Getting Help for Children with ADD / ADHD

Diagnosing ADD / ADHD in children

If you suspect that your child has ADD / ADHD, schedule an appointment with your doctor for a diagnostic assessment. At present, no laboratory or imaging test exists to determine if your child has ADD / ADHD. Clinicians base their diagnosis on the behavioral symptoms they observe and by and ruling out other disorders.
The American Academy of Pediatrics recommends that an evaluation for childhood ADD / ADHD include:

• A thorough medical and family history.
• A general physical and neurological exam.
• A comprehensive interview with the parents, the child, and the child's teacher(s).
• Standardized screening tools for ADD / ADHD.
• Observation of the child.
• A variety of psychological tests to measure IQ and social and emotional adjustment.

What is required for a diagnosis of ADD / ADHD?

To be diagnosed with ADD / ADHD, your child must exhibit multiple symptoms of hyperactivity, impulsivity, and inattention. In addition, the symptoms of ADD / ADHD must:

• Severity – The symptoms must be more frequent or severe than in other children the same age.
• Early onset – Some of the symptoms must have been present before age 7.
• Duration – The symptoms must have been present for at least 6 months.
• Impact – The symptoms must have a negative impact on the individual's school, family and/or social life.
• Settings – The symptoms must be present in multiple settings, such as home, social settings, and school.

Choosing a specialist to evaluate your child

When choosing a specialist, it's a good idea to get recommendations from other doctors, therapists, and parents. Talk to former patients and clients, if possible, and find out what their experience was. It's also important to find out what's covered by insurance. Will your health insurance cover part or all of your child's ADD / ADHD evaluation?

Find out:

• the professional certification and academic degrees of the specialist,
• the procedural code (CPT code) and diagnostic code (ICD code) that the specialist will use to bill for the evaluation,
• how comprehensive the evaluation is, and
• how much the specialist will charge.

Then talk with your health insurance provider about what your plan covers for evaluation for ADHD. Some insurance policies cover evaluation for ADHD from one kind of specialist, but not from another.

Co-existing conditions and ADD / ADHD

Major stressful life events can result in temporary symptoms that look like ADD / ADHD. These events include parental divorce, child abuse, death of a loved one, a move, or a sudden traumatic experience. Under these circumstances, ADD / ADHD-like symptoms may arise suddenly and, therefore, would have no long-term history. Remember, ADD / ADHD symptoms must exist for at least six months and cause some difficulty before the age of seven. Of course, a child can have ADD / ADHD and experience a stressful event, so such events do not automatically rule out the existence of ADD / ADHD.

Other mental health conditions such as those listed in the box below can be the result of ADD / ADHD, in addition to ADD / ADHD, or mistaken for ADD / ADHD. That is why evaluations need to be conducted by a professional who is trained in a wide variety of child and adolescent disorders.

Disorders That Commonly Co-Occur With ADD / ADHD

Oppositional Defiant Disorder

A pattern of negative, hostile, and defiant behavior. Symptoms include frequent loss of temper, arguing (especially with adults), refusal to obey rules, intentionally annoying others, blaming others. The person is angry, resentful, possibly spiteful, and touchy.

Conduct Disorder

A pattern of behavior that persistently violates the basic rights of others or society's rules. Behaviors may include aggression toward people and animals, destruction of property, deceitfulness or theft, or serious rule violations.

Anxiety

Excessive worry that occurs frequently and is difficult to control. Symptoms include feeling restless or on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances.

Depression

A condition marked by trouble concentrating, sleeping, and feelings of dejection and guilt. There are many types of depression. With ADD / ADHD you might commonly see dysthymia, which consists of a depressed mood for many days, over or under eating, sleeping too much or too little, low energy, low self-esteem, poor concentration, and feeling hopeless. Other forms of depression may also be present.

Learning Disabilities

Problems with reading, writing, or mathematics. When given standardized tests, the student's ability or intelligence is substantially higher than his or her achievement. While children with ADD / ADHD frequently have problems with reading fluency and math, these problems have to do with attention and memory, rather than a learning disability.

Finding professional help for childhood ADD / ADHD

Although there are many ways parents can help a child with ADD / ADHD at home and many strategies teachers can use in dealing with ADD / ADHD in the classroom, sometimes a physician or therapist who specializes in ADD can help you decide how to proceed in treating your child with ADD / ADHD and can provide appropriate interventions.

Your family doctor or pediatrician is a good place to start. He or she can provide an initial assessment and refer you to ADD / ADHD specialists for further evaluation and treatment.

Child and adolescent psychiatrists can:

• diagnose ADD / ADHD
• prescribe medications
• provide talk therapy

Psychologists and psychotherapists can:

• diagnose ADD / ADHD
• provide talk therapy
• help children and families dealing with ADD explore their feelings.

Cognitive-behavioral therapists can:

• set up behavior modification programs for children at school and at home, including rewards and consequences
• help establish concrete goals for behavior and achievement
• help families and teachers maintain goals, expectations, rewards and consequences consistently

Support groups can:

• give kids with ADD / ADHD a place to share helpful strategies
• provide a safe place to vent feelings to other kids who understand
• show children with ADD / ADHD that they aren't the only kids with these problems
• teach children with ADD / ADHD how to understand social cues and transfer their new knowledge to the larger world

Educational specialists can:

• teach techniques for succeeding in school
• help kids learn how to manage their time, organize assignments, take notes, and keep track of materials
• help families of children with ADD obtain accommodations from schools
• advise families about assistive technology

Some other types of professional help are more suitable for adults and teenagers than for children. Much depends upon the maturity of your child and your child's desire to change the behaviors of ADHD. See Professional Help for Adult ADD for information about ADD coaches and professional organizers.

