Q: How can parents tell the difference between a child who is occasionally distracted and one who may have ADHD?

Dr. Watkins: The biggest difference is consistency across multiple settings. Children with ADHD often struggle not just at home, but also at school, during extracurricular activities and in other environments.

Parents and teachers may notice difficulties staying seated, following directions, waiting their turn, staying organized or completing tasks. Teachers often report that these children require more redirection to stay focused and on task.

Q: What are some common signs of ADHD that caregivers and teachers may notice?

Dr. Watkins: ADHD symptoms generally fall into three categories: inattention, hyperactivity and impulsivity.

Signs may include:

• Frequent daydreaming
• Becoming distracted easily
• Needing repeated reminders to stay on task
• Excessive fidgeting
• Difficulty remaining seated
• Trouble standing in line or waiting their turn
• Blurting out answers
• Interrupting conversations or activities
• Difficulty organizing schoolwork or belongings

These behaviors occur more frequently and persistently than what would typically be expected for a child's age.

Q: At what age can ADHD be diagnosed?

Dr. Watkins: According to the American Academy of Pediatrics, ADHD can typically be diagnosed starting around age 4. Before that age, many behaviors associated with ADHD, such as impulsivity, high energy and short attention spans, are also normal parts of early childhood development.

Most children in the United States are diagnosed between ages 6 and 7, often after concerns are raised by teachers.

Q: If parents are concerned about ADHD, where should they start?

Dr. Watkins: Start by gathering information from the people who spend the most time with your child. Teachers are often the first to notice patterns because they work with many children and can compare developmental behaviors across age groups.

Parents know their children best, though, and their observations matter too. Coaches, dance instructors, childcare providers and other trusted adults can also provide valuable insight.

Once concerns are identified across multiple settings, families should talk with their pediatrician or primary care provider about an evaluation.

Q: What if a child is homeschooled?

Dr. Watkins: It can be more challenging because there are fewer opportunities for comparison. However, parents can still look for patterns.

Is your child taking significantly longer to complete assignments than siblings or peers? Are they becoming distracted more frequently during lessons? If they participate in homeschool co-ops, sports, church activities or other group settings, do they require more redirection than other children their age?

Looking at behavior across different environments remains important.

Q: What is a 504 Plan?

Dr. Watkins: A 504 Plan provides accommodations that help students access learning more successfully in the classroom.

Examples may include:

• Preferential seating near the teacher
• Modified assignments
• Frequent check-ins for understanding
• Small-group testing
• Additional support with organization
   

Creating a 504 Plan typically involves collaboration among parents, teachers, school staff and the child's healthcare provider.

Q: How is an Individualized Education Program (IEP) different from a 504 Plan?

Dr. Watkins: An IEP, or Individualized Education Program, falls under special education services and is intended for students who require more comprehensive support.

While a 504 Plan focuses on accommodations, an IEP provides specialized educational services and goals tailored to a student's needs. The process is more involved and often includes formal evaluations from educational specialists, school psychologists or speech-language pathologists.

Because of those evaluations and planning requirements, IEP implementation typically takes longer.

Q: What is the Child Find program, and how can it help families?

Dr. Watkins: Child Find is part of the Individuals with Disabilities Education Act and requires public schools and charter schools to identify and evaluate children who may need special education services.

The program serves children from birth through age 21. Younger children may qualify for early intervention services, while school-aged children can receive evaluations and support through the public school system.

Parents who have concerns can discuss them with their child's pediatrician or teacher to begin the process.

Q: Are children being overdiagnosed with ADHD?

Dr. Watkins: Parents are exposed to an overwhelming amount of information, and much of it can be contradictory.

Rather than focusing on debates about overdiagnosis, it's important to focus on the child in front of you. If a child is struggling academically, socially or emotionally, an evaluation can provide answers and guidance.

On the other hand, not every energetic, daydreaming or quirky child has a disorder. Every child has unique traits and develops differently.

Q: What's the biggest misconception about ADHD?

Dr. Watkins: One of the biggest misconceptions is that children with ADHD are behaving badly on purpose.

ADHD is a neurodevelopmental disorder. Many of the behaviors associated with it stem from impulsivity and difficulty regulating attention, not deliberate defiance. These children are not trying to be disruptive. Their brains simply process information differently.

Q: Is it better to wait and see or ask questions early?

Dr. Watkins: Both.

If you're concerned, ask questions early. Gathering information helps you understand what to watch for and what may be developmentally appropriate. Then you can continue observing your child with better context and guidance.

There's no harm in learning more.

Q: Should parents worry if their child learns differently than other children?

Dr. Watkins: No. Every child learns differently.

Differences in learning styles do not automatically signal a problem. The key question is whether the child is thriving and progressing or struggling significantly compared to expectations for their age and environment.

Q: What's one thing you wish every child could hear from the adults in their life?

Dr. Watkins: “You're doing a good job.”

It's easy for adults to focus on correcting behaviors, improving grades and helping children meet expectations. But being a kid is hard. Children need encouragement, reassurance and reminders that they're loved and valued for who they are, not just for what they accomplish.

Q: What's your message to parents who worry they're not doing enough?

Dr. Watkins: If you're concerned about your child, showing up, asking questions and looking for ways to support them, you're doing enough.

Parents often put tremendous pressure on themselves, but perfection isn't the goal. Being a caring, engaged and "good enough" parent matters far more than having all the answers.

Final Thoughts?

Dr. Watkins: In today's world, it's easy to assume every challenge means something is wrong with your child. But sometimes kids are simply kids. They may be energetic, distracted, imaginative or a little wiggly, and that's perfectly normal.

Pay attention to patterns, trust your instincts and seek guidance when concerns arise. Most importantly, remember that every child develops in their own way and deserves support, understanding and encouragement along the way.

In the eight counties served by Cook Children’s Health Care System in North Texas, approximately 237,000 children between the ages of 6 and 17 have received a mental health diagnosis. According to the 2024 Community Health Needs Assessment (CHNA), ADHD remains one of the most reported conditions, affecting children’s educational and social development. 

Yet behind those numbers is a troubling reality: not all children have equal access to diagnosis and care. Data provided by the CHNA shows that 18% of Hispanic children and 16% of White children have been diagnosed with ADHD, while only 10% of Black children and 6% of Asian children have received a diagnosis.

“Many parents hesitate to seek therapy or mental health services due to feelings of stigma or guilt. Mental health challenges are common and treatable medical conditions—not a reflection of parental failure,” said Cook Children’s psychiatrist Akemi Watkins, M.D. “Early intervention improves outcomes and many families benefit from the additional support offered through the mental health system.”

Debunking Common Myths 

Early diagnosis is crucial to a child’s well-being and overall health. Debunking myths about ADHD and viewing therapy as a proactive strategy are important first steps toward providing children with the care they need, while also making parenting a child with ADHD a bit more manageable.

Some of the most common myths are:

• Myth: “It’s bad parenting.”
  Fact: ADHD is not the result of poor discipline; it is caused by differences in brain development and brain activity that affect how children focus, sit still, and behave.
   
• Myth: “It’s just hyperactivity.”
  Fact: While many children are naturally active, ADHD is diagnosed when behaviors significantly impact daily functioning at home and at school. 
   
• Myth: “They’ll grow out of it.”
  Fact: ADHD symptoms don’t simply disappear over time. Without support, they can lead to anxiety, academic struggles, and low self-esteem.

Why Early Intervention Matters 

An early diagnosis can give children with ADHD the tools they need to succeed academically and socially.

Untreated ADHD is not just a childhood phase that children will “grow out of it”. Without proper support, they may face long-term consequences including higher rates of school absenteeism, grade retention, an increased risk of substance abuse, involvement with the criminal justice system and potential self-harm or suicide.

