Some children struggle to keep focused, follow instructions, remain seated, wait their turn, keep organised, and finish tasks on time, especially at school. These are common reactions of children with Attention-Deficit Hyperactivity Disorder (ADHD).
However, adult and paediatric neuropsychologist Analisa Wittet stressed that just because a child demonstrates ADHD symptoms such as inattention, hyperactivity and impulsivity, it does not necessarily mean the child has ADHD, as there are several other medical, psychiatric, and developmental disorders, as well as environmental factors, that have similar symptoms or cause similar reactions.
"Firstly, the symptoms must significantly impair their daily functioning and be significantly above what would be expected for their age. Also, these behaviours must be present across more than one setting. For example, not just at school or at home, though symptoms do vary depending on context within a given setting."
The National Institute of Mental Health described ADHD as “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.” It is usually diagnosed by neuropsychologists and clinical psychologists, but it could also be diagnosed by medical professionals.
Wittet said she understands why it can be misdiagnosed, since the brain is a complex organ that cannot be fully understood just by looking at someone. She said a child may be restless, hyperactive or distracted because they are stressed, anxious, or depressed. They can have learning disorders, intellectual disabilities, disorders such as autism, language problems, or sensory sensitivities. They can also be tired or sleep deprived, or have medical conditions like thyroid issues, anaemia, seizure disorders, or abnormal blood sugar levels.
“All of these issues and more can affect attention and behaviour. Sometimes children have more than one condition. Professional consultation is necessary to determine the root causes of the issue. The more accurate the diagnosis, the more effective the treatment is likely to be.”
She explained that the treatment will depend on the severity of the symptoms, as well as if the patient has other conditions. She said children just need small adjustments like sitting close to their teacher and the board, allowing them to move while they work, getting extra time to do tasks, or getting frequent breaks. For some, a classroom aide is necessary to help keep them focused, while others need small specialised schools with specially trained teachers. Most, she said, need therapy to help them better control their brains and bodies, and some need medication.
If misdiagnosed, however, the wrong type of treatment may be recommended which will not help the child. Both parents and children can become frustrated, in addition to the time and money wasted trying different treatments before finding one that works.
Further, Wittet said a misdiagnosis, or no assessment at all, can have more serious consequences. “Without help and understanding, children can feel misunderstood, frustrated, and depressed. They may eventually lash out, give up on school, or get involved with the wrong crowd. This is especially concerning since we live in a society plagued by criminal activity and gang warfare. It is critical that the well-being of our children be prioritised.”
What does TT need?
“We need to start by valuing and understanding the magnitude and severity of problems related to ADHD and other conditions which are not properly identified and treated.”
She said TT needs to place greater emphasis on special education in teacher training programmes, especially since children spend most of their days with their teachers. With training, teachers will know what to look out for, when to refer for an assessment or treatment, and how to support the child in the classroom.
“For all children with ADHD, they need parents and teachers who understand ADHD and use a positive approach to helping them. Adults have to get creative and find interesting ways to keep them focused and able to get through the day successfully, especially when they are very young. As with all children, they need structure and routine but also time to play and have fun.”
According to Wittet, another shortcoming is the limited availability of assessment and therapeutic services in the public sector. She said the country needs either more qualified professionals in the public system, or assistance from the government for subsidising services by private qualified professionals.
She said TT also needs more people trained in diagnosing and treating specific developmental disorders. “We do have well-qualified professionals dealing with ADHD and other developmental conditions in Trinidad. However, many of our young professionals struggle to find good internship, supervision, and hands-on training after they graduate from university here in Trinidad. Greater availability of post-degree training opportunities is important in order to ensure that our mental health professionals are ready for independent practice and can provide a high quality of service to our citizens.”
Wittet assures parents of children with ADHD that it was not caused by bad parenting. She said it is not a lack of willpower or desire, nor is it a measure of how smart someone is.
“ADHD has a biological basis and it reflects dysfunction in specific brain networks... Your child may have ADHD but that does not define them. Sure, life with ADHD can be challenging but train yourself to notice the many positives. Children with ADHD are often full of life, creative, passionate, funny and generous. They have the potential to succeed just like anyone else, especially with the right support. Have fun with your children and make happiness and laughter a big part of your family.”
She said it is also important to advocate for your child by teaching others, especially close friends and family who interact with your child, about ADHD, and to build healthy working relationships with your child’s teachers or anyone else working with them.
