I was as sceptical of ADHD as most of the commenters here and have been resisting sending my son for an assessment for about a year because I guess what the diagnosis will be. However the more I've been looking into it and observing him, the more I'm coming to the conclusion that it seems to be something physical that he can't control. Just this evening we were in a restaurant and he was standing in his chair, climbing up a pole. etc... When he eventually knocked something over and I sternly reminded him to sit down, he started hitting himself on the head, apparently rueful that he's disappointed me again. It seems to be something he can't control and his repeated failures to do so seem to be affecting his self-esteem.
What would you recommend as the best interventions to explore? I would prefer something behavioural but am opening up to considering medication if the will make him feel better about himself and facilitate smoother interactions with his peers.
I was diagnosed with ADHD in my 50's. Without meds I have to spend an enormous amount of energy managing my cognitive state. Imagine you had to spend 60% of your time creatively managing yourself into a mental state where you can do something meaningful with the remaining 40%. And I've been practicing meditation for 30 years, I'm very active, I've adapted my lifestyle around my needs.
All that work doesn't even come close to the benefit I get from Vyvanse. I get effortless self control, and all that time back.
I figured out I had ADHD by observing my (very intelligent) daughter in kindergarten--she was the obvious behavioural outlier. All the other kids were mostly attending to the teacher, my daughter was attending to everything else. We didn't medicate her until Grade 4, when she started to think she was dumb. Meds changed everything for her, allowed her to develop a better self-concept (and winning the academic prize that year). She's off meds right now, struggling a bit, but a least she knows she's not dumb. That's huge.
Here's my thinking: stimulants are relatively safe. They aren't particularly addictive. Yes, they suck, there are tradeoffs. But if they don't work out, you can stop. You can stop whenever you want.
But once a kid has internalized "I'm dumb" or "I'm a loser" it is very hard to undo. That can stay with them for life.
I was diagnosed with ADHD in my 50's. Without meds I have to spend an enormous amount of energy managing my cognitive state.
I appreciate if you don't want to answer, but I've been diagnosed in my mid 30s (it came out of the blue, I was not seeking the diagnosis) and wonder what you mean by "managing your cognitive state"? I have so far not sought medication but wonder if I should do so.
I do software and system architecture, and I'm generally responsible for creating original content. In order to make any progress on deliverables, I have to be calm, have my memory loaded up with all the necessary context, and have just the right level of stimulation--too little and I fall asleep, too much and I'm wrapped around the axle.
I'm much better in the mornings, so I wake up early, 4 or 5AM, and I spend some time reading interesting technology stuff. Then I start casual reading on the task, not really trying to work on it, but just loading my brain. I set up my visual workspace (I have 3 monitors because visual context assists my shitty memory.) After an hour or two I reach a point where I can really focus and make great progress. I guess it's a way of getting into flow.
But a morning meeting that isn't directly relevant will wipe most of that prep away, and then I have to start again. So I avoid early meetings like the plague, unless it's purely an exercise in optics and I can ignore it completely and continue working.
When I'm medicated, it's way easier. I can direct my attention and it is resistant to distraction. My short-term memory doesn't keep reloading on every stimulus. I can get into flow in a reasonable amount of time throughout the day.
I'm off medication last few years, but plan to go back on in the next year. I love the cognitive benefits, but I have a couple of the rare side effects.
Thanks for replying! That's all very interesting to hear. I am much like your explanation but just considered that to be "normal". Maybe I should explore the medication options I've been signposted to after all.. I once experimented with modafinil and it had similar effects to what you mention.
Her decision. She's been reading stuff on the Internet that says ADHD might be fake and over medicated. :-) Her main real issue is the appetite suppression, which she hates.
Her mom and I can see the difference on/off, it isn't subtle. We aren't pushing. I'm committed to her success, but meds are just one tool. I expect she'll go back on them at some point, once she's exhausted her youthful political correctness.