Early intervention can significantly improve outcomes and provide families with the resources they need to support their child’s well-being.

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When 12-year-old Deacon Swaim sits at his desk in math class, his peers might notice how focused he is. What they don't see is the journey that led him there.

Deacon is one of just 16 students selected out of 332 to participate in his grade’s accelerated math and science program. He also has Attention-deficit/hyperactivity disorder (ADHD)—a fact that might surprise people given his academic achievements.

"I'm always the quiet kid, but I'm really smart," Deacon says, prompting a laugh from his mother Jennifer Swaim. She adds, "Yes, and humble!"

Early Signs of ADHD

Jennifer, who has worked in the Cook Children's psychology department for almost 17 years, said she recognized signs of ADHD in Deacon when he was still a toddler.

"He's always been a kid that is full of energy," Jennifer said. "We have videos of him sitting on the ottoman in front of the TV, constantly bouncing because he couldn't physically contain himself."

According to Deacon’s psychiatrist—Kristen Pyrc, M.D., medical director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s Medical Center – Fort Worth—ADHD presents in three different ways.

"One is the inattentive type where you have trouble with details and staying on task. The second kind involves hyperactivity and impulsiveness. These are the kiddos who you can spot from across the room because they have a ton of energy," she explains. “The third type combines both characteristics.”

The Path to Diagnosis

While Jennifer recognized the signs early, she waited to pursue formal testing until Deacon’s ADHD began affecting his daily life. His early elementary school years were manageable thanks to a brain-based learning environment that incorporated group work, frequent breaks, and movement.

However, by fourth grade, Deacon started encountering challenges. "If it got too loud in class my ears would start to ring and it made it difficult for me to concentrate and get work done," he recalls.

In 2021, Deacon had a full psychological evaluation at the Cook Children’s Denton Psychology clinic, which confirmed his ADHD diagnosis. At the time of his diagnosis, Jennifer worked in the same building as Dr. Pyrc and asked her if she would be comfortable seeing Deacon, since she was already seeing his older brother Joshua. Dr. Pyrc agreed and has been working with Deacon ever since.

"We tell parents we would think about treating ADHD if it causes impairment in functioning," Dr. Pyrc said. "So if your child is constantly getting in trouble at school or it's really affecting their academic performance, that's when we think about starting treatment."

Both Jennifer and Dr. Pyrc added that consulting with a pediatrician can help parents make an educated decision on if, and when, to pursue a formal diagnosis.

The Power of Understanding and Support

Before his diagnosis, Deacon often felt like he was doing something wrong.

“For a lot of kids who are on the hyperactive end of ADHD, they are told ‘no’ all the time. Don't do this, don't do that,” Dr. Pyrc explains. “As a result, many of these kids can start to feel defeated and stop caring about school.” 

“I think part of it is just validation,” Jennifer said. "It helps Deacon to know he’s not doing anything wrong, his brain is just wired this way.”

After Deacon’s diagnosis, he was met with nothing but support and compassion from his teachers at school. One of his teachers has a child with ADHD and was able to work with him on a game plan to support him in the classroom.

Now, Deacon even has several friends with ADHD, including a buddy from kindergarten who has since moved out of state. The pair stay in touch by playing video games together, bonding over their shared experiences. Deacon also finds support in hanging out with his dog Winston, who he says helps him regulate his emotions.

Finding The Right Treatment

For Deacon, medication has been an effective tool for managing his ADHD and staying focused at school. According to Dr. Pyrc, medications are highly effective in treating core ADHD symptoms like hyperactivity and impulsivity and can give kids a sense of autonomy.

An ADHD brain, Dr. Pyrc explains, has a tendency to explore mental “rabbit trails”—which can be great for creativity, but not for subjects like math. Medication can help kids stay on task by providing helpful mental guardrails for clarity and focus.

Though some parents worry about medication dependency, Dr. Pyrc notes that untreated ADHD actually poses a higher risk for future substance abuse issues than the medications themselves. She emphasizes that therapy can also help kids regulate and process their emotions and develop coping skills.

“There's a whole host of other skills that these kids need to be successful in school, like an organizational system or being able to finish tasks,” she explains. “For those types of skills and systems, therapy can be a helpful supplement to medication.” 

ADHD as a Superpower

Dr. Pyrc commonly reassures her patients that ADHD can be like a superpower.

"Kids with ADHD tend to be more creative because their brain takes those rabbit trails,” she explains. “They work really well in groups because they think outside of the box, and they're very energetic."

Deacon's creativity shines through in multiple ways. He plays euphonium in his school's honors band, dabbles in ukulele and guitar, and enjoys sketching. He also loves challenging video games and all things science—especially learning about space and the universe. Deacon’s passion for building with Legos without instructions shows his innovative thinking.

"It's really cool to see what people can do with just their mind and a couple of bricks," he said.

In fact, Deacon feels his ADHD has actually improved his ability to focus.

"I learned to work hard at getting myself to do better and pay attention," he explains. "In certain subjects, I am one of the most focused ones in my class."

Over the years, Dr. Pyrc has seen Deacon’s confidence grow as he’s come into his own and discovered his strengths.

“To see Deacon’s personality shine through is always the best part for me,” Dr Pyrc said. “He is such a bright and kind kid who is good at so many things and so creative, so I always love to hear what he's up to and what's challenging him.”

Dr. Pyrc encourages parents to remember that while ADHD can be frustrating at times, children are doing their best. She emphasizes the importance of helping them develop the skills they need to be successful—and giving them grace throughout the journey.

October is ADHD Awareness Month. If you're concerned your child might have ADHD, talk to your pediatrician. They can help determine what's standard for your child's age and connect you with appropriate resources as needed.

September is National Suicide Prevention Month and it can make the difference in someone’s life to have emotional and mental health support with access to the resources they need. Being open to mental health education and counseling as well as finding the right medication or treatment is key. Often, parents can be hesitant to have their child on psychiatric medication. Cook Children’s psychiatrists are answering parents’ questions and raising awareness to help alleviate stigma and treatment for children.

What are mental health conditions?

Depression, ADHD, anxiety and behavior problems are the most common mental disorders found in children. According to the U.S. Centers for Disease Control and Prevention (CDC), “Mental disorders among children are described as serious changes in the way children typically learn, behave, or handle their emotions, causing distress and problems getting through the day.”

Kristen Pyrc, M.D., Medical Director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s, said they diagnose mental health conditions when they are limiting a child or teen’s functioning.

“Worries, sadness, and anger are all normal emotions, but we become concerned when a kid’s sadness or anxiety keeps them from doing things that bring them joy, or things they need to do to take care of themselves like attending school, showering and interacting with friends,” she said.

How can mental health conditions be treated? 

Both counseling and medication can be used to treat a child with a mental health condition that affects their everyday life, but parents are often hesitant about having their child try medication.

“I’ve found medication and counseling to be equally effective for a child with anxiety and depression, but the combination of both gets kids better faster and safer,” Dr. Pyrc said.

Akemi Watkins, M.D., in Cook Children's Behavioral Health also recommends medication when needed. “If a child has moderate to severe depression or anxiety, we’ll recommend starting medication because current evidence suggests that a combination of medication and therapy is more effective than medication or therapy alone.”

Why are parents hesitant about their child taking medication?

Many parents are concerned with their child taking psychiatric medication because of potential side-effects, medication dependency, the stigma associated with it and even their own experience with mental health medications. The cost of prescription medications, especially name brand, can also be a major hurdle.

If a parent is questioning their child trying medication, Dr. Pyrc recommends, “Consider the risk of not treating anxiety, depression and ADHD, and whether that keeps them from reaching their full potential.”

Is it possible to get financial help to access medication?