She also stressed the importance of parents taking care of themselves and taking the time to recharge, do the things they love and seek support. She emphasised the importance of awareness.
She said it is important to let people know there is nothing shameful about having ADHD. She said many parents are afraid to have their children assessed because people may “look down on them” or “label them.”
“This is a crippling view which our society has to change since it stops too many children from getting help. Secondly, knowledge is power! The more people know about ADHD and other neurodevelopmental conditions, the more they can support persons with it.”
In fact, she said, because of increased awareness, over the past five years psychologists are seeing more and more adults with ADHD. She said people are recognising the symptoms in themselves and going in for diagnosis and treatment.
She stressed that it was never too late to get assessed, and that there are medical and therapeutic interventions, as well as simple changes adults can make in their daily lives that could help. "Getting diagnosed helps people understand themselves better and see their struggles in a new light. They can then learn strategies to reduce how much their symptoms affect their daily lives and happiness."
Factors that are often mistaken for ADHD
Anxiety and emotional problems: Children with anxiety often present as inattentive and restless. Their minds may be elsewhere since they may be consumed by worry, fear and distress. Stress, anxiety, depressed mood and other sources of emotional distress can also result in disruptive behaviours such as emotional outbursts and “lashing out.” This is often the case for children with traumatic histories such as those who have been exposed to abuse and violence, as well as children who have grown up in chaotic or neglectful home environments. Children with other mood disorders such as bipolar disorder can also present with symptoms similar to ADHD such as distractibility, increased energy, risk-taking behaviours, and mood instability.
Although behaviours due to emotional/mood issues are often confused with ADHD, it is important to know that many children with ADHD also struggle with emotional issues, particularly anxiety and depressed mood. Professional consultation is necessary to determine the root cause of the issue.
Learning difficulties: Often children do not focus during class time because they do not understand the work being taught. They may become “lost” because it is simply too difficult for them to keep up. In these cases, children may have undiagnosed learning disorders such as problems with reading (dyslexia), math (dyscalculia) or writing (dysgraphia).
Their learning struggles are often accompanied by anxiety and frustration which further compromise their ability to focus. It is important to note that ADHD and learning disorders often occur together, even though they are separate conditions.
Language and auditory processing problems: Children who struggle to make sense of language and words have great difficulty following instructions and staying focused. Imagine being an English speaker sitting in a class being taught in German – you would probably zone out very quickly. Auditory and language processing problems often result in children “missing” information and getting lost in all of the words being spoken to them.
Sensory processing problems: Children learn by getting information from their senses. However, some children have trouble handling this information. They may be over-sensitive or under sensitive to sights, touch, sounds, and smells. Sensory sensitive children may become overwhelmed or distracted by noises, bright lights, colours and so on which may result in restlessness and “acting out” behaviours.
Medical conditions: There are many medical conditions which can interfere with a child’s attention and behaviour. Some conditions include thyroid issues, anaemia, seizure disorders, and abnormal blood sugar levels. Certain medications can also have side-effects which result in ADHD-like behaviour. Checking in with your child’s paediatric is often a good first step in the process of understanding your child’s behaviour. Additionally, all children should undergo vision and hearing testing since vision and hearing problems will certainly affect attention, behaviour, and learning.
Not enough sleep: Children who don’t get enough sleep often struggle to stay focused at school, follow directions, work quickly, remember information taught, and control their emotions. Many scientific studies have validated the link between sleep problems and ADHD-like behaviours.
Problems with compliance/defiance: Some children have some degree of control over their attention and behaviour yet often intentionally refuse to follow rules and be cooperative with others. In most cases, these children are reacting to factors such as emotional distress, family dysfunction, inconsistent discipline, or a lack of structure and routine at home.
Age: Sometimes, children who are younger than their classroom peers may look like they have ADHD symptoms when really, they are just more immature than their peers.
Intelligence: Children of all levels of intelligence can have ADHD. However, children both high and low in intelligence can demonstrate symptoms which look like ADHD even when there is no ADHD. Firstly, children who are high in intelligence may struggle with inattention and restlessness because they are bored with the level of work presented. On the other hand, children with intellectual disabilities often face a range of difficulties including difficulty controlling their attention and behaviour. Therefore, assessment of a child's level of intelligence is an important component of an ADHD evaluation.
Source: Adult and paediatric neuropsychologist, Analisa Wittet