Tuesday, April 24, 2012

Not Your Typical Child Tuesday #4

Today I'm going to tackle what to some, is a controversial topic. Today, I'm taking on ADHD head on. Now, I know some of us don't understand why this is controversial and truth be told, it shouldn't be at all but, there are those out there who don't understand it and therefor chalk it up to bad parenting, or kids just being kids, or kids being bad kids even. So, in an attempt to understand this disorder, I'm going to delve into the world of ADHD.

What is ADHD?  ADHD is a neurobiological disorder characterized by developmentally inappropriate impulsivity, inattention and often time hyperactivty. While everyone is spacey at one time or another or has a hard time sitting still, those with ADHD or ADD can't seem to focus on a daily and consistent basis. They not only can't seem to focus on a task or two or ten, they can't seem to sit still for very long. This problem is on a daily basis and effects their daily lives. Most often, children with ADHD also have something called Executive Function Disorder. This is why they have problems, analyzing, planning, organizing, scheduling or not only completing tasks but unable to meet deadlines in life. That said, often children with EFD will often get misdiagnosed with ADD. Which is simply the inattentive type of ADHD without hyperactivity. Though, children with ADHD or ADD may well have both! Most noticeably those with EFD when put on stimulant meds, will not have symptom improvement.

How do you know when a child has ADHD?
Well first, thing you need to know is the difference in the types of ADHD. One being true ADHD and the other being ADD.

ADD kiddos, tend to not pay close attention to things, have difficulty sustaining attention to most anything and often make careless mistakes. They don't seem to listen, struggle with following directions, have struggles organizing, most often will not do anything that requires a sustained mental effort, forget or get distracted easily. For example, my boys' half brother has a classic case of ADD. He will do fine in class but, when asked what his homework is, he could not remember. On his way out of the school for the day, when most kiddos are throwing coats on and running out the door, the teacher would report that he would be zoned out, coat half on, stopped and staring at nothing or the wall. His teacher would report that in class he'd seem to get it but, later at home when it was time for homework, he could not manage to figure out how the teacher, just hours earlier could get A+B=C. This behavior was not sporadic but, a consistent DAILY thing that impacted and still does every area of his life. Most teachers were frustrated by him because for all intents and purposes he was a good kid but, seemingly easily distracted. One year, a teacher wanted to put him in a cubicle in the hallway so that he would be less distracted! Because of things like this, he was gradually soloed out as "that bad kid" and began to loose friends. At 13 yrs old when he comes to visit the boys, if he is asked to do something requiring more than two step directions, he still cannot do it. If asked to clean a room, he can't do it. Instead, he'll stand there staring at the mess. You literally have to tell him to pick up one item at a time, ie. just pick up the Legos, just pick up the transformers, etc. He struggles daily with this and it has cost him friends, respect of his peers and teachers and with one more year of middle school, he's on the verge of flunking out!! All because the school system refused to help or acknowledge his issue, nor do some other people in his life but, that is for a different discussion! ; )

ADHD kiddos are the hyperactive and impulsive ones! They're the ones that will either keep you young or kill you! :P Just teasing! Seriously though, ADHD kiddos cannot seem to sit still...EVER! If they're not getting up and down or running, etc. they can't seem to not fidget. They can't seem to commit to quiet activities, sometimes talk EXCESSIVELY! They often run or climb a lot, never able to connect that if you climb on a bookcase and they've been told to get down because it will fall and they'll get hurt, that the bookcase will fall and they will get hurt! Even after they've fallen from the bookcase and broke an arm, you may catch them climbing to the top shelf in their closet! They seem to run on some kind of motor or caffeine line that you know nothing about. Taking turns and waiting to talk are just not in their manners bank, no matter how many ways you've tried to teach them these basic skills. If the thought of anything crossed their mind, their brain is unable to restrain the action and impulsively they respond, react or do without being able to think it through.

What are the causes of ADHD? 
We don't really know what causes ADHD. It's more prevalent in boys than girls, which as most know, means that there is a genetic component. Which is backed up by families like my boys. In my family, two of my cousins on my mom's side have ADHD, several relatives on my father's side also had ADHD, my little sis has ADHD and growing up, I had ADD - hence the occasional remarks about having the attention span of a gnat! :P The boys older, half brother has ADD as well. So, if you were using a family like my sons', it's quite obvious there has to be a genetic component. There are even some studies that show, like a lot of other things, prematurity can also have something to do with whether a child might have ADHD. To this day though, there is no confirmed real thing that they can nail down as to why some have it and some don't. There are a lot of theories about where it comes from and even contributing risk factors but, no concrete evidence. 

They can say though, that most likely the culprits of ADHD are neurotransmitters. Most likely the chemical neurotransmitter, Dopamine. Dopamine is mostly the chemical in the body responsible for keeping the attention centers of the brain stimulated. So, without a proper level of Dopamine, a person's attention span is compromised. There are also studies on the actual structure of the brain of boys with ADHD. They tend to have more symmetrical brains in shape. With 3 structures in their brains that are smaller than a neurotypical boy of the same ages. They were the prefrontal cortex (believed to be command central of the brain), the caudate nucleus and the globus pallidus, which both help translate those commands from the prefrontal cortex into an action or actions. There is even evidence that shows not only are the structure slightly different but, that the brain uses those areas differently than a neurotypical child. By doing brain scans, they've noticed that ADHD boys have abnormal increases in the frontal lobe and the striatal areas below it. These parts help with voluntary actions! So, if you follow that evidence through, ADHD boys, despite the appearance, are working harder to control their impulses than a neurotypical child is!