The cost of medication often prevents parents from having their child try it. Name-brand prescriptions, especially when they are new to the market, are also out of most people’s price range.

Both Dr. Pyrc and Dr. Watkins help patients have access to their medication by finding similar, lower cost medications and recommending ways to find more affordable pricing.

“GoodRx can help you find the lowest cost pharmacy in your area,” they said. Dr. Pyrc also tells patients about CostPlus Drug Company which has many psychiatric medications at much lower costs that can be mailed.

How can we make taking medication a routine?

Helping a child get used to a new daily routine of taking medication can be challenging. Dr. Pyrc advises “habit-stacking” to make it easier.

“It means ‘stack on’ taking medication to something that you already do every day. Most people brush their teeth twice a day, so getting into the habit of taking medication after brushing your teeth is easier than trying to remember to take it at noon,” she said.

Setting phone notifications can also be helpful and Dr. Watkins advises the parent or guardian to be responsible for dispensing medication for safety reasons.

Medication Success Stories

Both Dr. Pyrc and Dr. Watkins have seen a lot of success stories when children and teens find the right medication.

“One of my favorite memories was a 1^st grader who had ADHD and got into trouble at school every day to the point that he did not want to go to school,” Dr. Pyrc shared. “After we started medication, he brought me his behavior log that had a smiley face for good behavior every day. I still remember the look on his face glowing with pride, and honestly, that is why I do my job.”

Dr. Watkins also experienced seeing her patients’ overall well-being and mental health improve.

“I had a teenage patient with depression and anxiety, and she was started on sertraline,” Dr. Watkins said. “After getting to a therapeutic dose, she was less socially isolated, less overwhelmed with anxiety and said that she was having fewer days where she felt depressed. She felt more motivated to attend school and her grades eventually improved as her depression and anxiety improved.”

Additional Support

When parents are still debating whether or not to have their child or teen try a psychiatric medication, Dr. Pyrc recommends they visit with their pediatrician who can help them understand what is “normal” or if something does need to be addressed. She also recommends researching the American Academy of Child and Adolescent Psychiatry (AACAP) to learn more about anxiety, depression, ADHD, sleep disorders and Autism in the AACAP Parents’ Medication Guides.

Your child has ADHD, and you’ve gone through testing, 504 plans, in school accommodations, trialing of different medications and dosages. Now what?

ADHD is a difficult condition to treat because treatment has to be tailored to each child. Standard stimulant medications such as Adderall and non-stimulant medications such as guanfacine (Intuniv) do a good job, but what else can you as the parent do to optimize your child’s ADHD treatment?

Behavior therapy by a licensed psychiatrist or psychologist can be very helpful, and they often will have an option for parent training too. Parent training focuses on age and developmentally appropriate behavior expectations, and giving clear commands/ rules rather than a general “behave” or “be good.” Behavior therapy can also be offered to your child one-on-one or in small groups, but is more effective when the parents are involved in sessions.

Children, especially those with ADHD, live in the moment. I recommend a reward chart calendar with stickers given for good behavior and accomplished chores, a daily visible reminder and source of accountability. At the end of the week, review the chart together and only give the small reward (i.e. a Sno-Cone) for a complete week of good behavior. If your child had several days at school of poor behavior notes, no prize should be given that week. Praise good behaviors when they occur, “You’re playing so nice with your brother right now” or “I am proud of you for sharing your toys”, that way your child hears and acknowledges what behaviors you want them to continue.

You also need to appropriately discipline your child. Again, age and developmental ability is key. No 6 year old boy, ADHD or not, can be expected to sit still for eight hours in a row. Children need plenty of physical activity and brain breaks. Find what discipline works for your child. For some, time outs and calm down techniques do the trick, others need electronics or favorite toys taken away for the day.

Regarding discipline: you will NOT irrevocably damage your child by disciplining them. They can be told NO and turn out just fine. They can be punished by time outs or however you deem is necessary and still be fine. The American Academy of Pediatrics offers good advice on the best ways to discipline a child.

Raising children is HARD. Raising a child with ADHD can be harder. When a child misbehaves, respond calmly and clearly. Hold your hands tightly behind your back, bend down to the child, speak in a low and authoritative tone, and let them know that behavior is unacceptable. Then turn away, no attention is given to a poor behavior. I have so much respect for the parent of the screaming child on the floor of Walmart who will not give in to their child’s demand, compared to the parent or grandparent who silences the child by giving the desired treat. What does a child learn from that? Answer: throw a big enough fit and I’ll get whatever I want. This is NOT what we want, the child cannot be the one in control!

After they are settled down from the tantrum, now is the time for a conversation on what wrong they did, their feelings in that moment, and let them brainstorm on how to not duplicate the bad behavior. Now time for the punishment- i.e. put away the toy out of reach but NOT out of sight if the poor behavior was throwing that toy at their brother, or saying I’m sorry and being grounded from an upcoming activity for sass-mouthing mom. Again, point out times the child is acting well so they don’t feel like the only time they’re getting feedback is for naughty behaviors.

Other tips for parents: Create a routine and try to stick to it daily. Limit choices so they still can assert some independence, but not be overstimulated (i.e. choose this outfit or that one, or between two vegetables at dinner). Limit distractions during homework time, but know that some children concentrate better with white noise (i.e. classical music) or when they are moving (i.e. under desk cycle). Be clear, specific and brief when giving directions. Help your child get organized and put their backpack, shoes, etc in the same place every day. Create opportunities for positive feedback, whether from sports, art, or music, find something where they feel good about themselves and watch their self-confidence grow!

In the classroom, busy bodies with hyperactivity need special non-distracting accommodations to better their attention and to not be disruptive. I recommend a balance ball chair, or under desk cycle to allow for muscle movement without constantly jumping out of one’s chair. Give your child’s hands something to touch (not those fidget spinners!). I suggest taping both sides of Velcro strips under the desk to allow for the tactile stimulation that these kiddos crave.

There is evidence that the brains of children with ADHD are deficient in certain kinds of omega-3 fats. I like the Smarty Pants brand of kid’s vitamins that contain omega 3 along with a complete multi-vitamin.

Also, caffeine can HELP your child to FOCUS and be more CALM. I know. This seems counterintuitive! But think of how a stimulant medication works: the same way caffeine does, it balances what brain chemical is low and instead of the brain over-reacting and creating too high of levels causing hyperactivity, the brain can “relax”. I don’t like the thought of children drinking sodas on a daily basis, but allowing a mini can of caffeinated beverage at breakfast for a struggling ADHD child can be of big benefit, just make sure they brush their teeth very well afterward.

Continuing the topic of food/ drinks and ADHD, some children are highly sensitive to processed foods and/or food dyes. Red dye 40, among other artificial dyes, is known to worsen behavior issues. As we should anyway, eat more whole fruits and vegetables, lean proteins and whole grains. Limit or eliminate highly processed, sugary, and dyed junk foods and snacks. This includes breakfast cereals: Lucky Charms, Fruit Loops, Cap’n Crunch and Apple Jacks are full of food coloring. Cheerios (plain and many of their varieties), Trix, Cocoa Puffs, Reese’s Puffs, and Golden Grahams are free of artificial coloring and have no high fructose corn syrup. Start looking at the ingredient list of any packaged item you buy, from cake mix to jello, to ketchup and popsicles- try to find a “natural”, “no artificial dyes or ingredients” version.

There is so much that goes into optimal management of your child’s ADHD. Talk with your Pediatrician about where to start. Talk to them again when you’re stuck in a rut and need to know what else can be done.

Believe it or not, summer’s almost over and the new school year will begin before you know it.

