Category: <span>Teenage</span>

ADHD Advocacy Child Wellness Children Therapy Confidence Teenage Testing Therapy By Beth Church 0 Comments

How Do We Know ADHD is a REAL Disorder?

 

 

Anastasia Skobkareva, MA.
Dr. Julie Braciszewski, PhD.

Some people may think that ADHD is just a set of habits or a quirky personality type, but the truth is far more in-depth and interesting ADHD is a neurodevelopmental disorder that first appears in childhood and continues to affect individuals throughout adulthood. The label neurodevelopmental means that ADHD stems from differences in brain development. These differences in brain development result in difficulties with emotional and behavioral control as well as the brain processes responsible for planning, organizing, and executing tasks. Of course, most people have difficulties with inattention, overactivity, or impulsiveness at times. What distinguishes individuals with ADHD from those without the disorder, is the far greater frequency and severity with which these behavioral and emotional patterns occur, and the far greater impairment these difficulties cause in many areas of life, such as school, home, work, and relationships. ADHD is primarily a disorder of the cognitive abilities needed for self-regulation. These cognitive, or mental abilities are called executive functions and are the fundamental brain processes responsible for organizing goal driven behavior and inhibiting impulses. Individuals with ADHD struggle to remember what needs to be done, make a plan, conceptualize and manage time, remember and follow constraints and rules, identify ways to overcome obstacles, and experience extreme variability in their responses to situations. They also struggle to switch between tasks or situations, inhibit off task or ineffective behavior, and modulate emotional responding. Getting an accurate diagnosis of ADHD can be tricky because several other disorders have overlapping behavioral and emotional symptoms. Because of this, it’s important to understand how we know ADHD is a real disorder, and how we go about making an accurate diagnosis.

How do we know that ADHD is a REAL disorder?

Many people ask, how do you know ADHD is a real disorder? How do you know these difficulties aren’t just ‘bad’ behavior, ‘bad’ habits, or a ‘difficult’ personality? To answer this, we turn to the last several decades of brain research on ADHD. Research clearly and repeatedly indicates that the ADHD brain is developing differently from the non-ADHD brain. When we look at groups of hundreds or even thousands of ADHD brains compared to non-ADHD brains, the differences in brain development between the groups are very clear. This profile of brain development differences is distinct and does not mirror any other disorder or injury. It is incredibly important to dispel any ideas that ADHD is due to an individual simply not trying hard enough or poor behavioral management. Instead, individuals with ADHD, and parents raising kids with ADHD, are often the hardest working people in the room! So why can’t we diagnose ADHD with brain imaging like a CAT scan or MRI? The truth is, ADHD affects several areas and functions of the brain and is a disorder with a wide range of symptoms and presentations. Although we can tell the difference between groups of brains very clearly, when just looking at one individual’s brain imaging results, the information just isn’t enough to ‘see’ ADHD clearly. This is actually the case for many medical disorders and diagnoses that originate or involve the brain. Many disorders can not be detected by brain imaging alone and require further testing, often by a psychologist or medical professional. To diagnose ADHD we use a battery of tests that assess these specific areas of brain functioning, and also rule out all other disorders that have common symptoms with ADHD, such as anxiety disorders and learning disorders. This type of assessment, a neuropsychological assessment, is an accurate way to diagnose ADHD in both children and adults.

What Causes ADHD?

Research suggests that ADHD is a result of one or more issues that affect brain development. In the majority of cases, ADHD brain differences are due to genetics; inherited from parents. In recent years, specific genes and gene mutations have even been identified as likely causing or contributing significantly to ADHD. However, in a minority of cases, brain development delays are due to subtle brain injuries or exposure to substances or toxins that occurs during gestation, birth, or early childhood. We also know that getting the correct treatment helps brain areas affected by ADHD to develop further.

How are ADHD brains developing differently?

We know ADHD is a real disorder and that ADHD brains are developing differently, but in what ways? The brains of individuals with ADHD have structural and functional differences, as well as differences in brain chemistry when compared to typically developing brains.

Brain Activity

Studies using an electroencephalograph (EEG), which measures brain activity, indicate that the electrical activity in brains of children with ADHD is lower than that of typically developing children. Specifically, children with ADHD have an increased amount of slow-wave brain activity which is often associated with immaturity of the brain, drowsiness, and lack of concentration. Children with ADHD have also been found to have less blood flow to the frontal area and in the caudate nucleus, which is important in inhibiting behavior and sustaining attention. Now, you might be wondering how is it that children with ADHD, who appear more active and energetic than children without ADHD, could have brains that are less active? The areas of the brain that are less active in those with ADHD are those areas that are responsible for inhibiting behaviors, delaying responding to situations, and permitting us to think about our potential actions and consequences before we respond. The less active these centers are, the less self-control and self-regulation an individual will be able to demonstrate. Thus, these areas of underactivity result in more difficulty regulating emotional and behavioral responding.

Brain Chemistry

Neurotransmitters are the chemical messengers in the brain that help transmit information from one nerve cell to another. Individuals with ADHD appear to have less of these messengers, or cells in the brain are less sensitive to them. Specifically, evidence seems to point to a problem in how much dopamine (and possibly norepinephrine) is produced and released in the brains of those with ADHD. Therefor, stimulant and non-stimulant medications, used to treat ADHD, work to make more of these chemical messengers available. This helps with communication between brain centers and structures and produces significant improvements in behavioral and emotional regulation of those with ADHD.

Treatment of ADHD: There’s Hope!

