Is it immaturity? ADHD? Or what?
What type of attention span is normal for a young child
Monday, December 20, 2004
The phone calls started the second month of first grade. “Your son won’t sit still ... your son won’t write in his journal ... your son sat for 10 minutes just twirling his pencil ... ”
My son had an answer for everything. And if the answers seemed off to me, they seemed valid to him. So, I explained, lectured, grounded and even begged. But, the calls grew more frequent. Then came talk of inattention and soon after, there was a push to get my son tested for attention deficit hyperactivity disorder, also know as ADHD.
“ADHD is a condition of the brain that makes it difficult for children to control their behavior,” according to the American Academy of Pediatrics’ literature, which also refers to the condition as one of the most chronic of childhood. Boys are more readily diagnosed with ADHD than girls—some studies indicating by as much as 3-to-1. There is not yet a proven cure for ADHD, but there are treatments. Nor is there a proven test. Rather, diagnosis is subjective and made in accordance with guidelines.
The National Institutes of Health places the national average of ADHD cases in school-age children at 4 to 5 percent. The American Academy of Pediatrics puts the range at 4 to 12 percent.
“People claim that it is much higher, that there has been an increase, almost epidemic. This may or may not be true,” says Bill Walsh, the founder of HRI-Pfeiffer Treatment Center in Warrenville, a place that offers alternative treatments for numerous disorders including ADHD. “Mayo Clinic did a study in a small concentrated area and measured it at 7.5 percent. That is the highest I’ve heard of so far. The concern is that in some areas, doctor diagnosis has hit levels of 20 and 30 percent. Some of the larger areas have more than 20 percent of their school-aged kids on medications like Ritalin. These medications may be necessary as a last resort, but do have serious side effects.”
I was surprised we were even talking ADHD. Yes, my son was active, energetic, immature and at times even had “ants in his pants.” No, he didn’t sit very well for an hour of church. And yes, he fidgeted when forced to sit for long periods of time. But ADHD? He was 6—just 6—and even though he was one of the youngest in his class, his grades were above average. At home, he could play quietly, loved board games and could sit 45 minutes playing games such as I Spy and dot-to -dot.
I searched for information on what was typical immaturity for a 6-year-old. All I found was list after list of ADHD symptoms. The trouble is that most of the ADHD symptoms can be found in any child. Frustrated, I reread the list. It described my son’s entire Cub Scout den.
What defines ADHD? “Symptoms of ADHD and those of immaturity are synonymous,” says Thomas Phelan, a clinical psychologist and author of many parenting books such as 1-2-3 Magic: Effective Discipline for Children 2-12. “The thing that makes it ADHD is that you don’t grow out of it.”
Phelan says that while there is a risk of misdiagnosis when assessing those in younger grades, in his opinion there is a bigger risk in not diagnosing it at all. “A child’s academic self-confidence is crystallized by third grade. If a child is constantly in trouble, it will ultimately affect how he feels about himself academically.”
While diagnosing early may be important, parents need to remember that kids mature at different levels and a child’s environment—be it home, school or social—all play a role in behavior. And, because diagnosis is subject to observation and opinion, parents need to make sure the person observing is qualified. If they are not, there is a greater risk that preconceived notions, personality differences, patience level and observational skills could affect the results.
Also, don’t let your child be judged solely on appearances. “You can have a child who can’t sit fully in his seat and is staring out the window, seemingly not paying attention ... yet he is,” Phelan says. “Then, you can have a child who is making eye contact ... and he is not [paying attention]. You have to look deeper.”
Confused? Phelan suggests subtracting 30 percent from your children’s age. If your 6-year-old is acting more like a 4-year-old there may be a problem.
You also can use Phelan’s five-point system:
• What has been the child’s developmental course to date?
• How is he doing socially?
• What is mom’s intuition telling her?
• How is the rest of the class doing? If too many kids are having problems it may point away from ADHD.
• And, what is the family history? Chances go up 30 percent if a sibling has ADHD. Consistency is key.
Even when you have a solid case of inattention and hyperactivity, it doesn’t automatically mean ADHD. “There are many things [other than ADHD] that can significantly impact a child’s ability to focus and organize thinking,” says Shawn Daugherty, coordinator of psychological services at the Streamwood Behavioral Health Center. “Emotional disorders such as non-clinical sadness, depression, mood disorders and trauma can be manifested as irritability in children and impact a child’s ability to pay attention.”
Lack of sleep also can affect a child’s memory, concentration, reaction time and even cause a child to become inattentive and more impulsive. The National Sleep Foundation recommends 10 to 11 hours of sleep per night for first-graders, but the national average is only 9.5 hours.
By now, most of us know that a diet containing too many stimulants such as soda, chocolate and products high in processed sugar can play a role in hyperactivity and inattention. But there is a lot of research going on to find other connections regarding food allergies, metals and vitamin deficiencies.
What about treatments? The amount of children diagnosed with ADHD means many alternative treatments have been springing up in the market. They include things such as biofeedback, applied kinesiology or realigning bones in the skull and optometric vision training. The American Academy of Pediatrics says that these methods have not been proven to work in scientific studies. But it hasn’t stopped people from shopping for nontraditional and non-medication alternatives. The academy urges more research be done, suggests parents investigate any advertised method and recommends that a parent tell the child’s pediatrician about any treatment the child is undergoing.
The traditional route of research through a government grant can take up to seven years, says Dr. Linda Williams, national medical director for Dore Achievement Centers. According to its literature, Dore uses an exercise-based approach that is noninvasive and drug-free. The program requires parents to commit to doing 10 minutes of exercise twice daily with the child. The for-profit company began in the United Kingdom and in the past two years has opened five centers in the United States, including one in Schaumburg.