Are you ready? Or are you like a certain dad I know who usually waits until the last minute? Last year, this dad forgot:

• To book his child's physicals so he had to scramble to get checkups before flu shots.
• His daughter has some pretty significant fears about going into school the first day and he didn’t take the time to properly prepare her.
• To get his son's asthma inhalers refilled and the forms on file so that he could have it at school (until April when he was having a flare).

Don't be like me…here are 10 steps you can take to make sure you and your child are ready for back to school.

1. Vaccines - Make sure that your child is up to date on vaccines. As your kids get older, your school might prevent them from enrolling in classes or other benefits, which might make it difficult to get their classes scheduled, etc. Vaccines are routinely scheduled at 4 years old (measles, whooping cough and polio among others), 11-12 (whooping cough and meningitis) and 16 (meningitis). At Cook Children's, we also recommend the HPV vaccination starting at age 11.
2. Physicals - If your child plans to participate in a sport or marching band they may need a sports physical form to be completed by your child's doctor. This requirement is required by the UIL before junior high, ninth and eleventh grade but many schools ask for it each year. The marching band requirement is new so not as many parents are aware. I expect we'll be doing a lot of those in the first few weeks of August. Students who are attending private schools or participating in sports that aren’t governed by the UIL may have other physical exam requirements. Many of these kids are already out in the heat working hard preparing for their upcoming season, so I recommend getting these as soon as possible.
3. Forms - Don't be that parent who realized in April that their child doesn't have his inhaler or the form required to take it at school (ahem ... me). Here are some common medications your child might take which might need to be administered at school: inhalers/nebulizers for asthma, insulin, ADHD medications and pain reducers.
4. Sleep - Transitioning back to a sleep schedule that works for school might be the most difficult transition in prepping for back to school. The older your child, the more likely they are to be going to bed too late and sleeping in. Start making subtle changes in their bedtime over the next few weeks. Rolling bedtime back 30 minutes at a time can make the transition to early morning easier.
5. Screen time - Just like sleep, screen time can get away from us a bit over the summer (Fortnite! I’m looking at you). An immediate drop off in daily screen time can be a struggle so starting to make changes now can help your screen junkies detox a bit before they go back to school.
6. Your child’s back to school fear or anxiety - Many children deal with some fears about going back to school. These fears can be mild or they can be more severe, almost debilitating. Helping your child prepare for the transition by talking them through their day, setting up a play date with classmates ahead of time or taking a tour of the school can orient (or re-orient them) back to school in a way that can be helpful. If the anxiety is more severe, consider talking with your pediatrician or a play therapist in advance to help them and you prepare.
7. Your back to school fear or anxiety - Getting yourself prepared for back to school is almost as important as preparing your child. Some parents will kick their kids out the door and drive off to their gym class without a second thought. For others, the transition can be just as hard on the parent as the child. Begin now to prepare yourself for what it will feel like those first few days at drop off. Showing emotions with your child is certainly OK, but a prolonged, tearful drop off can make things harder on your child.
8. Supplies - Get your child ready for back to school by buying their school supplies in advance whenever possible. Whether you buy the prepared packet from school or enjoy the process of shopping for individual supplies doesn't matter, just make sure your child is well prepared with what they need to start the year off right. Buy some extra tissues or hand sanitizer to help the teacher out.
9. Set goals - My favorite part of a new school year is the fresh start that kids can get. Whether last year was amazing or a huge struggle, it's a great opportunity to help our kids realize that they can always work on something to make themselves better. Using last year as a guide, help them set some goals that focus both on their strengths and challenges.
10. Attend meet the teacher night - Sometimes these events occur before school and sometimes they occur a little after school starts. Use meet the teacher night strategically to help frame your child in a positive light. This can go a long way to helping your child accomplish their goals for the year.

Whether you're counting the hours until you can send the kids back or dreading the return of early mornings, hopefully, these tips will help you think through some of the things you need to consider. I know it did for me.

What topics did we miss?

Related To This Topic:

• Vaccines and Immunizations
• Immunization Schedule
• Common Questions About Immunizations
• Knowing Your Child's Medical History
• Sleep Center
• Your Kids Are Ready For School. But Are You?
• 5 Questions Every Parent Should Ask Their Child's Teacher
• 6 Ways You Can Help The Teacher Understand Your Child

Studies have shown that activity and movement can be very beneficial to children with ADHD and can aid in their ability to pay attention and learn.

Short bursts of exercise during frequent breaks can be a solution but the number of schools cancelling PE and recess has seemingly increased. In addition, children with ADHD are frequently punished by restriction of PE/recess or asked to complete work during these important breaks in their day.

Outside of vigorous physical activity, studies have shown that children with ADHD perform better on tests of attention and learning when they move. The problem is, if it is not controlled, that movement can be disruptive and distracting to the child with ADHD, their classmates and their teachers.

A new class of products, called fidget devices, seeks to solve that problem by giving children an opportunity to have a slight distraction in a controlled way.

Fidgets devices come in a wide range of options - fidget cubes, fidget spinners and fidget eggs are just a few of the options. Most have a variety of actions that you can do such as spinning, flipping a switch, rolling a ball or turning a dial.

Studies have been done on related items, such as stress balls, which have shown increased attention and learning while children are using them, but we are still awaiting evidence on the effectiveness of the newer and more versatile devices.

So fidgets aren’t for every kid and children should know that sometimes they won’t be welcomed in their classrooms.

But I believe they can serve a purpose for some children. You may even see me using one now and again.

About the Author

Justin Smith, M.D., is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

The American Academy of Pediatrics (AAP) says that while hyperactive behavior can be considered normal for some children, hyperactivity can, but doesn’t have to, be indicative of a neurological-developmental condition, such as ADHD.

ADHD is a diagnosis given when a person shows a persistent pattern of inattention and/or hyperactivity-impulsivity that negatively impacts his or her life.

“A hyperactive child is one who is more physically and/or verbally active than other children his or her age,” said Carolyn Cruse, PsyD, a licensed psychologist at Cook Children’s. “It is important to remember that what qualifies as hyperactivity in one age group may not be called hyperactivity in another.”

In addition, it's crucial for parents to note that having a hyperactive child does not necessarily mean the child has ADHD. When hyperactivity presents as a single symptom, it’s probably incorrect to assume the child has ADHD.

There are different subtypes of ADHD that could be part of a child’s diagnosis:

• Predominantly Inattentive Type - only symptoms of inattention are present and there are no or very few symptoms of hyperactivity.

• ADHD Predominantly Hyperactive-Impulsive Type- mainly symptoms of hyperactivity-impulsivity and a few symptoms of inattention.

• ADHD Combined Type - symptoms of both inattention and hyperactivity-impulsivity.

What Is Hyperactivity?

Hyperactivity shows itself in children as talking excessively, fidgeting or squirming in their seat at school or church, running or wandering when expected to walk or be still and having trouble sitting still for calm leisure activities like coloring or doing puzzles.

Parents sometimes describe their hyperactive children as constantly in motion or always on the go. The overactivity should be more than what is typically seen in other children that age and should negatively impact the child’s ability to function in school, home or other situations in order for it to be considered an indicator of ADHD. Thus, hyperactivity may be the first concern that is noted by parents or teachers.

“Parents should be concerned when their child’s overactivity is negatively affecting his or her ability to learn and behave appropriately in school, complete homework or follow the rules at home and/or participate in extracurricular activities,” Cruse said.

For example, a 5-year-old girl who is starting kindergarten may be observed having trouble sitting still in her seat and constantly wandering the room during “circle time,” but this would generally be seen as age appropriate. However a 7-year-old second grader who moves so much that he falls out of his chair and repeatedly gets out of his seat when he should be completing class work is more likely displaying symptoms of hyperactivity.