Not OP, but I strongly suggest getting a full neuropsychological evaluation to diagnose your child. This could ADHD, it could be some other disorder, or it could be nothing at all, and a standardized professional evaluation is the best way to tell. They will also be able to suggest the best path forward for treatment. I can speak from experience, because when I was having trouble in elementary school my parents had be evaluated, which was how I was diagnosed with ADHD. I received behavioral therapy and medication and it really improved my functioning and my quality of life.
I was diagnosed with ADHD (inattentive) when I was a senior in college. My oldest son was diagnosed a year ago, when he was in first grade.
I began to suspect my son might have it when he was frustrated at learning to read—especially when he reported that distractions in the classroom (such as a new pencil sharpener) were making it difficult for him to focus. At home, I noticed that he was much more effective—and self-confident—when he did his reading in our basement den, away from his younger siblings and other distractions.
We took him to a prominent local child psychologist, who spent a few hours with us—first with me, going over my observations, his history, family, etc.; then with him alone. A few weeks later, we received a ~10-page report with his assessment, which included results from a battery of tests he had done with my son, concluding with a diagnosis of ADHD. Based on this, our pediatrician had us try a couple of different stimulants, and we've landed on Vyvanse as the best combination of convenience and efficacy. The difference has been staggering—not only with his progress at school, but most importantly, his self-confidence has risen remarkably.
I haven't read it, but the title of one ADHD book—"You Mean I'm Not Lazy, Stupid or Crazy?!"—has stuck with me. Growing up with undiagnosed ADHD, I often felt that I was simply inadequate, or not trying hard enough. Of course, personal responsibility still plays a role, but I now understand more what's going on.
Medication has markedly improved my life as well. But I think being diagnosed in early adulthood meant that I still had to deal with years of bad habits, self-esteem issues, perception by family and friends, transcripts filled with bad-to-mediocre grades...
Both my son and I present the inattentive side of ADHD more than the hyperactive side, but I suspect the results would be similar.
Getting my son's diagnosis started with his pediatrician, who recommended the child psychologist. I'd suggest starting there.
BTW, the reason I think my son was diagnosed earlier is due to the curriculum: it's simply more challenging at an early age than what I remember. I was able to coast on intelligence alone until I was a teenager, when I finally had schoolwork that required sustained concentration. My son was being asked to read books in first grade that I probably didn't read until second grade—and there wasn't nearly the systematic focus on it. My suspicion is that the increased diagnoses of ADHD is due in large part to this—it's always been prevalent, but has been less of a burden in the past (career options, too—so many ADHD-compatible jobs are getting automated away).
If it's ADHD, behavioral therapy isn't super effective, unfortunately (at least according to research I've seen). Medication could help and you... should see results pretty quickly (after a nasty adjustment period though. It changes how your brain works and feels extremely weird)
My understanding is that if you actually don't have ADHD, the medication isn't effective, so if it's helpful there's a strong signal there.
A proper analysis by a psychiatrist would be helpful (and you should share your doubts). But I think if you look at things beyond the "attention" and "hyperactivity" aspects . For example, saying things without thinking, lots of remorse for actions after the fact (showing proper judgement but lack of control), etc. Medical professionals are the best for this, but there's a lot of reading out there that you can check out.
To expand on this: for about two-three weeks after starting to take a Ritalin variant (this was in working life, I didn't have meds in HS + college for reasons) I was pretty on edge, getting pretty mad at stuff and even just pre-emptively cancelling meetings with some friends because I felt I would start yelling at the next person who talked to me.
I've heard this happen to other people too, and it's frustrating, but luckily it also comes with the feeling of clarity that was always missing, and fortunately people around me are supportive. No lasting damage, just "oh yeah I was a bit on edge then"
> If it's ADHD, behavioral therapy isn't super effective, unfortunately (at least according to research I've seen).
I'm surprised by that impression as my understanding was that it was "generally accepted" that a combination of therapy and medication was more effective in treating ADHD than either alone.
