The American Psychiatric Association (APA) estimates that 5% of American children have ADHD. The average age to diagnose ADHD is 7 years old, but symptoms of the condition typically appear when a child is 3–6 years old. APA research also found that boys are three times more likely to be diagnosed with ADHD than girls. In this episode, Dr. Sean Akers will help parents understand what normal behaviors are and when parents may consider getting their children assessed for ADHD
Gina Melton: So, when I was a kid, they often used to say that, you know, kids were just unfocused or, you know, specifically when I was a kid, it was hard for me to concentrate and things like that. And, my parents found out way later in life, that I had ADHD but that isn’t necessarily, you know, something — back when I was a kid — that they really talked about. Well, I think this is an interesting subject because I have a feeling that a lot of parents are wondering, you know, is my child just unfocused or do they just daydream a lot or do they have ADHD?
Well, the great news is, we have an expert to talk about that today.
I’m Gina Melton with the Just Kids Health podcast from Children’s Hospital & Medical Center. Join me, as I talk with the region’s pediatric experts about everything related to your kids — things like medical issues like ADHD, mental health — all to keep your kids healthy and that’s really what we all want. Now, today, I’d like to welcome pediatric psychiatrist Dr. Sean Akers with the Children’s Behavioral Health to discuss ADHD and ADD. Good to see you, Dr. Akers.
Dr. Sean Akers: Thank you. Good to see you too today.
Signs of ADHD & ADD in Children
Gina: Yeah. I’ve a feeling there’s a lot of parents out there that are thinking, “Is this a case of my child just daydreaming or fidgets a lot, or do they have ADHD?”
So, first, let’s talk about — how do you know if your child has either of these things? And, maybe what’s the difference?
Dr. Akers: Yeah. It’s a really good question. So, there’s a number of points that we would wanna talk about. The first thing that I always wanna point out is that parents — you are the expert on your child, right? In terms of behavior, in terms of functioning, how they do in different settings — and that’s really important, but we wouldn’t expect you to know whether your child has ADHD. It really is an evaluation process and there’s different types of ADHD.
Gina: Well, I know as an adult, I happen to have ADHD but it wasn’t diagnosed till much later in life and I think, my parents just thought, you know, I was kind of a high energy kid and I was a little unfocused and I like to daydream. But, you know, many parents are — I’m sure will be glad to know that the experts at Children’s Hospital & Medical Center are there to answer all of those kinds of questions. So, what are the early signs of ADHD and how can it be diagnosed?
Dr. Akers: So, very good question. The first thing I’m gonna talk about is that we wanna keep in mind development, right? Everybody develops a little bit differently and we wanna be real clear that there’s a really wide range of development in young kids. We wouldn’t expect a toddler to have a long attention span, right?
Dr. Akers: We start looking towards school-age. We start looking towards when we are asking kids to sit for a little bit more extended periods of time before we really start looking into an official diagnosis.
Gina: So, maybe when they get into elementary school?
Dr. Akers: Kindergarten is usually when we start looking at — we do look, at times, younger if it’s a more extreme case but the guideline is we wanna look at how it’s affecting their functioning when we’re placing demands on them.
If you think about homes — homes and schools are very different. You know, most of our homes are a little bit less structured. They can play, they need to play. There’s not as many guidelines that you need to sit 4 hours at a time, at a station to do something. So, it’s important to keep in mind development and normal developmental, sort of, issues with kids.
The second thing, I wanna point out is that there’s a continuum with attention span, with ADHD signs. It’s not necessarily that somebody has it or they don’t. A lot of us have some ADHD sort of symptoms. Like myself, I don’t have ADHD and I can sit at a very busy nursing station and I can write my notes and I can keep focused, and parents and nurses, and doctors walking around me doesn’t bother me a bit and other people would be very distracted by that. That doesn’t mean, necessarily, that they have ADHD. They might just need a quieter space.
Dr. Akers: So, the other point is that — the way we look at terminology now, with ADHD, is that there’s 3 different types. Okay. So, we call them all ADHD — attention deficit hyperactivity disorder. The first type is, what we might call inattentive and that’s — sounds like more what you talked about, being a little bit of a daydreamer. Those are hard to point out. They’re hard to find. We often don’t easily diagnose them until a little bit later — in childhood or even later because they are not the troublemakers or they are not the kids who are acting out as much.
Dr. Akers: The second one is gonna be the more hyperactive-impulsive ones and those are the ones you’re gonna see a little bit quicker. And then, the third is what we call the combined type where you have both the inattentiveness and distractibility, as well as the hyperactive-impulsive sort of signs. And when you talk about what are the early signs?