Hyperactivity can be seen in very young children or toddlers, but a diagnosis of ADHD should be made cautiously. In very young children, hyperactivity may appear as though the child is having difficulty functioning at home or school. These children are constantly shifting from activity to activity, jumping on furniture, climbing up cabinets and unable to sit still—even briefly—for quiet activities.

Again, the overactivity should be more than what is seen in other children their age. Younger children are also likely to display their hyperactivity and impulsivity as aggressive behavior. These children have not fully learned to respond appropriately to frustration or irritability and may impulsively respond with aggression. Older hyperactive children may also behave aggressively because of their hyperactive/impulsive tendencies.

Hyperactivity is seen in both boys and girls, though boys are more likely to experience hyperactivity at a heightened level that indicates ADHD, according to Cruse.

What Can You Do?

A hyperactive child will benefit from the chance to hand out papers in class, take a note to the teacher in the next room or simply walk to get a drink from the drinking fountain every so often.

Some hyperactive children actually function better when allowed to stand at their desk rather than sit. This cuts down on fidgeting and squirming in the chair. Parents may need to let their child have a chance to run and play once he or she get home from school to release pent up energy before starting chores or homework.

Parents can channel their hyperactive child’s energy into positive outlets such as sports, dance or karate. They can also use their child’s energy by making games out of small chores (make putting away toys a beat-the-clock game, putting laundry in the washing machine into a basketball game or sweeping the floor as a dance routine).

“Hyperactive children are often seen as very charismatic and fun-loving,” said Cruse. “They can often find fun in whatever they are doing and tend to be creative. When that hyperactivity is channeled appropriately, these children can grow up to be very high-achieving adults.”

Getting a Diagnosis

If parents believe their children’s hyperactivity is severe enough to be interfering with their daily functioning, and increasing their children’s involvement in appropriate physical activities has not improved the problem, they can contact their pediatrician or Cook Children’s Psychology department regarding a possible evaluation for ADHD.

Once a diagnosis of ADHD has been made, there are various treatment options to help improve a child’s functioning. A therapist/psychologist can help by teaching children to monitor their own behavior and learn to think before acting. They can also help parents learn more effective ways to handle their child’s hyperactivity. Schools can also make accommodations that will help with school performance.

Finally, medication is another treatment option that parents can discuss with their pediatrician or a child psychiatrist.

While that was an easy question to answer, I do get more difficult questions about young children with hyperactivity.

In order to start this conversation, it is important to remember the core ADHD symptoms: inattention, impulsivity and hyperactivity.

Based on appropriate diagnostic criteria, you cannot diagnose ADHD until age 4. It is also difficult to diagnose children until they are in school because the diagnosis requires that symptoms be present in more than one environment.

As with any type of behavioral problem, the degrees of severity present a wide spectrum of the various symptoms of ADHD.

Inattention-Some children can focus for hours at a time but some jump from one activity to the next very quickly, seeming to never really focus on one thing for a significant amount of time.

Impulsivity-Some children are very cautious and don’t do anything dangerous, while others jump from my exam table across the room to the chairs on the other side.

Hyperactivity-Some children can sit still for long periods of time, while others are constantly fidgeting and restless.

So, how does this look in a 3-4 year old child?

All 3 and 4 year olds show signs of inattention. There are a select few children in this age group who can maintain focus for extended periods of time. Because of this, it’s hard to get too excited about concerns about a 3 year old’s attention span.

I have definitely seen varying levels of impulsivity in this age group. Those that are highly impulsive, in my experience, often go on to meet criteria for ADHD as they get older. Remember, however, that talking back and aggression are not necessarily impulsivity.

The most common symptom that parents interpret as ADHD is hyperactivity. There is definitely a difference between the general restlessness of a typical 3 year old and a child that truly becomes ADHD in the future.

Children at this age are often described by parents who report, “Their motor is just always running” or “They just go non-stop from the moment they wake up.” Because I see so many children of this age group every day, I also have some subjective sense of what is normal or abnormal for the age group and this can help my assessment over time. However, I never make snap judgments because any child can act like they have ADHD on a particular day.

So, what if you are concerned that your young child may be showing some signs of hyperactivity? A great place to start is here: ADHD Behavioral Treatment-8 Tips.

Here are some basic things to remember:

1. Try to stay patient.

Because so many of these young children will outgrow these symptoms, it is important to stay patient with them.

2. Try to stay calm.

Anxiety only makes hyperactivity worse. Yelling at a kid to sit down and shut up will most likely just make your problems worse.

3. Try to stay consistent.

Children with hyperactivity do their best with structure and clearly defined boundaries. If these children don’t know what to expect from minute to minute, they cannot adjust as easily as most kids. If they are not disciplined consistently, they do not know where the boundaries lie. With any behavior problem, I ask my families to pick out what 1 or maybe 2 behaviors that they want to extinguish and be consistent in the their punishment for those. It is not feasible to fix all of your child’s problems at once.

Also remember to praise them when they do the proper behavior. If a child is only getting negative reinforcement, they will often choose that over positive reinforcement.

If you have a child with ADHD and have chosen to go for a non-medical route, more power to you, and if it is working well for you, that is awesome. However, I also have families that have stressed for years because of something they have heard in the media or from their friends and they and their child suffered because they didn't want to place their child on medicine for whatever reason.

Won't They Get Addicted to the Medicine?

Children on ADHD medicines are not addicted and are not more likely to have addictions later in life.

Here is the definition of addiction: "compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly  : persistent compulsive use of a substance known by the user to be harmful."

ADHD medicine do not form compulsions in children who actually need them and they are not habit forming. Just like any other medicine, parents and kids will forget from time to time and the only effect they see from missing a dose is that their child's behavior is not as good that day. There are no other side effects.

Tolerance is the effect where a person develops a bigger and bigger need for a substance in order to develop the desired effect. While there are times when I do have to increase a dose of medicine it is typically more related to the size of the child increasing and the changing stressors (increasing difficulty, etc) at school that require the increase. Changes are often necessary around puberty as well.

Finally, there are no withdrawal symptoms when a person comes off their stimulant ADHD medicines. In fact, the child “comes off” their medicine every night and can take weekends or summers off without developing symptoms (other than being more hyperactive). By definition, this means that there is no withdrawal.

So, without compulsion and habit, tolerance or withdrawal, there is no single characteristic about these medicines that make them addictive.

As for the question about children with ADHD going on to have more addictions later in life, it seems that this is more related to the ADHD than the medicine and adequate treatment may actually help prevent some of these later behaviors.

I Don't Want Them to Act Like a Zombie!

I hear this complaint or concern with just about every consult that I see. Understandably, parents don't want their children to act differently or have a change in personality because they are on medication. Guess what? Me neither. If I were to see personality changes in my patients, I would change their medicine or come up with other treatment strategies. However, this is a very uncommon complaint when families actually start medication. In my 6 years of practice, I have heard this complaint only twice and both of the parents were extremely worried about it prior to starting medicines, which makes me wonder if they weren't looking too hard for it in the first place.

It is my opinion, this was a bigger problem before with the short acting medicines (like Ritalin). Because they needed to be dosed more twice in the day, the children may have experienced the change in their blood level throughout the day which led to more drastic behavior changes.

Will This Stunt My Child's Growth?

While there have been some studies showing a slight decrease in weight and height growth over the first year of starting a medicine, these differences disappear when you recheck the children at 2 and 3 years out from starting medicine.

What are the Common Side Effects?

The most common side effects I see from the ADHD medication (primarily stimulants) are loss of appetite and difficulty going to sleep.

Loss of appetite-We usually see this problem just after starting medication and it certainly can improve over time. The child usually has the biggest problem with lunch time as that is the when the medicine is at its highest level in the blood stream. Usually, you can make up for this problem by making sure the child eats a good breakfast and dinner and eats what they can at lunch. I follow my patients’ weights closely especially when there is a concern about the child's appetite.

