There’s a strong counter-narrative out there that ADD and ADHD are over-diagnosed for the benefit of pharmaceutical companies. Dr. Thomas E. Brown is of the other school. The clinical psychologist, University of Southern California professor, and consultant for Understood.org (which has no pharmaceutical sponsors) believes these are very real conditions with very real consequences. For him, this isn’t just about kids struggling to pay attention in school or behave themselves on the bus. If untreated, ADD and ADHD can double the risk of drug or alcohol abuse later in life. So, focus up.
What Exactly Are ADD and ADHD, Again?
For the non-doctor, Dr. Brown doesn’t separate ADD and ADHD, but the clinical definition has to do with the executive functions (not that time you went to your boss’ wedding — it’s things self-control and problem solving) around these disorders.
“We’re looking for problems with the unfolding of the development of the brain’s self-management system,” says Dr. Brown. There are 6 components parents should look for:
- The ability to focus or shift attention at will
- The ability to organize one’s self and manage time
- The ability to regulate alertness and sleep, and to sustain efforts
- The ability to manage emotions, and avoid getting overly anxious or annoyed
- The ability to keep something In mind while doing something else
- The ability to understand consequences and avoid being impulsive
When Is ADD And ADHD Real?
Dr. Brown says the most common misunderstanding is that everyone who has ADD or ADHD can perform a few of the above tasks with no problems when they’re doing something they’re interested in. Likewise, everyone has trouble performing some of these tasks at times. “It’s not all or nothing,” he says. Like most things, it’s a spectrum, but disorders are for real when there’s evidence your kid is impaired by any of the components. Sometimes it’s by one of them, sometimes it’s by several of them. “We’re looking for someone who’s having more difficulty with these things than most of the kids the same age.” So if you think your 3-year-old does all of the above, just take a peek into a preschool classroom and realize it’s not just them.
Is It Different From Plain Old Hyperactivity?
Hyperactivity generally denotes behavior problems. But, behavior issues aren’t necessarily a part of ADD and ADHD. “Usually the hyperactivity stuff gets better as you get to your mid-teens, though it can continue to adulthood,” says Dr. Brown. When trying to spot ADD or ADHD, the key is to look for impaired learning or school performance, or trouble with interpersonal relationships with no other explanation. (Karmic retribution for what you did to your folks is a valid explanation.)
Can Your Doctor Or Therapist Tell?
Though many pediatricians are good at diagnosing these disorders in younger kids, most doctors have little training with them, says Dr. Brown. Psychologists and teachers may make the mistake that kids with ADD or ADHD must have behavioral issues. “It’s important to find out if this person has experience with ADD and ADHD and has an updated notion of what they are,” he says. Also make sure to take family history into account. Disorders are generally inherited, and “One-in-4 kids have a parent or someone else in the family who suffers from it.”
When Is It Time For Medication?
Pharmaceutical meds are usually only prescribed for school-age kids when they struggle in class for a significant period of time, “and it’s clear they’re not medically ill, depressed, or smoking too much weed,” says Dr. Brown. (Also, if they are an elementary school stoner, you have bigger problems.)
He also says that side effects of the meds, “are usually small potatoes.” The drugs usually work for 8-out-of-10 kids, and there’s a sliding scale of efficacy. For some they work a lot; others they work a bit. The dose a person needs depends only on how sensitive their bodies are to the drugs, not body weight, age, or severity of the disorder. If your little kid is getting horse pills, it’s not a harbinger.
Don’t Automatically Rule Out Drugs
Separate the decision to get your kid diagnosed from the decision to treat them with meds. “Don’t start out saying, I don’t want my kid on medication,” says Dr. Brown. The best approach is to assess the severity of the problem. If drugs are going to benefit them, will help them do better in school, and will decrease their risk of using illegal drugs later in life, it should be a consideration.
What Are The Alternatives To Meds?
The usual suspects of good health can help, but may just be one part of the cure. Those are the pillars of sleep, exercise, diet, and even a reward system that will help with their self-regulation. But don’t be fooled by apps claiming to improve kids’ attention spans. “The science behind those is virtually nil,” says Dr. Brown.