May I have your attention, please.

He starts everyday being sweet and affectionate. I ask him how he slept, and he’ll tell me what he dreamt about over breakfast. Then I’ll ask him to get ready for school. This is when things start to change. He knows his routine. He’s supposed to go to his room, fix his bed, get dressed and brush his teeth. For a normal person, this should take less than ten minutes. For a four year old, it can vary between forty five minutes on a good day, to “holy crap, we were supposed to be at school twenty five minutes ago,” on a bad day. I usually have to tell him thirty times over the course of fifteen minutes if he put his sock on yet. And let’s not forget the attitude that he starts giving me when I start to raise my voice. You may ask, what does a four year old do instead of putting on his sock in the fifteen minute time frame? He’s usually lying in his bed, looking at the pictures in his book, or staring at a wall, or looking at his sock imagining it’s talking to him. I love my son, Dylan. I would do anything for him. But there are days where I just want to lock him in a room, lose the key, and drive very, very far away. 

This is how my day starts almost everyday. He would also have episodes where he would get energy out of nowhere and start going crazy. He’d jump on my bed, run across the room, start yelling gibberish. If he wasn’t four, you’d think he were on an amphetamine of some sort. And of course, he would be ignoring every single word I say. At first, my wife thought that Dylan may have some sort of ADHD, or attention deficit hyperactivity disorder. And I won’t lie, at first I did too. He wouldn’t stay still. He would fidget in his chair if he’s sitting for more than three or four minutes at a time. He would laugh hysterically at my face when I’m trying to yell at him for any number of reasons. My wife would ask why is he acting like this. She’d say, “my nephew never acted like this when he was Dylan’s age.” I would reply, he’s possessed. Or maybe your nephew was a saint. Or it’s just some boys are harder to raise than others. Truly, it’s just boys being boys. 

So when is it more than just boys being boys? For most parents, the struggle is very real. The only difference between what’s considered normal and ADHD is defined by excess. It’s actually quite subjective, but it’s in the excess of this manic type behavior that actually defines it. Parents usually struggle to keep up with the behavior and this ultimately disrupts their home life. The excess carries over into kid’s school activities and their grades are affected. Usually, a school teacher is one of the first people that will direct parents to have their child tested for this. 

There are several types of tests that are performed to diagnose ADHD. Like I mentioned, there is a bit of subjectivity when it comes to making the diagnosis, which is why it is a bit difficult to really verify this as a problem. How many parents do you think will actually tell you that their child doesn’t listen to them? In addition, there are different subtypes of ADHD, suggesting that there is a spectrum in its presentation. Recently, a study in JAMA Pediatrics found that upwards of ten percent of children are diagnosed with some form of ADHD. That’s 1 out of 10, which is a massive increase over the past twenty years. Some suggest that we, as doctors, are overdiagnosing it while others believe we are just understanding it better to make the diagnosis. 

There is an emerging concept in the field of neuropsychology that ADHD, along with autism, is actually part of the neurodiversity model. These diagnoses are not actually disorders, but rather, a variation of what is considered normal. The same way that I have brown eyes and my wife has blue eyes. The concept tries to normalize the behaviors and instead of casting out the differences, trying to find a better way to change how we teach to those with the differences. If we can teach to those differences instead of treating a disorder, it would potentially result in much better and healthier outcomes.

The current treatments for ADHD are changing, but the mainstay is usually a stimulant. Stimulants like Ritalin or Adderall, work surprisingly by calming an overactive brain, so that attention can be paid when it is needed. The issue is that these stimulants will work regardless of diagnosis. They will work in improving my attention as much as they would to anyone with ADHD. In other words, these drugs are essentially performance enhancing drugs since they truly work on anyone and are not targeting a specific disorder. There are several side effects to stimulants, like insomnia, palpitations, loss of appetite. Besides the side effects, giving stimulants to young adults and children just feels inappropriate. Whichever side of the argument you stand on, it’s an extremely difficult subject because we are treating children.

There are several things that you can do to help your child with their attention, regardless of an ADHD diagnosis. Creating a structured environment and establishing a routine is extremely important. Dylan knows what he should be doing and what is expected of him every morning. Some days are harder than others, but setting limits on how long he can act out will set the tone for the future. Also, limiting television or screen time can help limit the distractions out there for a child. These distractions can also impact the way that your child’s brain will eventually learn, which can present as a possible problem down the road. You can also try to reduce the amount of anxiety that might be present in a child’s life, which is easier said than done. I’m not talking about pampering your child to the point where he has zero stress and zero expectations in his life. I’m talking about gradually introducing responsibility and pressure to your child in small doses, to help him develop coping strategies for when the pressure does get greater. For instance, I expect my child to make his bed. If I didn’t have this expectation of him, he wouldn’t have it for himself. It’s a simple, small pressure that hopefully will help reduce bigger and worsening pressures he may face in the future, kind of like the way a vaccine works.

Being a parent is hard. Kids don’t come with instructions manuals. Sometimes, I think of Dylan growing into adulthood and hoping that he’s successful, smart and maybe even follow in dad’s footsteps. The majority of times, though, I just want him to put on his damn sock. Being a parent requires a ton a patience, regardless of any disability or disorder. When it gets to the point where your patience is gone, talk to your doctor to see if there’s anything he can do to help.

By: Dr. Juan Borja
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