Sorry, the comment was more that behavioral therapy _alone_ is very ineffective according to a lot of research out there. Granted, the funders of such research are... well...
If you have to chose one or the other, medication will be much more powerful, but the combo is the best. But trying to fight ADHD with just CBT is a massive uphill battle once described to me as "asking someone who needs glasses to see to train their way to better vision"
Does your child have enough outlets to burn off his excess energy? It seems to me that kids really evolved to be outside running around with friends and siblings extensively.
I would bet if he was getting his heart rate up for 3-5 hrs a day he would be way way calmer the rest of the time.
It seems to me that the real problem is that we have constructed a world that is fundamentally at odds with our biology and then when people cannot function within it, we diagnose them as having a disorder.
It's a bit more than that though. I definitely got plenty of exercise as a child, but my ADHD still manifested in me getting hurt a lot more than my peers, because I either didn't have the impulse control to not do something obviously dumb, or because I would get distracted while playing a game and then get hit in the face with a soccer ball or something as a result. I had a poor summer camp counselor actually start crying to my parents because she felt she was doing her job terribly because I got injured so often. My parents knew that was just how I operated though.
Getting the excess energy out definitely helps with feeling overly-energetic, but it doesn't fix many of the core issues that ADHD causes.
> It seems to me that the real problem is that we have constructed a world that is fundamentally at odds with our biology and then when people cannot function within it, we diagnose them as having a disorder.
I don't know if you meant it this way, but this certainly sounds like you are implying that people with ADHD (or some portion of them) don't really have anything wrong with them, they just need to exercise or something. As someone who has lived with ADHD for their whole life, I find this attitude really offensive. I have a medical disorder, there's a chemical imbalance in my brain that has been diagnosed by doctors. I can't just walk it off.
It's not a case of the modern world being at odds with how we were evolved, I would be struggling in the ancient world too. Without my medication I have real trouble remembering things, making plans, and following directions. Moreover, if the modern world is so at odds with our biology, why does the overwhelming majority of the population have no problem functioning in it while I do? And I don't mean to come off as hostile here, but I find it insulting to be told by someone who presumably has no problem functioning in the modern world that my inability to function in it isn't really a problem.
I actually have ADHD-PI (primarily inattentive), and have struggled my whole life with it. It did not manifest as being hyperactive, just being extraordinarily bad at focusing on anything i don't find highly stimulating and being really damned forgetful. Adderall was a godsend for me as a child and I would have never gotten through school without it. I had to discontinue use of it in High school because it started to have very bad side effects for me as I got older.
I am no way trying to imply that ADHD is not real. I know it is real. But I am skeptical that every single kid diagnosed with it really would still have hyperactivity problems if they were running around and riding bikes for hours every day. If the kid still can't focus in school even with improvements to diet and more exercise, then yeah the kid probably really has ADHD and may need stimulants.
Even though I struggle with it, I don't think it's really a 'disorder' except insofar as it can interfere with one's ability to function in modern society.
It seems to me to be just a different way of thinking, one that is unfortunately much more suited to activities like hunting than it is to remembering to pay my parking tickets on time.
The majority of the population has lots of problems functioning all the time.
Its not that there isn't a problem, its that you are not the problem. The majority of the population manages to cope in various ways, you don't know how bad it is because everyone is hiding this coping away, as the modern world suggests they do so as not to be a burden.
Are you offended because you actually have tried working yourself to exhaustion and still were hyperactive?
I don’t believe that’s what the OP is saying. I understood his comment to mean that ADHD can be considered more of a “bad fit” for the person’s environment than an objectively diagnosable disease. Perhaps by changing the environment, ADHD’s symptoms may be mitigated. Maybe it’s not a 6-year-old’s fault that he/she cannot sit still and quiet in a room for 8 hours with maybe a 30 minute break for recess? Maybe it’s our expectations that are at fault.