Those are the ones — the combined or the hyperactive-impulsive kids — are the ones where we are gonna see them a little bit earlier on, partly because they have a really hard time sitting still. And they’re gonna be more impulsive and they’re gonna have a harder time following the rules or they’ll try to follow the rules and then, you know, two minutes later they’re back up out of their seat again and it’s this constant pull with the behavioral impulsive parts.
Treatment for Children with ADHD
Gina: Well, I know, just as an adult — I know, we’re talking about kids but as an adult, I had trouble thinking about — should I go on medication? Because my doctor and I had discussed that — should I go on medication or not? And it’s been so helpful to me, you know, in my adult life — just being so inattentive. So, I don’t know if there’s, you know, parents out there that are thinking, “Well, I don’t know if I should put my kid on medication, you know. What are some of the long term effects of that?” Do you have any insight into medication for kids?
Dr. Akers: So, let’s talk about that in terms of treatment — the important thing to remember is that treatment typically is looking at medications and then looking at what we call behavioral therapy. It’s typically a little bit of both. We certainly wanna look at both. The medications have been out there for years and they’re certainly well-studied. If you’re talking to your pediatrician or psychiatrist about that possibility of medication, I think those are important questions to answer in terms of, what are the long-term effects? You know, what are the side effects? There are certainly some common side effects of some of the meds that you’d wanna keep an eye on.
Gina: Now, where do you come in on all of this? Because I have a feeling that, you know, in your position, you might see some kids who have ADD or ADHD. You know, how does that help — being in your position at the hospital?
Dr. Akers: So, when we get that diagnosis, the thing that we always want to remember is, how is it affecting their functioning? And going back to, you know, there are many of us who might have a few traits here and there — is it affecting your functioning? If you can easily accommodate to — okay, I just need a quieter space, and then I can function fine — then, you know, we’re not looking at medication or therapy or anything. We just have some of those accommodations — we don’t even necessarily have the diagnosis.
To get the diagnosis, we’re looking at how is it affecting their functioning? And that’s why the evaluation process needs to look across settings. So, if somebody struggles with impulsivity at home but in school, they function fine, they are not impulsive, they attend to their school work — then it’s probably not ADHD. It may be something else. That’s why we have to evaluate, making sure that it’s ADHD and it’s an accurate diagnosis, because there’s a few other types of things that can affect attention. You know, anxiety and depression come to mind — are disorders that can absolutely affect attention span and the ability to attend.
Managing ADHD & ADD
Gina: So, what about — is there, you know, a cure for this? I know as an adult, I still have it but is there an overall cure for ADD or ADHD?
Dr. Akers: You know, it’s not a word that we typically use with ADHD in terms of cure. The word that we really use is — it’s manageable and we manage it. And so, my role as a psychologist is, really, looking towards behavioral types of therapies which are working on how do we manage that behaviorally, often with meds. Because the meds don’t last all the time — most meds don’t. A lot of the meds are really designed to be on board during their school day.
Gina: Like 8 hours or something like that.
Dr. Akers: Like 8 to 12 hours or something like that. So, you still have to deal with some of the behavioral aspects, you know, in the evenings or at homework time or, you know, other times of the day. So, you know, my part is working on how do we manage the child’s attention span and behavior? Especially, if you have the impulsivity from the caretaker side — what can the teachers do, what can the parents do to help keep that child on task? And that’s an individual thing. So, it’s really about that aspect. Is it the behavioral therapy? It’s not a cure. It’s a — how do we manage this to make them as successful as possible?
Gina: Well — and I want to reassure parents that actually, my ADHD has made me and my life more creative and, kind of, more able to multitask and things like that. So, it’s not necessarily something that, you know — it is manageable. That’s basically the bottom line. It’s manageable and, you know, it’s great to be able to see an expert at Children’s Hospital if you have those questions. Finally, I guess what it really boils down to — what happens if you don’t, you know, treat ADHD? Is there any problem with that?
Dr. Akers: Well, let’s go back to the word I used earlier, which is, if it’s affecting your functioning then that’s gonna be the problem area. So, if your attention span is affecting your academic abilities or your impulsivity is affecting your social — your friends or you’re getting into trouble a lot and you’re not treating it, then that’s where we’re gonna get concerned. Those types of things are not just gonna get better necessarily over time. We do wanna treat it, so they can be successful in the areas that we ask of them, we require of them — such as school, such as their social life.
Gina: So, if parents are concerned, you know, they think, “Okay. What Dr. Akers is saying right now, that seems to resonate with me — maybe my child has ADHD.” What’s like the first step that they should take? What would you suggest?
Dr. Akers: You know, the first step I think is always gonna be — talk to your pediatrician. You know, they’re gonna be the experts, first off, who are gonna see you over time, you know. Hopefully from infancy, you know, into toddlerhood and into childhood, and be able to get some of those baselines of how they are functioning in the different areas of their life.
