Asking the Hard Questions about ADHD

Some vital questions to consider.

This post originally appeared on The Inner Life of Students on Psychology Today, and is the second in a two-part series on attention-deficit/hyperactivity disorder (ADHD) and youth development. Read part one: Development or Diagnosis?

In my previous blog post, I discussed the New England Journal of Medicine study which found that younger children in their class were more likely to be diagnosed with attention-deficit/hyperactivity disorder (ADHD) than their older peers. This study demonstrated that we need to rethink the threshold we use to decide when kids are put on medication. I expressed that before pursuing medication, we need to explore other avenues, including a reduction of over-stimulation in the classroom and changing criteria on when children should start school. Even when medication is considered the best option to help the child, it should be used in conjunction with behavioral therapy and changes to the school and home environment. If such issues are left unaddressed, children will typically face long-term use of medications, often beginning early in life. If your child’s principal, teacher, psychologist, pediatrician, or child psychiatrist suggests medication, you should be prepared to ask some hard questions. Keep an open mind because it could be the right decision, but even if medication is needed, treatment will only be truly effective if it is holistic.

Both children with ADHD or behaviors that lead educators to pursue a diagnosis can do quite well in one classroom and terribly in another. Why is that? Because the connection between a teacher and a child is enormously important and contributes to whether a child functions well or struggles. A positive relationship does not equate to permissiveness or leaving disruptive behavior unaddressed. In fact, structure and consequences are very important, but they have to come from a place of love, patience, and support. Rules, empathic relationships, experience, fitting in with a peer group, and having a safe and non-chaotic family and learning environment also contribute to the maturation process. In a supportive, structured environment, children can join or rejoin their natural developmental process to learn self- management -something children who enter kindergarten and school pick up at different speeds.

In many of my blogs, I advocate a radical developmental mindset to childhood and adolescence-with maturing out of certain behaviors and problems as a part of the process of growing up. Children are often capable of telling us what they need, though parent and teachers have to learn to pick up on their cues. The noise of misbehavior and inattention often hides anxieties, frustration, trauma, and a sense of being out of control. All of this can be at the base of what looks like ADHD but ultimately is not ADHD. A child’s development takes time, and the right environment and nurturing can result in a child establishing a stronger, more optimistic sense of competency and self-management that can take them successfully into adulthood.

If you find you and your child in this situation, here are some vital questions to consider:

• Has a trained professional or special needs teacher conducted a formal classroom observation to see if modifications to the classroom environment would help your child (particularly with the structure, teacher’s approach to de-escalation, and their general tone of voice and demeanor)?
• Has your child been observed in multiple classrooms to analyze differences and similarities of reactions and behaviors?
• Have you, as a parent, had a chance to observe them in the classroom?
• Are there afterschool programs that can help your child become more actively engaged, given the more relaxed nature of the setting?
• How can you work effectively with your child’s doctors, teachers, and other family members to provide a supportive environment?
• Consider changes that start at home-what are some things can you try at home to prevent unnecessary struggles, and is there someone who can observe and give concrete suggestions of how to provide behavioral guidance and support to your child at home?

These are just a few starter questions to get you thinking. You will have to decide on the ones that you are most curious about that fit your specific circumstances.

It can be quite uncomfortable to ask these questions as they can be viewed as entitled or provocative, especially in environments where no one has time-but they are not. In fact, these considerations reflect great care from the parent or advocate and most professionals want to have more parent involvement. The publication of the article in the New England Journal of Medicine should be read as a welcomed statement of caution from within the medical profession. A more holistic approach to development-which inevitably takes much more skill, patience, and time-will lead to far fewer children on long-term medication and many more children who are recovering and thriving.