Let’s Talk….What is ADHD, Really?

Okay, so what is ADHD, really? For me it is a journey that has many twists and turns and involves a lot testing and re-testing, with quite a few tears and laughs too. In my experience, when I mention that my son has ADHD, most people have heard the name, but generally don’t believe that it exists. I have had people ask ‘isn’t that the over-diagnosed disorder that they have in America?’ I have even had people completely dismiss it by saying, ‘no your son doesn’t have ADHD, I mean all boys are hyperactive and are meant to be rambunctious’ (cue… eye roll!). There are of course, those that just don’t know anything about it at all or those that accept its existence but have no idea on how to deal with it. So let’s break it down, into the science (I am a science nerd, after all) and the real life situation:

THE SCIENCE

When looking up ADHD, I find that many sites, throw out a lot of heavy scientific jargon that can often be quite confusing. If you see things like ‘Inattentive’ and ‘Hyperactive’ it can also throw you off, if you have a rambunctious kid (especially boys). If your child is inattentive or hyperactive, it doesn’t always mean that they have ADHD. Many kids get bored and lose interest in a topic, or get hyper in certain situations. These behaviours have to be pretty severe (i.e. it has to impair their daily activities) to be considered for a diagnosis.

ADHD is defined by three types: predominantly Inattentive, predominantly Hyperactive and Combined (both hyperactive and inattentive) (DSM 5, 2000). So in breaking it down further, mainly from the inattentive side of things, i.e. distracted easily really means there are internal distractions (mind wanders/unrelated thoughts) or finding task and activity organisation difficult means, there are problems managing time, like meeting deadlines, completing homework, or any tasks that are demanding. We see this in the adolescent/adult context, during conversations, sitting through lectures or having to read long text.

When looking at hyperactivity/ impulsivity, we see that in teens hyperactivity lessens or changes, but poor impulse control increases, something that is very significant in ADHD adolescents; for example, the ‘inability to sit still in class’, well really by the time your kid is a teen, they do have the ability to sit still in their classroom, but they struggle to process tons and tons of information, like being asked to read an hour long text (a task that is not uncommon in classrooms with teens). Adults often describe their hyperactivity as feeling restless and not being able to concentrate on boring tasks, or becoming agitated (internally) if having to wait in lines, or for events to happen.

This understanding shows that one thing is for sure, as the brain grows and matures, ADHD evolves, which for us parents mean that some of the behaviours will pass, and be more manageable and others will need understanding and patience. So what may have been symptomatically true for childhood ADHD is not necessarily true for adolescence and adults, i.e. from a small child not being able to sit still (like the energiser bunny) to an adult who appears calmer on the outside, but is internally agitated and restless.

The consistencies of ADHD symptoms, however is that no matter what the age, a person suffers instability in their emotions: mood swings throughout the day, agitation, frustration and anger. Unfortunately other mental health conditions also have these symptoms which mean that diagnoses of depression, Bi-polar disorder, anxiety etc. are not uncommon, especially in adults, making ADHD missed in people presenting such symptoms. These are where many of the negative aspects of ADHD play out throughout a person’s life.

How it all translates into my world:

In our household, ADHD, meant that when my son was in primary school, we faced the daily challenge of what will he do today? Or, am I going to get the dreaded phone call? So let me explain the negatives and the positives of this disorder as it plays out in our home and our world.

The negative aspects of his ADHD meant that he was excluded three times from school; once, for walking up and slapping his teacher (with a teaching assistant sitting beside him…don’t ask) and the other times for getting into fights with other boys. The other incidents that didn’t warrant exclusions, involved, throwing chairs in the classroom, disappearing and hiding (with a very terrified teaching assistant, looking for him, as I had arrived to pick him up), and scratching his teaching assistant among other things (there is a long list). Homework completion was a nightmare, a task that he found boring and so something that could be completed in an hour, took almost four hours, with a lot of frustration and anger in-between. By year 2 (school age 6), we had to suggest that the school refer us to CAHMS, which got us our assessment of ADHD and the medication route. By the time he reached secondary school, for the first two years, the hyperactive behaviour changed, but he was still not able to manage his emotional instability and impulses, which started getting worse. The medications did not always control his emotional instability (more on this topic to come in a future blog), but managed to increase his focus and lower impulses a bit. Sleep dysfunction however, still remains our constant; waking, crying out, talking in his sleep and even sleep walking.

The positive aspects (it’s not all gloom and doom) of ADHD means, we also have a 6″1′, very creative, charming and handsome 14 year old. He was the star pupil in every school play (primary school), because he was a great actor and narrator, so was often chosen to introduce the school assemblies and had important roles in the plays, an astronaut, the magician in Matilda, or an explorer (obviously ones that did not involve a lot of lines to learn). He is also an avid gamer, who has been clacking away at a computer from the age of three. He is a great story teller and has an immense imagination. He creates figurines with pipe cleaners or cardboard, that never cease to amaze. Unfortunately, teenage hormones, mixed with his ADHD and ASD, have slowed down the actor side of things, with him retreating from the spotlight and socialising. His creative side however is thriving. We watched as he moved from strength to strength, even though we still have all the emotional and anxiety struggles which we keep working on, but on the whole we have an outwardly less hyperactive child.

With the right support, things do get more manageable as your young child with ADHD evolves. Unfortunately many outsourced aspects of support like talking therapy (which does not always work; think ‘long conversations‘ and ‘inattentiveness‘) are expensive. Occupational therapy and speech and language therapy are offered in the schools, but only if the borough (here in the U.K.) has the financial capacity to maintain these therapies. Having an Education Health Care Plan (EHCP ) does help (more on EHCPs later) as that gets you the teaching assistant support that is so needed with an ASD/ADHD child. One encouraging thing that I heard recently, (at a coaching conference), from a speaker who has ADHD herself, was that although the struggles lie in the educational sector, it seems that when the person with ADHD reaches their employment years, companies appear to be far more accepting and accommodating. Promising, I know, but my take was that it is in those crucial years: childhood and adolescence where the understanding and support really matters. If we get that right during the education years, our children can thrive and we could reduce those other mental health aspects like depression and anxiety which is all too common in our ADHD teens.

References:

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.

Photo Source: www.unsplash.com. Stack of Jigsaw Puzzle pieces by Hans-Peter Gauster.