How do you treat ADHD? There are a plethora of answers for this. Like many other treatments for anything, what works for one, may not work for another. Depending upon your insurance issues, belief systems and money, the answers vary.
Diets are a natural thing to try and in all honesty work for a lot of people! Things like the 
Feingold Diet, worked well for my sister and her boys. There is a lot of research out there for this side of symptom/disorder treatment, just Google! If you're going to try this though, may I recommend: The Kid-Friendly ADHD and Autism Cookbook: The Ultimate Guide to Gluten-Free, Casein-Free Diet by Pamela Compart and Dana Laake.
I want to start off saying that don't let the Autism word scare you in any way! Once you start researching, you'll find that Autism and other things like ADHD have a lot in common. Secondly, though I whole heartedly,  recommend this book, I was not asked to review nor have any affiliation with anyone that has anything to do with the writing or printing of the book. So, trust me when I tell you that it is a great, eye opening book for anyone researching food and ANY of your child's neurobiological issues. Once you've given it a healthy once over, you'll never look at food the same way, ever.
If you're not into the diet and food related options for treatments, you can always try some kind of occupational therapy. Yes, I said OT! You'd be surprised to know that occupational therapists can employ a whole host of methods at their fingertips to help ADHD kiddos from "normal" OT practices, to Interactive Metranome, and cranial sacral therapy. Here is where I get to vouch for something that I was not paid to talk about nor asked to. Cranial Sacral sounds all hippy like but, it works and it works well for one of my boys. On the days he sees his OT and she does this for him, he actually takes a nap, holds still, listens, nor is he up and down on the emotional roller coaster. This doesn't seem to effect my other boy though, so remember what works for one kiddo may not work for another. 

Another thing you could consider would be some kind of therapy. The earlier you get in to see someone, the earlier you child can learn behavior that is positive and helpful for themselves. They can do psychotherapy, behavioral therapy - including CBT (Cognitive Behavioral Therapy), social skills training, parent retraining, etc. In my experience though not every counselor, psychologist or therapist is a good fit for a family. Some cling to older mentalities, some to a very hands off approach to dealing with various issues. I once had a therapist tell me to physically hold my son in timeout when he'd earned his way there....that is THE biggest no no for my oldest guy. He never did like to be held much and even though I told the guy that holding him, results in the "fight of flight" reaction, he still recommended that I try this. Needless to say, I never went back to him after that! Don't be afraid to try different professionals until you find one that fits! You have to have a great team, that communicates well to make this work. 

Lastly, and as a last resort, there is always medication. I will not say with or without medication is best because, as I've said a hundred times, not every child is the same. Some are further down the rabbit hole than others and some are more defiant than others. It's a hit a miss kind of thing. I will say that medication should be broached as a last resort though. It's too easy to take the smooth road, then to take the bull by the horns because going it without and even sometimes with meds, is NOT easy. If you are going to do meds though, here's my two cents:
  • I recommend asking and researching which ones are the safest first. With the new drugs out there being pushed to docs they'll most likely throw you on the newest one or two that they get but, sadly enough, Riddalin is still the safest starting point in a lot of cases - though not always. 
  • Keep an eye on side effects too. One medication worked well for a lot of kiddos, mine was no exception but, like his cousin, that medication caused stomach pain in both boys. 
  • If you're in it for the quick fix, think again. While some medications seem to produce a noticeable result for some families within a day or two, sometimes it takes up to 2 whole weeks for the medications to build up enough to be noticeable. 
  • Keep an eye on mood swings. One very popular medication right now seems to cause this issue in a lot of kiddos, my nephews and my son again are no exception. One nephew was removed from it, the other can tolerate it in small doses.
  • If a doc recommends medication, you have every right to say, "let me sleep on it" or flat out no! Don't let them run you over. Remember, this is your child, you are the parent and the pediatrician works FOR you!
The advice I give you here comes from experiences and as a mother who does do medications for one child and is able to opt for more natural treatments for the other. Honestly, after all these years and experiences with medications, if I could go for fully natural remedies for my oldest son, I would in a heartbeat. You'll understand in a later Tuesday post why I had to take that route. Just keep in mind during your research or dealings with various docs, that you have to do what is right for your family. If you opt for natural treatments, don't let your family or friends make you feel like you made the wrong choice. If you opted for meds, don't let anyone else make you feel as if you took the easy way out. For most of us, it was not an easy choice by any means. I cried for days when I found no other way out for my son. 

That being said, for those that don't know, medication is not the easy way out. If you do take more than one medication, it is tricky to find the right balance for your child. Not to mention too that as they age so does their body chemistry and so the perfect balance no longer works or they build up a tolerance to the medication....it is a merry-go-round for sure. AND the mother that chose to medicate, also still chooses a way to help treat her child, be it OT, therapy and/or food! So, here again, NOT the easy way out! My oldest does take medications, goes to OT, has therapy and has a diet that I found worked wonders for him. With all this in place, he went from 7 medications down to 4! Which is still a lot of medications and again, I'll explain why in another post but, suffice to say, he does not have just ADHD. The point though that all of these ways to treat ADHD have been employed and in conjunction with one another have worked well for him. Again, while my youngest son with just diet, and so far occupational therapy has done well! So, no matter what avenue you choose or if you're a split family like ours, remember to keep your options open, keep an open mind to other families who've chosen to do things differently and don't be afraid to challenge your doc if need be. They are not the be all end all on the subject of YOUR CHILD! 

If you're just reading this to learn, I say again, quit giving that kid and his mom the stink eye in the grocery store! Sometimes a fit is just a fit and other times, it's what you don't see under the layers that is real problem, not bad parenting or bad children. So, stink eyes off and learn to be a bit more open minded! :) 

Thanks for joining me for another Not Your Typical Child Tuesday! Now back to your regularly scheduled program....

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