, medical or social difficulties.
There’s no single or simple test to diagnose it, and the symptoms overlap with other medical and psychiatric issues, which need to be ruled out. Stein says that diagnosis is based upon a thorough history and evaluation. Rating scales completed by parents or teachers are useful screening tools and may signal the need for evaluation.
There’s good news: ADHD can be reliably diagnosed and treatment is often successful. Better school performance, improved relationships and a decrease in health risks, like accidents and substance use, are among the benefits.
Seattle Children’s PEARL Clinic
The PEARL clinic is a resource for primary care providers that offers comprehensive multidisciplinary evaluations and consultation for kids and teens struggling with attention, learning and behavior problems. The clinic also trains health and mental health professionals and has a research component to advance our knowledge of ADHD and its treatment. A parent training component to teach behavior modification to parents of children with ADHD is currently in development.
To learn more:
- Improving Treatment for ADHD
- Seattle Children’s Psychiatry and Behavioral Medicine program
- ADHD: Facts for Families
If you’d like to interview Dr. Stein, please contact Seattle Children’s PR team at 206-987-4500 or at [email protected].