And then, there are certain places, you know, such as Children’s Hospital & Medical Center and our Behavioral Health department — we have, actually, an ADHD clinic. And we have somebody, Dr. Kim Levering, who does a wonderful job. It’s a very thorough evaluation because we wanna make sure this is what we’re seeing — that we’re not diagnosing ADHD when it’s really something else.
Gina: Sure, that makes total sense.
Dr. Akers: So, we refer a lot of our children to that clinic to get that good evaluation, and then she’ll make recommendations once she establishes a diagnosis about whether there’s a medication referral to one of our psychiatrists or whether there’s on-going therapy that’s needed.
Advice for Parents
Gina: If a parent out there is listening and they’re thinking, “Oh my gosh. My child is unfocused and they’re high energy.” And, you know, what would you say to that parent to, kind of, maybe reassure them a little bit?
Dr. Akers: So, it’s gonna depend on age but I think a lot of those qualities — as you brought up — are wonderful. You know, and ADHD kids can be very social and outgoing and — I met with one earlier who is very popular in many respects. He’s got a lot of friends and he finds that part really nice and he’s also very creative like you. Being able to — he likes his art classes and the things that he can use his hands to do.
So it’s, again, being the expert on your child and those, you know, those aspects of personality and behavior. But also keeping track of — are there things that are affecting their functioning and are more — becoming frustrating to them? Because we don’t want them to go through their entire schooling frustrated because they are getting in trouble all the time or they’re not able to focus.
Gina: Well, the good news is — schools have really learned that there’s things that they can do for the kids. Whether it’s something called an IEP, where they give them special accommodations and things like that. I like that the schools recognize that, you know, this is what some kids have and they are helpful.
Dr. Akers: Yeah, absolutely. And schools are, you know, becoming more and more schooled on these kinds of issues and do the IEPs or 504 plans and, I think, those are wonderful supports for kids who might just need, sometimes just a simple accommodation that can make them really be much more successful.
Gina: And that’s good for everyone.
Dr. Akers: Yeah, absolutely. That’s really what we want — is them to be able to function well in a school setting and learn to the best of their abilities.
Gina: And I have to bring this up because I just think we have — first of all, Children’s is such a cool hospital. It’s just, all made for kids, and I really — what a blessing it is to have it here in our area. But I have to bring this up because I found out something about you and that’s that you are a painter. Is that right? And you’ve got some work on display here in this area.
Dr. Akers: That’s correct, yeah. I do what’s called mixed media. So, it’s painting but I also use metals and woods and other things just to create stuff.
Gina: How neat! Is paint therapy a good thing for kids — I mean, drawing and things like that when they have ADHD?
Dr. Akers: You know, the one thing I love about kids is that by nature, they’re often very creative and they don’t — they’re not as critical of themselves when they’re younger. They just love to create and draw and build things often. So, it can be a very therapeutic thing as well when they just allow themselves to be creative in their own kind of child, kind of way. I was a big Lego builder when I was a kid and so I see my mixed media creations as being a little bit like that — where I’m just building stuff until it looks right.
Gina: That’s good. But, you’re right. As kids, we’re not nearly as critical. Where today, I would say, “Oh that looks like a stick figure that I just drew.”
Dr. Akers: But what a wonderful stick figure that is.
Gina: Wonderful — that’s right. We should speak positively to ourselves.
Dr. Akers: Well and one of the last points I’ll make is, this is something that’s a little unusual — a lot of people don’t realize about ADHD is that there is the point that we often focus on is the under-focus of kids, right? They’re under-focusing and — often in academics or the subjects that they don’t like very much. But one of the things that we see often — not always, but often, is that they over-focus on areas that they’re really interested in.
And so, that’s where it gets confusing to some parents where they’ll come in and say, “Well, but my kid can play video games for 12 hours a day if I let him. I don’t think he has attention problems.” But that’s actually pretty common because it’s so interesting and stimulating to their brain — they often over-focus on something because some of those electronic things, especially, will just continue to pull that attention to the kids versus the under-focusing on the less stimulating things.
Gina: Well, that’s interesting. I didn’t know that. Well, that’s why we have you here.
Dr. Akers: And I’m really glad to be here.
Gina: Aw thank you, Dr. Akers. It’s very nice to see you and thanks for your expertise in this area. I know this is gonna really help a lot of parents.
Dr. Akers: Thank you so much. I appreciate you having me today.
Gina: You bet. And, thanks so much for listening to the Just Kids Health podcast, and just remember to rate, review and subscribe. And for more information on how we can help your child, visit https://www.childrensnebraska.org and follow us on social media.