“We are very upfront with parents about the research that has been done,” Williams says. “And what we are doing.” Parents must make the choice. “Some will say, I am willing to give this a go because I don’t want medications for our child. Others will prefer to wait for an official study to come out. But people have to feel comfortable.”
HRI-Pfeiffer Treatment Center in Warrenville treats ADHD-diagnosed patients with programs of vitamins, minerals and other nutrients. “There is a definite relationship between nutrients and biochemical imbalances with these types of behavior disorders,” says Walsh, the center’s founder.
“One of the problems is that the models teachers and educators are using today are outdated. They see differences as disorders. These models come from the Industrial Age where kids needed to be prepared for jobs where they will sit at a desk all day,” says Lara Honos-Webb, a clinical psychologist and an assistant professor at Santa Clara University, Calif. Honos-Webb has just written The Gift of ADHD: How to Transform Your Child’s Problems into Strengths, which will hit bookstores in March.
“This is a digital age and requires different teaching strategies,” Honos-Webb says, explaining that the very characteristics of the “disorder” are actually gifts: “These kids are full of creativity, sensitivity and will become tomorrow’s innovators. Most kids in my class ask me what will be on a test. The ADHD kids ask me questions that make me think about the material myself.
“Research shows that 50 percent of ADHD diagnosis have the first push come from teachers. Most parents have a small voice inside that tells them that their child does not have a disorder, but the authoritative voices around them often drowns out that small voice.”
Honos-Webb says that too often the school system makes parents feel bad about their children and about themselves as parents. She admits that these children may be harder for teachers in a classroom setting. But she stresses that if issues are dealt with individually, a teacher can often alleviate the problem through redirection and clever teaching strategies.
Environments are key Ruth Cross is a 32-year elementary education veteran and the assistant superintendent in Naperville Community Unit School District 203, which covers kindergarten through 12th grade. Cross admits that teachers’ expectations and management styles can play a role in a child’s behavior. Cross says that parents, if concerned, should ask themselves the following questions: “What is the classroom setting like? Is it a safe, orderly climate? How is the teacher monitoring and giving feedback on behavior?”
Cross, also mom to four grown sons, says when evaluating boys, keep in mind that typically, first-grade boys have less attention spans and empathy than girls. “Boys are more active, learn through play and exploration, and are more interested in objects than relationships,” she says.
It may also be time to reevaluate your home environment. “When children live in an environment overcome with yelling, lack of rules and structure, their tendency for hyperactivity, boundary testing and pushing of the rules increase,” says Leah Rubin, staff psychotherapist at the Family Institute at Northwestern University.
“We need to look at our expectations,” says Daniel Moran, a psychologist and director of MidAmerican Psychological Institute in Joliet. He says: “There are so many things at our fingertips ... Google ... cell phones ... we expect everything to happen immediately. Kids are not ready to be adults in first grade; their work is play. And, to adults, boys’ play may seem loud, disruptive and extremely functional. But, a child building a tower of blocks only to knock them down is really testing gravity. We should help kids by treating the areas that are negatively affecting their social, family and educational function, but parents and teachers should be careful in expecting boys to be docile creatures. We want spirited kids that explore their world.”
“The most important thing a parent can do is to become an advocate rather than an apologizer,” Honos-Webb says. She urges parents to see these traits for what they are—gifts. She also wants parents to know that they have a right to this view: “These kids are sensitive to their surroundings and how people view them. There is a real fear that these children will begin to see themselves the way they are being seen.” Honos-Webb warns that this sets up an environment for self-fulfilling prophesy: “The child will take on the traits that they think are expected of them.”
As for my son? He was tested. The finding? His “inattention and hyperactivity” was not consistent enough for ADHD. I have changed my son’s sleep and dietary habits, added more consistency to my parenting style and found a second-grade teacher who has a special talent for identifying both his strengths and needs. His skills are improving. So are mine. As long as that continues to happen, I know I’m on the right track.
Jean Dunning is a writer living in Plainfield and the mother of four ranging in age from 2 to 12.
We often turn to games and activities as tools to help our children learn everything from letters and shapes to sharing. Psychologist Daniel Moran suggests that games also can be a great resource for parents who want to help their children’s maturity, attention and self-control skills grow as well. “Certain games and activities increase and develop your child’s observation skills, perspective thinking, grasp of abstract concepts and cognitive organization,” Moran says. “Many of these games and activities require little or no supplies.” Moran suggests that parents use old favorites like the ABC imaginary trip game (where children take turns using letters of the alphabet to pack items for an imaginary trip) to develop cognitive organization and memory. And, parents can use games like Twenty Questions, I Spy and I’m thinking of An Animal to build skills in deductive reasoning. Many board games also can be used to build these same skills. My son’s favorites are Guess Who, Memory Game and Clue Jr. Moran says board games also can be a fun way for children to learn lessons in focusing, self-control, patience and how to be good winners and good losers. Moran says that puzzles and blocks also are good for building everything from patience to focus. I like color-by-number, dot-to-dot and mazes, they have the added benefit of encouraging my son to sit quietly for long periods of time (a must for church and long car rides). Don’t be afraid to get creative. If there isn’t a game to fit your child’s specific needs—make it up. My husband came up with a new twist on the ABC game to help with one problem area—the car. The object of his version is to find all 26 letters in the alphabet (in order) on signs or license plates. We work as a team and have to get all letters before the end of the trip. It is now a family favorite and gives our kids something to concentrate on (other than poking each other) while developing great observational skills. Our family has even been known to reroute a trip just to drive down a particular street because it has a Z in its name.