Learning Differences Part 5: Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder (ADHD/ADD)

Note: Attention Deficit Disorder is now officially classified as a subset of Attention Deficit Hyperactivity Disorder. I feel the older terms are more accurately descriptive, and ADD kids often get missed. So, I use ADD.

ADHD kids struggle with paying attention to less interesting things, have variable executive function challenges, and are fidgety and over active. These kids disturb the classroom and are often spotted by teachers. Be aware that they can hyper-focus for long periods on projects that interest them, yet still have “attention deficit.” ADD kids have the same challenges, but lack the excess energy. They are often quietly lost in the back of the classroom. They don’t upset things so they get missed.

Let’s take a minute to talk about brain development for kids in general. Up until puberty, the brains of all children are laying down more and more neural connections. Parts of their brains are literally thicker than an adult’s brain. As puberty hits, this overly enmeshed brain is steadily pruned. The thickness of these brain areas decreases while cognitive abilities increase.

Basically, the road map of fast, smoothly working neural connections is forming with the removal of extraneous routes that slow things down. This process goes on for many years. Furthermore, the frontal lobe that controls executive function is often one of the last areas to fully develop these superior and faster neural connections.

The result is that kids don’t act like little adults. They can’t. They live in a brain that is a jumbled tangle of neurons. Thus, some very normal kids exhibit behavior that does not function within the rules and constructs of daycare, preschool, or even early elementary school.

These are highly artificial environments which may seem reasonable to adults, but they do not reflect the environments our species evolved to live in. It is only realistic to expect that some children simply will not fit within our adult rules.

Unfortunately, our society doesn’t provide many schooling options. We don’t have the “outdoor pre-schools” and “forest kindergartens” of the Scandinavian countries. Those environments allow for more behavioral latitude and active, hands on learning.

Nor do we pay parents to stay home and raise kids. Women have joined the work force outside the home. This means we adults need our kids to function within the constraints of daycare, preschool, and grade school, so we can go to work. This also means that if our child doesn’t function well in preschool, then we are far more likely to seek an explanation that offers a hope of “treatment.”

Many life challenges can cause behavioral problems in kids. Anxiety, depression, trauma, abuse, and family instability can all cause children to act out in strange ways. It can be challenging to tease out the difference between a child whose behavior is that of a typical child acting out in response to stressors vs. a child whose brain has an atypical neurobiological structure which leads them to behave differently.

Children with ADD and ADHD have brains that are literally wired differently. The chemical neurotransmitters in their brain also work differently. Richard Branson, Simone Biles, Charles Schwabb, Bill Gates, and Michael Phelps all have some form of ADHD. There is a huge list of highly productive and creative thinkers who struggled through school due to these neurobiological behavior “disorders.” Perhaps we would do well to think of ADHD as a neurobiological variant. Normal, and one of many variants. Their “disability” may have more to do with how adults teach, manage, and guide these children.

So, how do you figure out if your child really does have a specific behavioral condition with a neurobiological basis? How do you figure out if she’s not fitting in simply because she is young or needs a different environment?

Well, it’s not easy to sort these things out. You’ll likely spend a good bit of time and energy looking for answers and solutions. You can start by gathering information and concerns from your child’s school, teachers, coaches, and caregivers. Don’t assume what you hear is all correct nor that it’s all wrong. Just gather the input and weigh the value of the sources. These people may seem like child-care “experts” to you, but most are not educated in the normal range of children’s neurobiological development.

Next, take a day and go and sit in your child’s preschool or classroom for as long as they will allow. The longer you are there, the more you’ll understand your child’s environment. You may decide the school or teacher is the problem. If so, you can work to get your kids somewhere else. Or you may decide the school isn’t the main problem.

The next step is to get a really good assessment of your child by someone educated in child development. These are often child neuropsychologists who have experience in teasing out behavior issues caused by stress and emotions versus those that are neurobiologically based.

Typically, an assessment for behavioral issues, such as ADD, ADHD, or Autism is done by a specialist referred through your child’s pediatrician. This evaluation is for behavioral concerns.

However, learning differences can also cause behavior issues, and can be overlooked if not evaluated. Thus, you may want to have your child assessed by their school system as well. They are required to evaluate all children age 3 or older if the parents have concerns.

This involves a psychoeducational assessment which can tease out learning differences that may be causing a child to act out. This evaluation is also useful if your child does have ADHD or other behavioral disorders. Many of those disorders come with delays or impairments in executive function.

Some school systems will look at a diagnosis of ADD or ADHD and decide all the child needs is extra time or a fidget device. However, a psychoeducational evaluation may show other very specific areas where active intervention by the school can be very helpful. If it is not defined or diagnosed, then the school will not be forced to help.

So, if you’re worried about a possible learning disorder, ask the school system for an evaluation. If you’re worried about a behavioral diagnosis, I recommend a psycho-educational evaluation from the school system, and a behavioral assessment referral from your pediatrician.

Next: Learning Disorders Part 6: Autism Spectrum and Sensory Processing Disorders

Kathleen Cawley is a physician assistant and author. She is a regular guest columnist for the Auburn Journal and Folsom Telegraph where she writes on parenting and childhood. Her books, Navigating the Shock of Parenthood: Warty Truths and Modern Practicalities — from a mom with twins, And Grandma Becky’s Blue Tongue, a children’s picture book, are available where books are sold.