It’s not just your imagination. The diagnosis of ADHD (attention-deficit/hyperactivity disorder) has been steadily increasing over recent decades. In New Jersey, nearly 6 percent of children aged 4-17 years old are diagnosed with ADHD. While scientists and epidemiologists work to sort out the causes, many parents are left to deal with the reality: a child with ADHD. For many parents of a child with ADHD, the word “treatment” often triggers an image of a child becoming zombie-like on medication. Parents cannot be blamed for such an intrinsic reaction. Media images of ADHD and treatment of ADHD have been demonstrably biased, providing low-quality and poorly sourced information.
While treatment for ADHD may require medication, no child should ever be zombie-like on medication. Furthermore, medication is just one piece of the equation. Proper treatment of ADHD requires a whole-child approach. Even if parents opt for medication, this only treats some aspects of the disorder. A more well-rounded and comprehensive approach addresses all the child’s needs by incorporating numerous treatment modalities.
More Than Just ADHD
Children with ADHD have numerous symptoms other than just inattention and/or hyperactivity. They may have fine motor delays, social difficulties, sensory integration disorder, gastrointestinal problems, poor emotional regulation, low frustration tolerance and sleep problems. This is not to mention that they’re also at higher risk of also being diagnosed with anxiety, autism, tics, learning disabilities, anxiety, depression, substance abuse, oppositional defiant disorder or bipolar disorder. That’s why it’s imperative to look at all the child’s symptoms. Becoming overly fixated on just ADHD symptoms can sometimes obscure the coexistence of other symptoms or disorders. Treating the whole child requires addressing all his or her problems, not just one.
Behavioral Support and Therapy
Ideally, any treatment of ADHD will also include behavioral interventions. Behavioral interventions could take the form of parenting interventions, executive function training, play therapy or more traditional talk therapy. Modalities such as sensory integration therapy are also often employed and may be, likewise, helpful. Finding a therapist with whom your child is comfortable (and with whom you are comfortable, too) is the key. It’s important that the therapist has specific training and experience in treating ADHD, so don’t be afraid to ask. Behavioral support and therapies are not quick fixes so, if you go this route, expect to invest a decent amount of time (and potentially money).
Setting Your Child Up for Success at School
For children, school is ostensibly their profession. Poor performance at school not only stunts academic progress but can also lead to symptoms of anxiety and depression. If the child is not performing up to his or her capabilities in school, then it’s incumbent upon the family and the school to ensure that the child can succeed. There are legal obligations to what must be afforded children in school that can range from “504 Accommodations” to an Individualized Educational Plan (IEP) to out-of-district placement. The key is that the children can succeed.
They Are What They Eat
What we put into our bodies certainly affects our brain. It is only logical, then, that diet can affect ADHD. Indeed, studies have shown that specific diets can impact upon ADHD, although much of the research admits that further studies are needed. Some of the more well-known diets for ADHD include the sugar-elimination diet, a natural (preservative-free and artificial food coloring-free) diet, and a Mediterranean diet. To properly implement such a diet, you should consult with a nutritionist that specializes in pediatrics and that has experience in ADHD diets. Concurrently, you should also work with your physician to establish some parameters of success, so you know if the diet is helping or not.
Vitamins and Supplements
There are several vitamins and supplements that may help with some symptoms of ADHD. Supplements such as omega-3-fatty acids have been studied extensively in the treatment of ADHD. In addition, children with ADHD may be at increased risk of vitamin deficiencies. As such, blood work may be useful in identifying these deficiencies. Before trying any vitamins or supplements, be sure to speak with your physician. When purchasing supplements, you should also note that not all supplements are created equally. Supplements with third-party certification and independent testing are preferred.
And Yes, Medications
There are literally dozens of medications that are now FDA-approved for ADHD. Medications are typically indicated for children with ADHD if one of these three situations arises: the child is dangerously impulsive/hyperactive (such as jumping off bookcases or leaving moving vehicles), the child is functionally deteriorating (such as failing school or unable to have any meaningful relationship with peers) or the child is becoming anxious or depressed over their symptoms (which often happens as children get older).
Every child’s situation is unique; the family and the physician need to have a thorough discussion prior to starting a medication. It goes without saying that all medications have side effects. However, everyone reacts differently to medications. What caused one person to lose weight could cause another to gain weight. What makes one person anxious could make another person calm. If there are side effects to the medication, there are plenty of other medications to try so significant side effects should not simply be tolerated. There are also some genetic tests which can help to predicate dosing and likelihood of side effects with various medications. However, these tests can be costly (as they are rarely covered by insurance) and are limited in helpfulness (since, again, each person is an individual and responds in a unique way to medication).
A modern approach to the child with ADHD should clearly have an approach that is whole child. While medication may be a part of the solution, so may academic accommodations, behavioral support/therapy, vitamins, and dietary changes. If your child has been diagnosed with ADHD or you suspect that your child may have ADHD, you should seek out a specialist that understands and implements such a whole-child approach.
Dr. Jeffrey Kornitzer is a board-certified Child Neurologist at New Jersey Pediatric Neuroscience Institute (NJPNI). He is also an assistant professor in the Department of Neurology at Rutgers-New Jersey Medical School and co-director of the medical school’s Neuroscience Course. Dr. Kornitzer has been awarded the prestigious Golden Apple award in teaching and was selected for induction into the esteemed Arnold P. Gold Foundation. He has published well over a dozen peer-reviewed articles and numerous scientific abstracts. His ADHD research has been featured on Neurology Advisor and the online magazine Attitude. He also co-authorized five chapters for McGraw-Hill’s Neurology Board Review board and authored the chapter on Complementary and Alternative Medicine in the definitive book for parents of children with autism, Navigating the Medical Maze. Dr. Kornitzer sees children and adolescents with a variety of neurological conditions. He specializes in neurodevelopmental conditions (such as ADHD), tics, seizures, headaches, concussion, and autonomic disorders (such as fainting/syncope). His emphasis is on a thorough workup using the latest technology to get to the root causes of the symptoms and then multidisciplinary approaches to treat the whole child.
Would you like your child evaluated for ADHD or another neurologic condition? Schedule an initial consultation online at njpni.com or by calling (973) 326-9000.