Individuals with ADHD posses a great many strengths such as creativity, ability to hyper-focus on tasks and areas of great interest, and less traditional problem-solving approaches. Evidence-based treatment for ADHD often includes medication prescribed by a medical practitioner, as well as Cognitive Behavioral Therapy (CBT) and parent support. Those uncomfortable with medication often engage in CBT alone and experience a great deal of improvement. While CBT helps the individual develop coping strategies and effective patterns of thinking and behaving, treatment also focuses on building personal strengths and positive identity. Although ADHD is a lifelong neurodevelopmental disorder, and symptoms generally persist into adulthood, we do know that children who are treated with medication and therapy (specifically cognitive behavioral therapy with parent support) have the best outcomes in adulthood. Medications and evidence-based therapy appear to improve brain volume and connectivity over time, implying that engaging in treatment may actually help the brain maturation process. The interaction of increased learning opportunities due to proper treatment also has a positive impact on brain growth and connectivity. As an individual with ADHD obtains treatment, they are actually changing their brain! Treatment for pediatric ADHD should also include a parent component. Parenting support focuses on developing parenting practices and strategies, as well as household structure that support the functioning and growth of a child with  ADHD. Kids with ADHD often do not respond to typical parenting strategies and need more ADHD specific support. And finally, treatment for ADHD also involves receiving support and accommodation in the school and/or work environment. Those with ADHD can flourish when they are working simultaneously to use effective coping and capitalize on their strengths.

 

Anxiety Children Therapy Pandemic Teenage • • By Beth Church 0 Comments

Calming Back to School Jitters:

 

Alyssa Hedke, MA, LLPC

As the days draw a bit shorter, the end of summer marks the beginning of a new school year. Children prepare by picking out their new backpacks and wait in anticipation for their room assignments, all while soaking up the last of the summer sun.  As parents, we want to send our children out into the new school year feeling prepared, confident, and excited. However, we enter this new school year bringing with us the experiences of managing life during a global pandemic. The changes in routines, family life, and ongoing pandemic continue to affect us all. Your child may be more nervous, anxious, fearful, or unsure compared to years past. Here are 4 ways to help with the new school year jitters.

Talk to your child:

Start by talking with your child!  I know it sounds simple – but it takes purpose and planning to set the time aside and initiate the conversation. Research has shown us that children and youth who discussed the pandemic with their parents were less likely to develop stress, depression, and anxiety symptoms. Many parents try to shelter children from current events, but we know that providing measured and purposeful information helps reduce anxiety. Additionally, children often do not talk about their concerns because of confusion or fear of worrying their loved ones.  Encourage them to verbalize their thoughts and feelings about the new school year and let their questions guide you. It’s important to remember that how we discuss COVID can increase or decrease our children’s’ fears. Don’t avoid giving them information that experts say is crucial to their well-being and staying healthy. You should answer your children truthfully and help them develop their expectations for the school year, routines (e.g., masks or no masks, seating at lunch, what will happen at their school if someone gets sick). However, leave out unnecessary details and unknown factors. It’s also ok to say, ‘I don’t know, but we will work together to figure it out.’ This is a great opportunity for modeling calm in the face of ambiguity, as well as collaborative problem solving. You can be a good listener while providing the love and reassurance your child needs.

During unpredictable times, foster a sense of control:

Before the pandemic, schools were a source of consistency in our children’s lives.  For most families, the 20/21 school year included constant changes which disrupted our daily schedules for months on end.  Keeping your child on a regular schedule provides a sense of control, calm, well-being, and predictability.  We can foster our children’s sense of control this fall by structuring schedules and expectations. First, think about your fall schedule and work with your child to make a daily or weekly calendar. Use blocks of color to represent places of activities to make it as visual as possible.  You may think this would only benefit younger children, but we find it very effective with high schoolers and even college aged ‘kids’.  You may also build concrete expectations to help your children foster a sense of control in their world.  Your children may fear getting sick, quarantining, switching to online learning, or closures.  Using language appropriate for their developmental level, describe their school’s new policies and procedures so they feel prepared for structured changes. Be clear about your household and school’s expectations regarding what your child will be doing to prevent COVID spread and infection.  Remind them about hand washing and other safety precautions – these efforts to mitigate spread might seem so simple, but they work!  Lastly, sit down together and make a list of what is in their control during their day.  When children are able to identify what they are in control of, they feel calmer and more confident!

Fight anxieties with activities:

Since the onset of the pandemic, children have increased their screen time and sedentary behaviors. They are sitting more than they ever have before! Engagement in physical activity is particularly important to help reduce anxiety during stressful periods. Research tells us that youth who regularly engage in physical activity report less stress and have an easier time regulating their moods. As kids resume in person school this fall, provide a physical outlet for their difficult feelings. It can take the form of sports teams, walks around the neighborhood, silly obstacle courses in the yard or living room, or simply tossing a ball around. It doesn’t matter how your child chooses to move, as long as they move! 

Stay vigilant and know the signs: 

Most youth will manage the transition well with the support of their family, even if they show some symptoms of anxiety.  Some youth may be at greater risk of developing mental health challenges and will need more support. If you notice your child has exhibited significant changes in behavior or any of the difficulties listed below, please reach out for more support. Research indicates that kids who receive supports earlier tend to recovery faster and have more stable gains in treatment.  Also, if you want general support in providing your child with the skills to succeed and thrive during these extraordinary times, don’t hesitate to reach out.  Emotional intelligence and regulation is one of the greatest predictors of positive child outcomes. It’s always a good idea to support mental wellness throughout a child’s development.

Clues that more support is needed:

Elementary Age Children– irritability, aggressiveness, clinginess, nightmares or other sleep disruption, school avoidance, poor concentration, stomach issues/headaches/body aches and pains, and withdrawal from activities and friends. 

Adolescents– sleep and eating disturbances, agitation or irritability, increase in conflicts, physical complaints, social withdrawal, poor concentration, and rule breaking/oppositional behavior. 

Together we can provide the skills and supports our kids and teens need to feel healthy and confident during these extraordinary times.