• Dr. Benton

Does Your Child Have ADHD?

ADHD is all the hype these days. Your neighbor's kids have it, your brother has it, and even your dog seems to have it. It seems like everyone has some form of ADHD. Your kid can't remember to brush his teeth in the morning and just lost his iPhone again. Maybe a recent report card has you wondering if your own child has attention problems. How do you figure it out for sure?

Attention problems are common, but not all attention problems are ADHD. There are many problems which can masquerade as ADHD, and it is important that these be considered before diagnosing your child with ADHD. I'll begin with a quick story.

When my own daughter was beginning elementary school, I noticed that she was having some trouble with spelling and reading. In fact, she said that she "hated reading," which kind of broke my heart because I have always been a voracious reader. None of this made sense to me, and so I began to do what many parents do ......I worried. Did she have a learning problem? Had I failed to notice any red flags? I hired another Psychologist to do a psycho-eduational evaluation to see if we could identify any underlying issues.

The Psychologist who tested her quickly handed us a report suggesting that our daughter "has ADHD." The primary recommendation was for us to seek medication consultation. My response was...."Huh?" I knew that she did not have ADHD, and that "medication consultation" was a ludicrous suggestion at the time. Savanna had no attention problems at home, even when working on schoolwork. It would be both unwise and harmful to seek a medication prescription for any child so quickly without looking at other possible factors. Thank goodness I knew differently, but how many parents without my background would rush to the psychiatrist for medication?

The battery did reveal some interesting nuances in her visual spatial abilities and her ability to discriminate between visual symbols, but I wasn't quite sure what that meant for her until about 6 months later. Savanna was sitting on the floor reading a book with our new puppy in her lap. I took a cute picture because the moment was too adorable to pass up the Kodak moment. When I gazed at the precious picture, I noticed something peculiar. Upon closer look, Savanna's eyes looked odd while reading. I zoomed in and noticed that her left eye was not tracking correctly with her right eye, and immediately scheduled an appointment with a pediatric ophthalmologist.

The appointment revealed 20/20 vision, but Savanna had an eye muscle weakness called convergence insufficiency. Her eye muscles had trouble coordinating together to focus on objects closer to her face, which caused eye muscle fatigue and frustration with reading and math timed tests. I soon learned that many of the symptoms of convergence insufficiency overlap with the symptoms of ADHD (5 out of 9, to be specific). By the end of a long school day, she was extremely irritated with school work and the mere thought of reading was enough to send her into an emotional spiral.

We did some basic visual OT three times a day to strengthen those muscles and eventually sought an evaluation with a developmental optometrist. He discovered that her eye muscles had indeed strengthened, but that she developed divergence insufficiency-the opposing eye muscles were weak in relation to the convergence muscles. This situation was similar to strengthening only your biceps muscles while neglecting your triceps-the other half of your arm. Savanna started some exercises to strengthen those muscles with a patented 3D computer program and began using some mild corrective lenses to take the strain off of her eyes. Her optometrist called these "training wheels for the eyes."

Six months later, my daughter was more attentive and less frustrated. Her grades improved, and she had an easier time reading. In fact, she seemed to even like reading. Savanna continued to do well, her grades improved, and the problems that once concerned me were resolved. In her specific case, a vision problem was causing her difficulties with concentration. Thankfully, we were able to address the root of the problem without rushing to medicate our daughter for a misdiagnosis. What's worse is the fact that the stimulant medications prescribed for ADHD can worsen convergence insufficiency.

Here's the rub, folks. Psycho-educational assessments are merely tools which can yield helpful information about a child. Testing results should always be paired with clinical experience and careful assessment of client history. Seeking consultation with pediatricians, developmental optometrists, and OT specialists is often appropriate to rule out other conditions which can mimic ADHD. In this case, it took me a year to figure out the problem because the clinician we used did not do so.

Keep in mind that ADHD is a term used to relate a dopamine deficiency or low blood profusion to the prefrontal cortex, cerebellum, and bilateral basal ganglia in the brain. We are merely gathering behavioral and psychological based symptoms with these measures. The only real medical test for ADHD would be conducted with a brain SPECT scan of the brain showing us a picture of the blood profusion problems in the brain. A SPECT scan is a type of nuclear imaging test, which means it uses a radioactive substance and a special camera to create 3-D pictures of the brain. The Amen Clinic offers these types of services, which you can see pictures of a brain showing ADHD blood profusion patterns here.

