Dr. Bob: I fear that my 5-year-old son has ADHD. He seems to be on the go constantly. He has already been called out in kindergarten for being too loud and disruptive. His father said he had similar problems and struggled in school. What should I do? Is there a specialist who can help?
Answer: The fact that you recognize this behavior and are concerned is a great start. Attention Deficit-Hyperactivity Disorder is a group of “disorders” (I prefer the term behaviors) that is very common in children with some estimates as high as 10% of children ages 2-17. It is more common in males but don’t let that fool you. Any child can have it.
The three main behavior symptoms that are described are: 1) inattention (tending toward easy distraction and disorganization); 2) hyperactivity (“on the go” and has difficulty in structured settings); 3) impulsivity (acts without thinking or has difficulty waiting). Many more behaviors can be ascribed to these categories. The CDC has grouped the following types of ADHD – 1) inattentive only (formerly called ADD or attention deficit disorder); 2) hyperactive/impulsive (these children can still pay attention); 3) combined inattentive/hyperactive/impulsive (the group that most people think of when hearing the diagnosis of ADHD).
There are multiple potential causes of ADHD. Genetics can play a factor (very common for one of the parents to be affected) but environmental causes (exposures to things in the environment like lead or possibly cigarette smoke) or a challenging home environment (due to illness, crowding, poverty, or other factors) can also be contributing factors. Of concern to pediatricians is that other problems like learning disabilities or unrecognized mental health issues can also be present and be obscured and therefore untreated.
A thorough assessment by your pediatrician can always get the process started to assess your child and recommend further evaluation, referrals and/or treatment. Do not hesitate to raise these concerns at your office visits especially during the well child visits. ADHD behaviors can be a significant impediment to learning, and both you and your doctor want to maximize learning and socialization.
Some basic things can help with the management of the behaviors –
- Have a healthy well-balanced diet for your children when possible. As a parent, I know that this can be quite a challenge at times but be aware of the need for fruits and vegetables and the avoidance of sugary-sweetened beverages. Caffeine should be avoided along with diet sodas.
- Have a healthy sleep schedule. Children need sleep (10-13 hours/night for ages 3-5 and 9-12 hours/night for ages 6-12). Poor sleep can be a significant contributor to ADHD-like symptoms.
- Have a healthy exercise schedule.
- As the parent in charge of controlling behavior, try to stay calm. Parents must be “regulated” if they are trying to help get their child regulated. Don’t yell or scream or make inappropriate threats. Remember that discipline means to correct behavior as a teaching experience, not a punitive one.
- Avoid situations where you know the child is likely to fail. For example, don’t take him to the grocery store if he always has a problem there.
Finally, parents always ask about medicine. I am not a fan of medicine without proper counseling of the child and family. I have seen medicines be of great benefit for children, and I feel that withholding medication for some children is doing them a disservice. Your pediatrician and/or a developmental/behavioral pediatric specialist can guide such therapy.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is www.mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com with more questions.