By Isabelle Banin

Understanding attention deficit hyperactivity disorder (ADHD) and knowing when to seek a specialist’s evaluation can make all the difference in your child’s life.

In general terms, ADHD is a neurodevelopmental disorder that affects the prefrontal cortex—the section of the brain in charge of attention, behavior, and other areas related to self-control and regulation.

There are different types of ADHD. ADHD Combined Type has three main features: inattention, high activity level and impulsivity. Some children have the Inattentive Type, and may seem spacey or lost in their thoughts. Others have the Hyperactive Type, and may appear fidgety or restless. Unsurprisingly, the Inattentive Type is more often overlooked. This type is also more common in girls and is one of the many reasons why girls with ADHD are underdiagnosed.

To make ADHD even more complicated, some children with ADHD hyperfocus when they play video games for hours, but have difficulty sustaining focus for homework, tasks, or activities that need to be completed. One reason for this inconsistency has to do with dopamine levels and transporters. Dopamine is a neurotransmitter that drives us toward activities that feel rewarding and pleasurable. As a result, some people with ADHD are hyperfocused while doing activities they enjoy, but struggle to attend to other tasks.

“If your child has ADHD, there’s about a 50% chance they have another condition. The most common co-occurring conditions are learning disorders, an anxiety disorder or other mood disorders,” said Rebecca I. Nelson, PhD. Dr. Nelson is a pediatric assessment specialist with the Developmental Follow-Up Clinic within the Department of Pediatrics at NorthShore. “Having more than one condition means that symptoms may overlap or mask each other, so close attention to differential diagnosis or dual diagnosis is important.”

For example, difficulty sustaining attention or completing activities could be due to a short attention span, learning difficulties, anxiety or depressive feelings.

Here are Dr. Nelson’s tips to support your child with ADHD and help them succeed academically and socially.

• If there’s concern from a parent, teacher, pediatrician, or anyone else centrally involved in your child’s life that they might have ADHD, it’s important to get them evaluated. Since ADHD is primarily inherited, the chances of your child having ADHD is higher if a family member has been diagnosed with it, especially first-degree relatives.
• Make sure your child is evaluated by a pediatric clinician who specializes in diagnosing neurodevelopmental conditions. Screening measures catch the most severe cases, and often miss mild or moderate cases that also would benefit from intervention.
• ADHD evaluations can begin as early as preschool, when ADHD symptoms commonly first arise. A formal diagnosis of ADHD typically is not made at that time unless symptoms are severe, but is helpful to establish a baseline with ongoing monitoring. Parents can initiate an evaluation by first discussing their concerns with the child’s pediatrician who then can write an evaluation referral.
• Behavioral therapy is the frontline intervention to treat ADHD, and is tailored to your child. During these visits, you will learn about how to best build environments that will help your child manage their ADHD.
• Examples of interventions your therapist may recommend include increasing structure throughout your child’s day with special attention to periods that are challenging for them, providing regular opportunities for sensory or physical activity if they are high energy, and breaking down non-favored activities so they become more manageable. If your child struggles to fall asleep, introducing a relaxing and consistent bedtime routine, limiting electronics before bed, and making sure their room is free from distractions (e.g., light, noises, etc.) is helpful.
• Those with moderate-to-severe ADHD symptoms benefit most from a combination of medication and therapy. Make sure to give your child their medication exactly as prescribed, and routinely take notes on how you believe the medication is impacting them. Include your child and teacher’s input. These notes will help your child’s doctor determine if the prescription is right for your child. There are also standardized tests to measure medication efficacy. If your child is in middle school or high school, encourage them to keep track of their symptoms in their own journal, and educate them on the importance of taking medication exactly as prescribed and not sharing it with anyone.

At NorthShore, our team is available to help you with any questions or concerns that you may have regarding your child’s physical, cognitive and/or social development.

If you feel that your child’s development may be delayed, please speak with your child’s pediatrician, who can provide you with information about testing and treatments offered by our specialists at NorthShore’s Developmental-Behavioral Pediatric Clinic or the Developmental Follow-Up Clinic.