The two most common psychological assessments used to diagnose ADHD in children are the Connor's and the BASC-3 (Behavior Assessment System for Children, Second Edition), usually paired with an IQ test like the WISC-V. I like the BASC-3 better because it offers a more comprehensive view of the child's presentation, offering scales for anxiety and mood problems which can often cause secondary attention issues.

Here is a list of the most common problems which can masquerade as ADHD. Consider this list if you suspect that your child has been misdiagnosed.

1. Poor diet. Consider learning more about the Feingold Diet. Many kids eat a diet full of refined sugar, preservatives, and food dyes. While many articles cite that the Feingold Diet is only 5% effective in reducing ADHD symptoms, this figure is based on nonexistent research. The few studies which have been done well have yielded extremely high success rates. Before medicating your child, consider doing this elimination diet first. You have nothing but dietary junk to lose!

2. Sedentary Lifestyles. The norm for many kids these days is to wake up, sit in school, go home and sit in front of the television, and go to bed. Rinse, wash, repeat. Movement, health, and learning are all interconnected. Sedentary lifestyles promote inattention, along with exponential health problems. Exercise and movement promote the release of BDNF (Brain Derived Neurotrophic Factor) and neurotransmitters, which pave the way for learning. Get moving to learn better and faster!

3. Poor sleep. Many kids are getting very little sleep, staying up too late at night on electronics and getting up too early. Chronic sleep deprivation in children lowers immune functioning and, you guessed it.....attention. Chronically elevated cortisol causes an inflammatory response, and this is very unhealthy for anyone in the long run (adults or kids!). Kids need far more sleep than they are getting (on average). I recommend the book, The Sleepeasy Solution

by Jennifer Waldburger, for parents who want to improve the quality and quantity of their family's sleep habits.

4. Convergence and Divergence Insufficiency. Have your child's vision checked beyond the basic vision screening. You can do a quick vision test to check your child for convergence insufficiency. This can cause visual spatial issues and visual processing problems in school, which can overlap symptoms with ADHD.

5. Anxiety Disorders-Anxiety causes the what the Buddhists refer to as "monkey mind." Our thoughts jump from one thing to another, usually the result of our fight or flight response being stuck in the "on" position. When our thoughts jump around, we are less able to sustain attention and......learn.

6. Depressive Disorders-it is well known that mood disorders can cause serious problems with attention. If your child has any trouble with depression or mood swings, it is highly likely that attention and memory problems will follow. In this case, addressing the mood problem should help alleviate attention and learning issues in school.

7. Head Injuries-you may be surprised to know that closed head injuries are a fairly common cause of mood, substance abuse, and attention problems. Many people who have sustained closed head injuries in the past don't even recognize the issue. This could have been a fall down the stairs, a tumble off of the bike, or maybe a baseball hit to the head. Wherever it happened, a closed head injury can be the root of severe, chronic problems for a lifetime. The Amen Clinic is a great resource for those who suspect a past closed head injury as the cause of attention or memory problems.

Other factors to consider with attention problems are age and environment. If the onset of inattention occurs during adulthood, then hormones and pre-disease states could be considered. Peri-menopause and menopause cause a major shift in several different hormones, therefore changing the entire hormonal cascade for women. This can cause major changes in attention and memory. I've written about that before on a different blog, and you can read that article here: Motherhood Dementia.

Consider environmental factors which may not necessarily cause attention problems, but could definitely contribute or maintain existing problems. Here is an article on the link between Pesticides and ADHD.

You should always consult with your physician if you suspect you have any of the ongoing problems I've described here. Obviously, this information is intended to empower you to make great decisions for yourself and your family, but it always helps to have an amazing physician to guide you through any health related decisions. If you think testing is necessary, I offer gifted testing and psycho-educational assessments in east Fort Lauderdale with The Psychology Group, along with Sports Performance Psychology services. You can call today at 954-488-2933, x2.

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