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Ants in the Pants or ADHD?

January 11, 2013 by  
Filed under Uncategorized

by Mommy MD Guides blogger Stacey Weiland, MD

My seven-year-old son, Andrew, is always on the go. He is up and dressed at 6:00 am every morning, even though school doesn’t start until 9:00. He rushes through his schoolwork and sometimes makes silly calculation errors on his math problems. He fidgets at dinner and rushes to play his new Wii game as soon as he’s excused from the table.

My husband, David, and I sometimes wonder if Andrew has “ants in his pants,” or could it be ADHD? I’ve asked Andrew’s teachers. Usually, their response begins with a sigh and a rolling of the eyes, followed by reassurances that he is “fine” and that he is “just a boy.”

I suppose I’m a bit oversensitive and may be overreacting just a little. But you see, Andrew’s older brother, Zachary, was recently diagnosed with ADHD. Believe it or not, it actually took the “experts” (a slew of psychologists, psychiatrists, and special-education teachers) about four years, and more than 50 tests, to come to this conclusion. The process was expensive, time-consuming, and stressful for all of us, and especially for Zachary.

After enduring this experience, I started looking into the scientific literature. I wanted to find out why it was so difficult to diagnose ADHD in our son. Some of the answers that I found were quite surprising.

ADHD, which stands for Attention Deficit Hyperactivity Disorder, is thought to be present in about 5 percent of kids and 10 percent of adults. There are actually three subtypes: a hyperactive subtype, an inattentive subtype, and a combined subtype.

The hyperactive ADHD subtype is the one that people always think of when they hear the term ADHD. These children are described as “fidgeters” who “can’t sit still.” They talk excessively, and interrupt others’ conversations or games. They can be reckless, have repeated injuries, and can be aggressive toward other children. Teachers notice these children because they’re disruptive in the classroom, and children complain about them because they’re bothered by them both in class and on the playground.

The inattentive ADHD subtype, in contrast, is often overlooked. These children sit quietly in class, don’t call out answers, and behave well. Unfortunately, these children still have major problems. They are forgetful and frequently lose their homework or articles of clothing. They are easily distracted by extraneous stimuli and fail to pay attention when instructions are given to them. They are disorganized and often avoid engaging in activities that are felt to be too difficult. They are criticized by teachers as being lazy or willful. Parents become frustrated when it appears as if their child just doesn’t seem to listen when spoken to.

Inattentive ADHD children (Zachary fits into this category), it turns out, are significantly more common than their hyperactive ADHD counterparts. Inattentive ADHD children are at just as much risk for academic and social difficulties, and possibly even more so, because they tend to be recognized later, if at all.

Another interesting feature of ADHD is that behaviors tend to change with time. Zachary, for example, was extremely forgetful in kindergarten. Nearly every other day, I would pick him up in the carpool line and discover that he was missing something. I would find a parking spot and run back into the classroom to retrieve his homework folder, or his backpack, or his lunchbox, or his coat. No amount of lecturing to Zachary or pleas or notes to his teacher seemed to make any difference.

As Zachary progressed into first grade, and then especially into second grade, his forgetfulness problem gradually disappeared. We thought maybe he’d grown out of it, and it was just some sort of maturity thing. However, in the ADHD child, when one difficult behavior disappears, another one always comes in to replace it.

As he got older, Zachary would freak out when it was time to do his homework. One page of math problems that should have taken two minutes would become a two-hour production. He refused to do simple chores around the house, such as making his bed, setting the table, and tidying up his room (things that his younger brother, Andrew, had no problem with).

Looking back, I now realize that there were signs pointing to Zachary’s differences even as a baby and a toddler. Many of these differences, I might never have noticed if I didn’t have two other children to compare him with.

Zachary slept way more than his brother and sister and was sometimes even difficult to rouse. Sleeping differences are common in ADHD children. Some have difficulty falling asleep, while others sleep excessively.

While he appeared just as intelligent as my other two children and developed language skills early, Zachary seemed slow to mature in other areas. Potty training took a full year longer than his siblings, and he had accidents in school and at night up until the third grade. Bedwetting has been documented as being significantly more common in children with ADHD, possibly related to an unusually deep sleep state.

Zachary didn’t respond to punishments or threats like my other two children and appeared to not even care about potential consequences. Ironically, Zachary always appeared to be a much easier child compared with his brother and sister. However, in contrast to Abby and Andrew who would yield in their behaviors with a little discipline, if Zachary did not want to do something, it was impossible to make him. This is also a classic behavior of ADHD children, who often are described as “good-natured except during outbursts.”

Taken individually, the behaviors I’ve described in Zachary, as well as a long list that I haven’t even mentioned, can be seen in all children. The difference in ADHD, however, is that these behaviors are excessive.

For a hyperactive ADHD child, for example:

…on the playground, his top speed is not greater than that of other children. What is so different about the ADHD child is that when he is requested to turn off his motor, he cannot do so for very long.”(Paul Wender, MD, a noted researcher and clinician in ADHD)

The excessiveness of behaviors in ADHD children negatively impacts their academic and social experiences and can lead to problems throughout life.

Unfortunately, there really is no one standardized test available to unequivocally make a diagnosis of ADHD (we should know).

Believe it or not, parents are actually the most qualified “experts” out there in figuring out if their child has ADHD. Parents spend the most time with their children and can notice subtle differences when compared with siblings and peers. Parents notice when certain behaviors are more extreme in their child or persist longer compared with others.

Parents can visualize the whole picture. They see not just individual behavior differences at one point in time, but a whole series of differences during the child’s development. And most important, parents are able to recognize whether the child’s behavior is negatively impacting his life.

My younger son, Andrew, for all of his activeness, is doing fabulously in school and has a wonderful group of friends. He’s quick to do his homework and rarely complains about his chores. His behaviors are really no more excessive than any of the other seven-year-old boys in his class, just like his teachers keep telling me. He does not have ADHD.

In contrast, while Andrew’s older brother, Zachary, may not ever have had ants in his pants, his forgetfulness and inattentiveness have had a significant impact on both his academic success and social interactions, despite a very high IQ.

If my husband and I had known what to look for, I feel sure that it would not have taken us four years and more than 50 tests to figure out that Zachary had ADHD.

ADHD is a difficult diagnosis to make. If you think your child is displaying some excessive behaviors, keep observing him. Compare him with your other children and his classmates. See if these behaviors are affecting his life. You are your child’s best advocate. Don’t be afraid to educate the experts if you have serious concerns.

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