Difficulty with sleep-Occasionally, we will have a child who has a difficult time going to sleep. Like appetite, this is most common right after starting the medication. My first treatment for this is to make sure that are taking care of doing the right things to help themselves go to sleep: no food or drink with 1-2 hours of bed time, no screens on in the room 1 hour prior to bed time, etc. If that doesn't work we can do a trial of melatonin. Other options are available if this doesn't work.

Some more rare side effects that I want to discuss are mood instability and tics.

Some of the medicines are worse that others about this but we will sometimes have a child who is very emotional and tearful when first starting the medicines. This typically happens in the afternoon or evening as the medication is wearing off. Usually, with just a period of observation, this will improve after about 1 week on the medicine so I first have my families continue trying for a bit and monitoring closely to see what happens.

Tics are involuntary movement disorders that result in a short jerking of the head, lip smacking or some other short, quick motion. These medicines do not cause tics, but in a child who is already predisposed to them for some reason can cause them to become much more obvious and frequent. If the tics are disruptive or concerning, we will usually need to switch medicine to something else as this does not usually improve over time.

Summary

1. Children do not become addicts because of ADHD medicines.
2. Children do not become zombies because of ADHD medicines.
3. Children do not become short because of ADHD medicines.
4. Children should be watched closely for loss of appetite or difficulty sleeping when starting ADHD medicines.

For more information

Visit our Checkup newsroom resource page to learn more about ADHD. 

New research published this week in the Journal of Clinical Psychiatry may challenge that stereotype or at least require us to broaden what we think ADHD “looks like.”

The research looked at the overall rate of ADHD comparing surveys of parents completed in 2003 and 2011. It might not surprise you to learn that the overall diagnosis of ADHD increased during that time. But you may not have heard that increases were found across all racial/ethnic groups, with the largest increase in Hispanics (83 percent). Perhaps another surprise was the fact that the increase in girls was greater than the increase in boys (55 vs. 40 percent).

Symptoms of ADHD can include difficulty paying attention, hyperactivity and impulsivity. Diagnosis is based upon a conversation you can have with your pediatrician or a psychologist and usually involves a screening questionnaire to be completed by a parent and teacher. Treatment starts with behavioral and parenting strategies to help children cope with symptoms but can require medication when these are not successful.

The study showing this increasing number of children diagnosed with ADHD certainly grabbed my attention. As someone who generally does not like medication for kids, I worry that this means the number of children on medications for ADHD is also increasing. As with all medications (and more than most), treatments for ADHD do not come without risk.

I do have some theories as to why the number of children diagnosed is increasing:

Theory No. 1 - Parents and teachers are more aware of the signs of ADHD.

Many hyperactive and impulsive children were previously labeled as trouble-makers and ended up spending lots of time in detention and in school suspension. Many inattentive children slowly started to have more trouble as classes got harder and parents and teachers eventually gave up on them as someone who just “wasn’t made for school.” Now we are realizing that those hyperactive/impulsive kids can’t simply “just sit still” and that those kids who were previously doing well shouldn’t be failing just because they can’t listen to lectures or get their paperwork turned in on time.

This particularly accounts for the increased rates of diagnosis in children of Hispanic and African-American descent. Previously, the stigma associated with all mental health conditions (including ADHD) prevented parents from seeking help. Also, because many girls are inattentive, rather than hyperactive and always in trouble, they could also go undiagnosed.

Theory No. 2 - Physicians are increasingly giving in to parent demand to “fix” their child.

This is by far my least favorite, but I just believe it is something we should at least consider. In a world where the expectation is that a pill can cure just about anything right now, parents increasingly want something today that will resolve their child’s behavior problems. Long term treatment plans that involve behavioral techniques and maybe even counseling aren’t as popular for all parents. However, we should fight against this as the diagnosis of ADHD and decision to start treatment should not be based on demand from a parent.

Theory No. 3 – The expectations and demands on children are changing.

Children are learning to read and do more intense math earlier and earlier. Homework was virtually non-existent when I was growing up until second or third grade. This is not necessarily the schools or teachers fault so don’t call up and gripe at your child’s teacher. Many of the requirements for what they teach and when they teach it come from above them. The simple fact is that, in trying to keep up with the success of other countries, we have decided to accelerate curriculum and to challenge students. It’s not always a bad thing, but it can be if you have a hard time sitting still for long periods or can’t keep yourself organized.

Theory No. 4 - New medications with less side effects have made parents more likely to seek treatment.

No one wants to see their child “turn into a zombie.” It’s still the number one concern I hear when starting treatment for ADHD. Fortunately, with newer medications, the side effects are much less severe and much less common. Loss of appetite and difficulty falling asleep are now the most common side effects I see, even those are not that frequent.

Keep in mind, each of these things are theories based on my experience. We will need to continue investigating why we are seeing this increase in the rate of ADHD. We all need to be observing our children for signs and symptoms, particularly if they are struggling with school but parents and teachers need to be careful not to attribute all school struggles to ADHD.

For more information, read: 

The first line of treatment for children with ADHD are behavioral options. I never ask (or let) a family jump first to medication if they haven't first tried some of the techniques I’m going to describe below.

What are the goals of treatment?

1. Improved interaction with parents, teacher, classmates and siblings

2. Improved grades

In my opinion, the goals are simple and should be taken in that order. It is important to consider these goals and re-evaluate them frequently during the treatment course. Perfection should not be the goal.

I recommend these behavioral techniques before medication for all children, especially those who are young or who have milder ADHD:

1. Make a schedule daily. All kids have difficulty and waste time with transitions. Children with ADHD do this to the 1000th degree. If these transitions are scheduled and the child knows what comes next it might speed up the transition. Things that should be included on the schedule are homework time, daily chores and self-care items (shower, brushing teeth, etc).

2. Make separate areas in the house for necessary tasks. Keep toys and video games out of the space where homework needs to be completed. This helps limit the child’s distractions so that they can finish the task at hand.

3. Set small goals that are attainable. Don’t ask the child who is failing to make the A honor roll in the next six weeks. Start with turning all assignments in and that they are complete, then slight increases in grades, etc.

4. Use charts and checklists. Children with ADHD are often very visual and concrete. If you can put a list in front of them that can be checked off, they are much more likely to complete what needs to be done. I find this to be helpful for me as well ...

5. Keep choices to a minimum. Don’t tell them to go to the closet in the morning and pick out something to wear. This is a sure way to start a huge fight as they stand in front of the closet for hours while you are trying to wrestle them out the door. Pick out two options ahead of time for them to choose from.

6. Don’t discipline them impulsively. Remember that one of their biggest problems is that they don’t stop to think about consequences before they act. If your discipline follows the same pattern, how can we expect them to learn to act differently? Plan out your discipline plan in advance and be consistent. As tempting as it may be, corporal punishment is rarely effective. I’m not going to get into a spank your child or not debate here, but timeouts and restriction of privileges seem to be more effective for children with ADHD.

7. Help your child with organizational skills. Developing a system that helps them keep track of all the papers is a way to keep them from getting thrown away, having them sit in the floorboard of the car or (more infamously) avoiding having the dog eat them. If you need some help establishing this system, check out this amazing book called That Crumpled Paper Was Due Last Week.

8. Get help. Raising a child with ADHD can be very frustrating and quite exhausting. There will be lots of times when you will feel like there is nothing left to do to help. If your child continues to struggle, talk with your pediatrician about options for treatment, including medication options. Find a family counselor that can work with your child but, maybe even more importantly, that can help you develop a plan for your child and help you cope with the struggles you will face.

I hope that you find these tips helpful as you begin to think about how you can help your child with ADHD.

