A New Way To Work With ADHD While Having FunApr 07, 2021
One of the most common conditions I see and love to help families with is ADHD. ADHD stands for Attention Deficit Hyperactivity Disorder. What comes to mind when you think of ADHD? Perhaps a child who cannot sit still and constantly moving? Or always talking in class? Maybe you think of someone who can't pay attention or has a hard time remembering to bring home what they need for homework? But, not everything is automatically ADHD.
Is it ADHD or not?
A colleague of mine wrote a New York Times piece: “Diagnosis is Key to Helping Kids with ADHD.” In it, Dr. Froelich writes: even though there is strong scientific evidence that ADHD has a biologic basis, there is always concern whether a child truly has ADHD and if it is misdiagnosed or over diagnosed.
"...pediatricians need to verify that each child's symptoms are actually impairing functioning, are long-standing and present from an early age, and occur at school as well as home. As clinicians, it is our job to rule out the many other diagnoses and circumstances that can produce A.D.H.D.-like symptoms by carefully interviewing the family, conducting a physical examination to rule out mimicking medical conditions, and diligently collecting information from the school." -Dr. Tanya Froelich.
There is not the equivalent of a “swab” or laboratory test to tell the pediatrician, parent or teacher that a child definitely has ADHD. I talk to parents all the time about the fact that what we can see on the outside is just a behavior. It's what the parents or teachers see and observe. Each behavior is a "clue" that needs to be looked at more. Why? Because not being able to sit still, daydreaming or being forgetful might be chronic untreated allergies, anxiety, learning disabilities, poor sleep, or just plain having an “off” day. Or, it may be something else going on in the home environment. This is why it is important to "dig in" and ask follow up questions. It is important to understand how behaviors affect how a child’s is doing at home and school. It takes really looking at the patterns and understanding the “why” of a behavior.
Explaining this to families is important and acknowledging the imperfect methods we have to identify behavioral conditions. It requires being flexible and re-evaluating if a child’s behavior or functioning does not improve. Also, being open to going back to the drawing board and thinking about other conditions that can mimic ADHD. It means partnering with teachers and educators, and other family members to get their impressions on how a child is doing. Primary care providers are able to develop long-standing relationships over time and build a working partnership with each and every one of their families. This is also why primary care providers are still best equipped to make the initial diagnosis.
Yet this is why behavioral conditions can be so challenging. Add to the mix that most primary care doctors only have 15-20 minutes to address these complex issues. This is one of the reasons why my research before leaving academia had been working towards developing a new model to improve care in busy pediatric clinics. By restructuring the typical brief visit for individuals into an hour long group visit for up to 6 families, pediatric providers not only educate and explore these issues with families, but also observe children with others.
RELATED: Group Visits for ADHD Families: A Win-Win (Video)
The group visit is one option that increased satisfaction for providers and families, despite the fact it also has its challenges. Yet, the group visit model may not be for everyone and is not always feasible. Scheduling can be hard, needing to have the right space and staff to run the groups is another challenge. Families need to be able to plan for the 90 minute appointment on top of the time it takes to get to the clinic after leaving work or school.
When group visits are not possible, what next?
While last year was just plain hard for everyone, it did afford me some time to re-think how to improve upon ADHD care. When a child has a diagnosis, the next step is to create a plan for treatment. In general, pediatricians can talk to families about the importance of getting enough sleep, healthy eating, limiting screen time, and getting physical activity that keep brains and bodies healthy. They also can prescribe medications, which has been shown to improve behaviors, but is by no means a "magic bullet." Studies have shown that even when medications are used, families still report ongoing stress and strain. That's because of the ongoing executive functioning challenges that need to be addressed.
But what are the other pieces of treatment besides medication? Behavioral therapy for the child to learn things like how to manage their emotions, how to improve motivation or plan and organize for school, and how to increase attention. Support for parents to learn how to handle common parenting challenges and set their child up for success. School accommodations to support the learning and attention differences kids with ADHD have so they can thrive. These other pieces are important but are things that require families to make additional appointments, involve other people and take some time to get going. That's because ADHD is a "team effort."
Do we hurry up and wait?
It can be hard to wait for the next appointments, especially when children are struggling. That's why I created the TEACH ME ADHD course for families. It's a course of kids and parents to take together. I've brought together elements of parenting support and behavioral therapy in an educational, interactive format that is convenient. That's why it is done on zoom so families don't have to go anywhere other than their living room or kitchen.
When families are given the knowledge and tools they need to begin to work with ADHD, it can transform the home environment. When kids are given child-friendly information about ADHD in ways they can reflect and understand, it helps them become an active partner. When they understand how it can help them, they are more open to it.
TEACH ME ADHD is a small group course for up to 10 families to learn, grow and interact with one another. Kids see other kids who are "just like them" and realize they are not so different. They realize there are some really cool things about having ADHD and that ADHD is not necessarily "good or bad." Up until then, they may have felt they were always getting in trouble, or the only ones who were having a hard time learning or behaving. Being in a small supportive group helps kids "see" they are not alone.
And that is the power of groups like TEACH ME ADHD.
Families who enroll in TEACH ME ADHD take on code names and become Sr and Jr Detectives at the All Deeds Help Detective Agency. They embark on family missions and complete daily deeds throughout the 8 week course. At the end, families are ready to co-create their ADHD Care Plan to take back to their pediatrician. But that's not all, families come away feeling empowered and ready to tackle life ahead "in the field" together.
Agency doors open three times a year: January, April and September. Click here for more information!
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