You can really see developmental differences at 5-7. My son is 6, his kindergarten last year had kids between 4-6 on the first day of school and they vary substantially. Their lives vary a lot as well... how do you expect a 6 year old in early day, school and aftercare from 7-5 to behave?
I’m sorry, but your individual anecdotal experience does not refute his hypothesis in any way. It is reasonable to hypothesize that the increase in ADHD may be due to environmental factors (diet / exercise / etc). Those factors may affect certain subgroups more than others. Your perceived offense is not helpful to the discussion because you cannot speak for all people with ADHD and it should not shut down any line of inquiry that could help people in the future. I completely understand that you are not considering yourself as part of that group, but please let other people try and find alternative ways to address the problem without trying to shut down the conversation by proclaiming how insulted and offended you are.
I don't know, "being able to put dishes in the dish washer", one of the tasks I personally particularly struggle with, doesn't seem like it's an unreasonable social construction.
> When he eventually knocked something over and I sternly reminded him to sit down, he started hitting himself on the head, apparently rueful that he's disappointed me again.
I'll admit that this was upsetting to read--your son is literally beating himself up over this. And I would guess his inner monologue is probably at least as equally unkind.
There's a lot to unpack from your comment to which I'd like to respond but given how long it's taken me to even sit down to write this, I will limit myself to urging you to read "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood" by Edward M. Hallowell & John J. Ratey (https://www.goodreads.com/book/show/108593.Driven_to_Distrac...).
One of the reasons why I recommend this book is that it is very focused (you may wish to excuse the pun) on establishing a correct diagnosis before moving onto possible therapeutic approaches. This includes a chapter on issues that are misdiagnosed as ADHD/ADD when the cause may be something else and another chapter on misdiagnosed issues which may actually be ADHD/ADD.
The book also addresses a wide range of other aspects related to ADHD/ADD which often aren't mentioned:
* Mood swings
* Difficulty communicating "serially"
* Acceptance of diagnosis
* Heightened sensitivity to criticism
* Parental guilt over existence or non-diagnosis
* Mourning over lost opportunities/time
* Impact on relationships with family, partners, friends & authorities
It also includes case studies of individuals, families & partners and how they have been impacted.
FWIW a common refrain from adults with ADHD/ADD is that frequently the biggest/longest-lasting damage that un-diagnosed ADHD/ADD has on an individual is the anxiety, depression & self-hatred that comes from not being able to do the "right thing" and not understanding why. Something exacerbated when others around them are all too quick to reinforce the message that it's because they're lazy, lack willpower, or, are just not trying hard enough.
On the other hand, unlike many other mental heath disorders, even just having a diagnosis can actually be helpful because it provides some answers to "why am I like this" and a new lens through which to view oneself & interactions with the world--and hopefully also leading to new ways to cope & progress.
Personally, I feel it's also worth contemplating why you (and others) were/are skeptical about the existence/reality of ADHD/ADD.
My observation is that a contributing factor to skepticism is that ADHD/ADD intersects with an almost perfect storm of societal/cultural fears, including:
* Fear of children being negatively affected by misguided/incorrect parental actions.
* Fear of the impact of "unnatural" medication.
* Fear of medication that can be misused by those not affected by the disorder (and lack of understanding on how the medications work for individuals with the disorder).
* Fear of misdiagnosis due to the "invisible" nature of the disorder.
* Fear of not applying discipline & boundaries in childhood negatively impacting the child's future
* Fear of enabling bad character traits such as "lack of willpower" & "laziness" by accepting an "excuse" for behavior rather than demanding more effort. (And other effects of a "puritanical" belief that the solution to every problem is to "work harder".)
* Fear of someone else gaining advantages/shirking responsibility through deception.
It's also worth noting that--like in relation to many medical issues but exacerbated by ADHD/ADD even triggering skepticism in the medical community itself--the response/assistance you & he will receive regarding an assessment will unfortunately be highly dependent on the individual medical practitioner.