As you walk through the process keep in mind that your goal should be function, not perfection.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

According to a lawsuit filed by the American Civil Liberties Union (ACLU) on Monday, the deputy violated the rights of two children when he shackled the kids around their biceps in the fall of 2014. The boy and a 9-year-old girl had both been diagnosed with attention deficit hyperactivity disorder (ADHD). The lawsuit alleges that both children were being punished for behavior related to their disabilities.

ADHD is a common challenge in classrooms across the country. So what should parents and teachers do to prevent a child from becoming too unruly to handle? Lena Zettler, director of Psychology at Cook Children’s, suggests the following:

• Have a plan
• Have a team
• Have an advocate

“What are the steps that will be taken and who are the key people involved? These things should be understood before an emergency happens,” Zettler said. She says it’s important to remember that kids with ADHD most likely aren’t acting up for attention.

“Education is the first step for treatment for ADHD. It’s is a neuro-developmental disorder. It is not a disorder of bad parenting,” says Zettler.

Students with disabilities make up 12 percent of the student population nationally. According to the U.S. Department of Education, they account for 75 percent of the students who are physically restrained by adults in their schools. To prevent such drastic measures from being taken, parents who have a child with ADHD should have a conversation with their child’s teacher about the condition before the school year begins.

Together, parents and school officials need to put a team in place to assist in the child’s education and plan out what will happen when the child acts out.

Parents and school officials also need to designate an advocate, someone the child can turn to for help. The advocate could be an assistant teacher, a counselor or even a principal. By putting a team together and a plan in place, parents can help ensure ADHD children and their classmates get the most out of the school year.

“Taking these steps will not only benefit a child with ADHD, they will help the entire class,” says Zettler.

ADHD stands for attention deficit hyperactivity disorder.

There are three core symptoms of ADHD:

1. Inattention

2. Impulsivity

3. Hyperactivity

Inattention

Inattention can present itself in many ways. Some of the most common complaints that I hear about are daydreaming, forgetting assignments and inability to complete a short list of chores at home.

Often children who mostly have inattention do not become recognized until they are older because they are not the ones causing all kinds of problems in the kindergarten classroom. They will skirt by making OK grades and not getting in trouble until they get a little older and the requirements to sit still and complete assignments on their own increase.

Impulsivity

Do you know that split second where you think about telling someone off but you stop yourself? Or you think about driving 100 mph because you’re running late but don’t because you realize it will be dangerous? That split second is another thing that children with ADHD are lacking. They push right through that pause and act before thinking about the consequences of their action.

The best summary for this problem is that they lack the ability to determine if the upcoming action is: safe or appropriate for time and place.

Hyperactivity

The hyperactive symptoms are the ones that most people (even strangers) will notice about children with ADHD. They are not even necessarily bad kids, it’s simply that they have a significant struggle with staying seated, staying still when seated and not talking out of turn. These symptoms are usually noticed by 4 years of age and progressively worsen until about 7 years.

Learn more about hyperactivity and ADHD here.

ADHD subtypes

There are three major types of ADHD and they are characterized by which of the core symptoms your child demonstrates: mostly inattentive, mostly hyperactive-impulsive and combined.

Diagnosis

The diagnosis of ADHD can be made by multiple practitioners: pediatricians, psychologist, psychiatrists and some counselors are trained to diagnose ADHD. I prefer to make my own diagnosis in my clinic unless the case is particularly challenging or there is something complex about the presentation.

There are many different modalities that can be used to diagnose ADHD but it is mostly made by parental history, teacher’s reports and screening scales. I prefer to use the Vanderbilt scale but there are many other scales out there that can be used.

Diagnostic criteria

Diagnostic criteria for ADHD start at age 4 so younger children are generally not diagnosed with ADHD. This is due in part to the complexity of trying to decide what is normal and what is hyperactive or inattentive for a child younger than 3.

The following criteria are used:

1. Be present in more than one environment (home and school) - this is important because children who have issues only at home or only at school are usually having more of a problem with the structure at one place than actually having a tendency towards ADHD

2.  Be present for more than 6 months

3. Be present before age 7 - this is becoming more of a problem as adolescents and adults are becoming more aware of the problem but demonstrating that there were symptoms prior to age 7 can be difficult

4. The symptoms must impair function-see below

5.  Be excessive for the developmental level of the child - An active 2 year old is not hyperactive but normal.

Does it impair function?

My main point when I am discussing a child’s ADHD with the family is focused upon this aspect of the diagnosis and treatment. For most children, impairment of function means that they are not progressing through school appropriately, are in trouble at school regularly for hyperactive or impulsive behaviors or have difficulty performing regular function at the house because of their ADHD.

Now she prays for Tre’s caregivers to make her son all better.

Tre, who is 9 years old, has been seen by the Rehabilitation Services team at Cook Children’s since his parents adopted him as an infant. Most of those issues centered on his articulation skills. Tre’s history with Rehabilitation Services started with audiology and other physician specialists; speech therapy services began at 7 years old working on articulation skills. 

Then about 15 months ago, Sara Adams, Tre’s speech pathologist, received a call from Jennifer to say her work with him would have to go on hold indefinitely.

Tre was involved in a horrible boating accident. He sustained a head injury and was in a coma at another hospital. But the miracle for the Faulkner family occurred and within two weeks, Tre was up and walking.

After his accident, Tre returned to therapy at Cook Children's Urgent Care and Pediatric Specialties – Mansfield and worked with Occupational Therapy, Physical Therapy and Speech Therapy to regain skills that were lost after his brain injury.

A year later, much of Tre’s care takes place at the Cook Children’s Rehabilitation Services at Mansfield. The focus is on Tre’s short-term memory loss and his severe ADHD, as a result of the injury.

“God has blessed us so much,” Jennifer said. “The Mansfield community has been with us since the beginning, I’m so thankful. I’m also thankful for the amazing care Tre has received since his injury. At Mansfield, Tre has really been helped in many ways, through his physical, occupational and speech therapy. They have helped him so much with his memory and his balance. It’s truly been miraculous.”

The rehab at Mansfield is working for Tre. Academically, Tre’s test scores are in the average range for a child his age. His mom says he’s learning and making strides every day.

And Tre’s doing very well physically. He recently received his gold belt in karate. Makes sense for a kid who has proven time and time again how tough he is.

“The progress Tre has made since his accident is truly remarkable,” Adams said. “Tre still has some struggles with his attention and memory that impact him every day. However, he continues to improve and learn how to work through these struggles. Tre’s sense of humor, determination, and supportive family are his greatest strengths. Tre is such a funny kid! He loves to tell jokes and riddles. One of his favorite jokes is: ‘Why don’t ducks tell jokes when they are flying? … They might quack up!’”

To see how far Tre’s come since his injury it’s hard not to smile at the miracle that’s occurred and the occasional duck joke.

For more information

At Cook Children's, we provide more than 60 pediatric medical and specialty clinic offices throughout Texas. Thanks to our skilled group of clinicians who support the leading-edge technology found among our specialty services, Cook Children's is the destination when it comes to taking care of your children.

Cook Children's Urgent Care and Pediatric Specialties - Mansfield is located at:

801 Matlock Road

Mansfield, TX - 76063

To make an appointment, call 817-347-8400.

Specialty services at Mansfield inlcude:

• Endocrinology and diabetes
• Gastroenterology and nutrition
• Nephrology and dialysis
• Neurosciences
• Orthopedics
• Pediatric surgery (inpatient/outpatient)
• Psychiatry and psychology
• Rehabilitation
• Urgent care

I know you are at your wits end. You are tired of getting the phone calls from teachers. You are scared that every time the day care calls, it could be the call saying that your child needs to be picked up and never come back. Believe me, I want to help … but medication does not fix everything.