During the course of treatment, most professionals who specialize in ADD / ADHD will educate you and your child about the condition so that you can better understand ADD behaviors.

Psychotherapy for childhood ADD / ADHD

Psychotherapy can provide for children with ADHD a critical element for success in dealing with ADHD: a particular person who believes in them and helps them to "turn the tide of failure" (Derek Wood, quoting Weiss & Hechtman).

Psychotherapy focuses on feelings—the feelings of having ADHD and the feelings of being in a family with a person who has ADD / ADHD. A psychotherapist, therapist, or psychologist meets with your family to help you to develop new skills, attitudes, and ways of relating to each other. In addition, the therapist can:

• help your child to feel better about himself or herself
• teach your child to handle emotions better
• guide your child in identifying and building on strengths
• train your child to cope with daily problems that result from the ADHD
• teach your child to control inattention, impulsivity, and aggression

A psychotherapist usually involves the whole family in therapy. The therapist may meet with the family as a group at first, then meet individually with different family members. Therapy usually continues to involve the parents intermittently, either with the child who has ADHD or separately.

Therapy is age-appropriate: the therapist will elicit feelings and self-descriptions at the level that your child can cope with. If your child is very young, the therapist will meet only with the parents and make ongoing recommendations about how to handle and change troublesome behaviors.

Behavioral modification and cognitive-behavioral therapy

Behavioral modification, or intervention, is direct negative or positive reinforcement of desired behavioral changes. For example, one intervention might be that a teacher rewards a child who has ADHD for taking small steps toward learning to raise a hand to be called on before talking in class, even if the child still blurts out a comment. The theory is that rewarding the struggle toward change encourages the full new behavior.

Behavioral modification (or behavioral intervention) has been shown to be a very successful treatment for children with ADD / ADHD. It is especially beneficial as a co-treatment for children who take medications for ADHD and may even allow you to reduce the dosage of the medication.
According to the American Academy of Pediatrics, there are three basic principles to any behavior therapy approach:

• Set specific goals. Set clear goals for your child such as staying focused on homework for a certain time or sharing toys with friends.
• Provide rewards and consequences. Give your child a specified reward (positive reinforcement) when he or she shows the desired behavior. Give your child a consequence (unwanted result or punishment) when he or she fails to meet a goal.
• Keep using the rewards and consequences. Using the rewards and consequences consistently for a long time will shape your child's behavior in a positive way.

Note that individuals with ADD / ADHD are notoriously variable in their symptoms. One day, the person may behave acceptably in one realm, and, the next day, may fall back into old, unacceptable patterns. This makes behavioral intervention difficult, because it seems as if the training is not working. However, over time, reinforcement does improve behavior; the person with ADD / ADHD may simply have more off-days than do individuals who do not have ADD / ADHD.

As parents, you can set up a customized behavioral modification program for your child who has ADD / ADHD. Or you can enlist the help of a professional, such as a cognitive-behavioral therapist, to design a behavior management program. (For setting up your own behavioral modification program, see Parenting Children with ADD / ADHD.) A cognitive-behavioral therapist focuses on practical solutions to everyday issues. This kind of therapist can set up a behavioral modification program of rewards and consequences for your child at home and at school and support you in shaping your child's behavior.

Support groups or social skills groups

Therapists and psychiatrists in your area may offer support groups for children with ADD / ADHD. Children sometimes listen to other children's suggestions better than they do to adult suggestions, and a support group can provide a nurturing environment. Also, if your child has been isolated in the struggle with ADD, a support group can be a place where the child feels socially accepted while working on ADD issues.

Social skills training groups are support groups targeted at helping children to interact more successfully with others. The therapist demonstrates appropriate behaviors and gives children practice within the group. Many people with ADD / ADHD are not skilled at reading social cues, which are communicated by facial expressions, tone of voice, and body language. A social skills group teaches children how to "read" others' reactions and how to behave more acceptably. Make sure that your child's social skills group also works on transferring these new skills to the real world. Much of the problem for children with ADD / ADHD, because they are so impulsive, is that they have trouble applying what they know about social skills to the real world.

For a support group or social skills group near you, ask for a referral from your school psychologist or a local mental health clinic.

Educational specialists

An educational specialist can help your child who has ADD / ADHD to overcome the challenge of school. The educational specialist is a kind of coach for your child, focused on the school environment. He or she can help your child to:

• keep track of assignments,
• get books and papers from school to home, and vice versa,
• manage time so that homework gets done,
• take more effective notes,
• study smarter,
• write better essays, and
• organize the backpack and desk.

An educational specialist will also have suggestions about assistive technology such as laptop computers and personal electronic planners. Some may also be able to advise about school accommodations, IEPs, and 504 plans. Ask your school for a referral or search in one of the two professional directories listed below.

Related Links for Diagnosis and treatment of Childhood ADHD

Helpguide's ADD / ADHD Series

• ADD / ADHD in children - Recognizing the signs, symptoms and effects

• Parenting a child with ADHD - Strategies for family and home life

• ADD / ADHD in the Classroom –Tips for teachers and parents

• Medications for Treating ADD / ADHD –Benefits, safety, and side effects