I'm just a stranger on the internet but for the sake of your son please strongly consider at least reading the book I suggested and preferably seek an assessment from a medical professional with experience in such disorders.
Oh, also, you don't mention how old he is but perhaps when a similar restaurant situation happens again (or even now) you could listen to his answers to some gentle questions from you about what he thinks just happened and why it happened. It might give you some insight into his experience of the situation/existence.
Additionally, I do think it's important to acknowledge issues like this aren't easy for child or parent, so I consider it positive that you shared your situation & asked for recommendations.
Thanks for taking the time to read and consider my suggestions.
Thank you for taking the time to write your comment.
That book looks exactly like what I am looking for. I will definitely look for it.
With regards to my scepticism, I think you captured a lot of it in your examples. I guess i am afraid of people taking the lazy approach of labelling and medicating anyone who doesn't fit into the system rather than questioning the legitimacy of the system in the first place.
My son only recently turned 6 and I also believed that with enough outside and physical play perhaps he would be better able to regulate his behaviour the rest of the time. However he goes to a very progressive school with no desks and all enquiry based learning through play yet he still struggles more than the others with self-regulation.
As I said I'm coming round to a diagnosis possibly being appropriate as I learn more about the condition. He will go for a full neurological and developmental assessment in the next month or two. I want to be informed enough by then to interrogate the results to ensure he receives treatment that is situated appropriate. Another commenter mentioned that the efficacy of stimulants is a strong signal in itself so that's something I want to keep in mind should we get to that point.
Thank you to all the thoughtful comments, much appreciated!
I have ADHD and I use to do this when I was younger.
I was diagnosed with ADHD when I was in 1st Grade. I was having a hard time learning to read, just moved to a new school, and was supposed to go into 2nd, but was held back because of my reading level. Once I was medicated I improved so much, I went from hating school to actually wanting to go and spend time with my friends. It also helped me to stay in control, it brought me down to a normal level.
It's really interesting that you used the story of him knocking something over. I can think of many times I have knocked something over or touched something and broke it. I remember when I smack myself or just break down. I did this when I was younger and yeah it's a feeling that will be hard for him to control. I felt like an idiot and that I ruined everything when it happened. Just build him up and let him know it is okay!
It's hard to make a recommendation but going to a neurologist and also seeing a therapist have been huge. That helped with the medication and diagnostic.
What has helped with everything is exercising and eating clean. There was an article posted recently that showed children's test scored improved by 10% (not positive on the 10 but it was enough) when they did cardio before tests. I know and feel totally different when I have exercised. It's hard to tell a child that they need to run or do some form of exercise, but getting them out and running around with them will do so much. Also not eating food with food coloring or sugar will be so helpful as well. It's simple but it is super key.
TL;DR: Go see a neurologist/Therapist. You don't need to medicate, and it's not the only solution, but it has helped me. Read as much as you can on ADHD. Exercise. (Scooters are hot right now)
My comment may be lost on you, as I feel we are looking at life very differently, but I'll try, and perhaps you can think about it. I would be interested if others have experiences that are similar to mine.
Let me give some background first...
I grew up like most kids, going to school, but also perhaps unusually for the time (20-30 years ago), spent nearly all my free time playing in the fields and woods and riding bikes with my small group of friends. Honestly, it was the highpoint of my life so far.
From about age 6, I was obsessed with "living in the wild" and survival skills. I read books about it, and taught myself skills such as plant identification and friction fire-lighting. I did exceptionally well at school, mostly through natural ability, but also a fear of getting told off, which meant I always did as I was told. It turns out that if you are naturally intelligent and stick to the task, you do well. Who knew?
By about about 13, I began losing focus. At first I still did well, but in the end, I left school with a mixture of As and Bs. It was made clear to me that for someone of my calibre, this should be regarded as a failure.