The primary and best, first treatments for Attention Deficit Hyperactivity Disorder (ADHD) are not medications.

If your child is hyperactive, he or she needs structure and a consistent behavior plan that is applied across all caregivers. This means that mom and dad, grandma and grandpa and the school need to all be on the same page about what is acceptable behavior and what is not. Reward good behavior, be consistent in responding to bad behavior.

For children who have problems with attention, medication might help them remember to get their homework home or turn it in on time or help them get their chores done at home. It might help, but many times their bad habits are so entrenched that medication won’t touch it until you put a system in place that will help them organize their day. A system of folders for homework, listing chores with checkboxes and other simple fixes can go a long way and will likely be necessary whether your child is on medication or not.

Anytime I make the diagnosis of ADHD and we move toward using medication, there is one message I want my parents to hear loud and clear: “The goal of using ADHD medication is not perfection.”

We are not looking to get your child to be the citizen of the year … at least not with medication. The goal of medication is to help your parenting strategies to be more effective.

Here are some symptoms that are not necessarily a result of your child having ADHD: being disrespectful (especially talking back), physically violent or being mean to other children. Medication is not likely to improve any of these behaviors. Yet, many of these are the behaviors you specifically want me to help with.

However, when these symptoms are present or when things are not improving the way we would like, it is important to include counseling in the treatment regimen for ADHD. Counselors can help children understand what is going on and give them strategies to cope. Perhaps more importantly, they can help you, as the parent, better understand and manage your child’s ADHD and other behavioral problems.

I can’t “fix” your child with medication but together we can help them.

Sincerely,

Justin Smith, M.D.

Dear person who think that ADHD does not exist,

I get it. Most likely you’re reacting to one of the following:

1.It seems like everyone you know is putting their kids on medications.

2.A teacher recommended that your child be put on medication even when you think they are normal (and they are).

3.You think that ADHD is a result of bad parenting.

You have a good reason to be concerned. But do not overreact and make the statement that ADHD is not real or smugly share the article, “Inventor of ADHD on his deathbed says that ADHD is a fictitious disease.” What he actually said was ADHD is over-diagnosed and doctors should investigate all the psychological and social reasons why the child is struggling before prescribing medication.

What I see in practice is this:

1.Parents who want a quick fix for everything (see above).

2.Parents who are desperate to help but just don’t know how.

3.Parents who are desperate to help, have tried everything and are coming to me as a last resort.

Some of my most difficult patients are #1. They get very angry when I will not prescribe medication and recommend counseling instead.

Some of my favorite patients are #2 and #3.

Most of these kids are not “bad kids.” They are struggling. They can be challenging to manage in the classroom and in the home. I am often exhausted after just a 30-minute consultation with them and their families; I can’t imagine what the parents are feeling.

My first discussion is generally walking through the non-medical tools we can use for ADHD. I can plug the families in with a good counselor. I can talk about what medication can do for their child, as well as the possible side effects, but I never prescribe medication as a first treatment.

The satisfaction that comes from seeing a child, who is struggling in school and at home, respond to either non-medical or medical treatment is amazing. I do not care what brings about the results, the goal is results.

So, please stop saying ADHD doesn’t exist. Stop sharing articles without knowing the true story. It’s insulting to me but, most importantly, it’s insulting to parents who are simply working hard to do the best for their children.

Sincerely,

Justin Smith, M.D.

“When a child plays an electronic game and receives frequent intermittent rewards, their brains release dopamine – a neurotransmitter that is closely related to reward motivated behavior,” said Lisa Elliott, Ph.D., a licensed psychologist and manager of the Cook Children’s Behavioral Health Clinic in Denton. “In school or in other social situations, a child does not normally receive these rewards, making it more difficult for them to stay focused in a non-technology based situation.”

Elliott believes this is a factor contributing to the recent rise in ADHD. She said she is concerned about gadgets, especially video games, and what they could be doing to harm our children.  By allowing so much focus on technology and mobile devices, children aren’t learning to hold their attention without some type of reward.

Whatever the cause is, Elliott offers four simple ways to prevent the damage that gadgets could be causing your child:

1.Remove any screens from the bedroom.

2.Pay attention to the content your child is viewing, especially violence.

3.Set limits on screen time each day. The American Academy of Pediatrics recommends screens be kept out of kids' bedrooms and children should be limited to less than two hours per day of screen time. For children under 2 years of age, all screen media exposure is discouraged.

4.Create healthy playtime such as outdoors or being active.

These simple changes may make the difference in how your children perform this school year.And while your kids may be upset now, they'll thank you later.

About the source

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children's Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appoinment with her, call 682-885-3917.

About the author

Caroline Gayler volunteers in the public relations department at Cook Children’s Health Care System. She is a senior at TCU majoring in Strategic Communications. 

In the morning, they begin with stretching, but by the middle of the afternoon they are running with real-life Olympians or breathing their way across the United States – all from the comfort of their own classroom. GoNoodle is a new interactive resource that allows children to not only increase their physical activity, but improve their academic performance.

Thanks to a sponsorship from Cook Children’s, 60,136 kids in Tarrant County enjoyed GoNoodle this past year. GoNoodle allows children the opportunity to participate in a fun, interactive “brain breaks,” while measuring the minutes of moderate to vigorous physical activity. The brain breaks include running, dancing, stretching and calming exercises. Kids play the games that include spelling, vocabulary and math with physical activity.

“Other programs seem to focus on one or the other – activity or academics; but GoNoodle was unique because it focused on both areas,” said Larry Tubb, senior vice president of the Center for Children’s Health. “We look at bringing GoNoodle as an extension of our Promise, to help the well-being of every child. That doesn’t always mean treating them to get better in a doctor’s office. It also means helping them get better in the classroom. By bringing this physical activity to schools, we are improving the health of these kids. That helps our children and our community.”

GoNoodle brain breaks give the children activities to help keep them focused during the day. They have breaks that help them stretch, release energy or reduce stress. Some of the breaks align with core subjects such as spelling, math, vocabulary, geography, math, reading and even nutrition.

Breaks include:

Airtime. Students “breathe” their way across the United States. They pick their state and begin breathing in and out. The simulation of blowing out blows a balloon on a screen across the country, giving fun facts along the way.

Run with us. Real-life Olympians, on a screen, coach children in track and field events such as the hammer throw, 200-meter sprint and javelin.

To The Maximo. Children perform stretching activities to get their body and mind going early in the morning.

The faculty at A.V.Cato elementary have seen the benefits of GoNoodle. Michelle Miles, the school’s counselor, said she saw the breathing exercises work during the State of Texas Assessment of Academic Readiness tests. The kids did their breathing exercises to calm them before the tests and give them the chance to perform their best.

“GoNoodle has been the greatest opportunity for ADHD students because you can just tell when those students become disengaged from a lesson and are just tired and antsy and unmotivated,” Miles said. “If you can just get them up in between transitions for a few seconds at a time and give them an opportunity to either get the wiggles out or start focusing on how they are going to move forward, it tends to help them just get the energy out; and have it be OK and accepted before they move on to the next lesson. This has been ideal for some of our younger kids who have all that extra energy bottled up.”

Amber Grier, an elementary teacher at A.V. Cato, said she recently saw the benefits of GoNoodle. She had been working with her students throughout the day on mixed fractions and adding fractions. One child in particular just didn’t seem to understand the lesson. She had exhausted her efforts for the day. Then they began to play one of the GoNoodle games and was pleasantly surprised to see the child get every answer correct.

“I had a huge smile on my face because I was so relieved to know that he had learned what we were doing,” she said. “But he wasn’t able to produce the answer quickly until he got moving and stopped worrying about making me happy. He was just playing the game and he was able to get all the answers. True learning is play.”