Last week I received a consultative phone call from an upset mother. The daycare that her 5 year old son attends gave her an ultimatum, either obtain counseling for your son, put him on medication or he will no longer be welcome at the center. WOW, quite a statement for a daycare center to make! So you can see why she was so upset. When obtaining more detail from her. She stated that her son had begun to have more frequent “meltdowns” during the day. She described her son as being a “high energy” child that often acts impulsively and seems to always find trouble. She went on to explain that the center had some staffing changes along with program changes. She also stated that her son became a big brother 7 months prior. She continued to state that his little brother was born 10 weeks early and was in the NICU for almost 8 weeks. She was in the hospital for almost 2 full weeks before delivery due to preeclampsia. This had been a traumatic time for their family. The mother was so worried and felt helpless. Was it the major life change with having a new baby in the house? Could it be the program and staff changes that are creating this behavior? Most importantly what can be done to help her son? I went onto explain that counseling can help her son and also to talk with her pediatrician to determine whether or not to medicate her son.

In obtaining more information, I was suspecting that her son could be diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). What information was I using to suspect this disorder? Let me break down some of the basic information for you.

ADHD is the current term for a specific developmental disorder seen in both children and adults that is comprised of deficits in behavioral inhibition, sustained attention and resistance to distractions, and the regulation of one’s activity level to the demands of a situation (hyperactivity or restlessness). 

There are three subtypes to this disorder. I will list the criteria listed from the Diagnostic and Statistical Manual (DSM-IV), The Bible for those working in the mental health field, for each subtype. They are:

Inattentive Type – six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

1.  often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2.  often has difficulty sustaining attention in tasks or play activities.
3. often does not seem to listen when spoken to directly.
4. often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the work-place (not due to oppositional behavior or failure to understand instructions).
5. often has difficulty organizing tasks and activities.
6. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
7. often loses things necessary for tasks or activities (e.g.,toys, school assignments, pencils, books, or tools).
8. is often easily distracted by extraneous stimuli.
9. is often forgetful in daily activities.

Hyperactive type – six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

1. often fidgets with hands or feet or squirms in seat.
2. often leaves seat in classroom or in other situation in which remaining seated is expected.
3. often runs about or climbs excessively in situation in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
4. often has difficulty playing or engaging in leisure activities quietly.
5. is often “on the go” or often acts as if “driven by a motor”.
6. often talks excessively
7. often blurts out answers before questions have been completed.
8. often has difficulty awaiting turn.
9. often interrupts or intrudes on others (e.g., butts into conversations or games).

Combined Type- Criteria from both categories have been met for the past 6 months.

Some of the additional criteria for ADHD include the following:

1. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
2. Some impairment from the symptoms is present in two or more settings (e.g., at school, work, or at home).
3. There must be clear evidence of clinically significant impairment in social, academic or occupational functioning.

ADHD is a performance deficit, not doing what you know. The child or the adult has problems maintaining a consistent level of performance. A diagnosis should not and cannot be made without some detailed history. These histories should include: A Detailed Family History, A Detailed School History, Interviews/Observations with the child, Other Psychological Testing as Indicated.

Based on the information that mom was giving me, her child did meet many of the diagnosis criteria. There is help available in dealing with ADHD, either as an adult or a child. One interesting note is that the research today is suggesting that ADHD has a genetic feature which indicates it is highly inherited, it is neurological suggesting that children are “born with it”, it is internal vs. eternal, and it is NOT deliberate on the part of the child.

Treatment for ADHD consist of Medical support (medication), Psychological support through a Professional Counselor (for the Child and the Parents), and Educational support through the school system. 

Lory Naugle, MS, NCC, DCC, is a Professional Counselor in Private Practice. She offers counseling in her office and online. She specializes in Anxiety Disorders and ADHD for both children and adults.

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