Looking back, knowing what I now know about mental health, it was clear to me that going to secondary school had been emotionally devastating for me -- I was overwhelmed by the pettiness and the bullying -- and was increasingly depressed as time went on. On reflection, the tone of pettiness and bullying was actually set by the teachers, and in fact, the school system itself.
Skipping forward, I became an arborist (tree-surgeon) when I was 20. Even as a previously active person, I discovered a depth of "animality" that was unknown to me. I became profoundly tuned to my strength and power. It was liberating. All this time, I found it difficult to socialise, as I found other people so boring, not because of who they were, but because of what they did, or rather, didn't do. Once everyone got to age 16, they took up drinking, which is just an elaborate form of spending your time sitting down, which I found intolerable. When they weren't drinking, they would maybe go to the cinema, or drive around in their cars, all activities a million miles away from my outdoor interests.
It wasn't until I was 27 years old and suffered a knee injury, that I learned how to be comfortable sitting down. I didn't really like it, but I got used to it. Since then, I have spent plenty of time sitting down, the internet has taken over all our lives, and I have developed chronic sleep problems. I've never felt worse. I never did go and live off the land; it turns out the UK isn't really set up for that kind of thing.
So that's my experience of life. I don't know what yours is. It's probably quite different. From my perspective, I have zero difficulty understanding where children are coming from. Think about it. You're born an unknowing blob, unable to even focus you're eyes on things, but you're growing, and have many built-in urges. As you learn, naturally, to walk, you begin to explore and learn about the world. In the first years (and in fact, you're whole life) your outlook on the world just keeps getting bigger. You need adults to watch your back, but you want to get out there on your own too. How? Walking, running, climbing, engaging those animal instincts that I found so intoxicating in my twenties after years of education.
But then you reach an age (5) where your world starts to get smaller; you're sent to school by people who you thought cared for you and a stranger makes you do things that you don't want to do. A year later, things change and a different stranger bosses you around. This pattern repeats every year. If you ask mum or dad why you're doing this, it's said that it's for your own good.
Maybe the early years aren't so bad, but for my own part, even as as kid with no formal training in exercise physiology, as I got older, I had a visceral sense that I wasn't getting enough exercise, and would strenuously devote all my free time after doing homework to being outside, even in the dark winter nights. I was lucky, as I had friends who would do the same, but still, it was boring at times.
Restaurants are designed for adults, with refined sensibilities in cuisine and conversation. These sensibilities are usually lacking in children who just want to eat and get back to playing.
Your son was hitting himself over the head. Sure, why not? After all "[you] sternly reminded him to sit down, [leaving him] apparently rueful that he's disappointed [you] again". I don't know you, so won't judge your parenting, but you might want to judge yourself, by noting how many times a day you sternly remind him of things. If it's frequent, then what's in it for him? It's one thing to be corrected now and again, but if every day is one correction after another, then what does he have to look forward to? Clearly not family time at the restaurant. You might be surprised just how upset this all makes him. If people are upset and feel they have no control, then they tend to act erratically and "uncontrollably".
There is debate in the other comments about whether ADHD is over-diagnosed and people "just need more exercise". Your kid hasn't even been assessed, let alone diagnosed, so while other people in the thread may be talking about ADHD, we are not. We are talking about your perception of your child's behaviour. Hopefully, I may have given you a different perception.
I was as sceptical of ADHD as most of the commenters here and have been resisting sending my son for an assessment for about a year because I guess what the diagnosis will be. However the more I've been looking into it and observing him, the more I'm coming to the conclusion that it seems to be something physical that he can't control. Just this evening we were in a restaurant and he was standing in his chair, climbing up a pole. etc... When he eventually knocked something over and I sternly reminded him to sit down, he started hitting himself on the head, apparently rueful that he's disappointed me again. It seems to be something he can't control and his repeated failures to do so seem to be affecting his self-esteem.
What would you recommend as the best interventions to explore? I would prefer something behavioural but am opening up to considering medication if the will make him feel better about himself and facilitate smoother interactions with his peers.