Common Questions/Reliable Answers: learning more about ADHD
Dr. Elena Geiger-Simpson is a Clinical Assistant Professor in the UMN School of Nursing and a psychiatric nurse practitioner at the UMN Child and Adolescent Psychiatry Clinic. Her patients come to her for the diagnosis and treatment of a range of mental health issues, including attention deficit/hyperactivity disorder or ADHD.
In her work with kids who have ADHD, she gets a lot of questions from caregivers about the condition. Is it caused by too much screen time? Too much sugar? How is it treated? How is it diagnosed? Aren’t all kids hyperactive and easily distracted?
How ADHD is diagnosed
While more needs to be learned about exactly why ADHD occurs, it does have a genetic component. “We also know that there are differences in brain structure and functioning and neurotransmitter activity in ADHD,” said Geiger-Simpson. “But as of now, there is no genetic test, blood test, or imaging to diagnosis the condition.” That said, there are a few ways to confirm the diagnosis:
- Pediatric providers, such as pediatricians or pediatric nurse practitioners can diagnose and treat ADHD, and are often the first to do so
- When Geiger-Simpson is working with her patients, she performs a psychiatric diagnostic assessment. During structured DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) interviews, she gathers information from the caregivers and their child. “Prior to online learning, we also got information from teachers,” she said. That component of the diagnostic process will return when kids are back in the classroom.
- If Geiger-Simpson feels that more information about a child is needed, she may refer them to her psychologist colleagues for a neuropsychological evaluation. “They use additional tests to evaluate brain function and have standardized ways of measuring attention, processing speed, working memory, language, and executive functioning.” she said.
Treating the condition
When all the information is gathered and the diagnosis of ADHD is made, it’s back to that common question: how is it treated? “It depends on the child’s age and level of functional impairment,” said Geiger-Simpson (pictured at left), whose patients with ADHD range in age from 6 years old to their early 20s. “The first line of treatment is behavioral training. We teach caregivers how to navigate problematic behaviors, which could include focusing on positive communication, positive reinforcement, and providing structure.” The kids are trained in social skills, life skills (organization, time management, breaking down tasks, etc.), and improving executive functioning. Classroom interventions and support are also important. If behavioral interventions are not enough, Geiger-Simpson prescribes medication.
“When I talk with patients and their families about medication, I often tell them the medication provides a little more support in an environment that’s not necessarily set up for them to thrive,” said Geiger-Simpson. “A psychologist colleague of mine once compared it to sunscreen, so now I use that analogy with patients and families. For me, if I go outside in Minnesota in the summer, I get a nice suntan and don’t burn. But if I go to Florida and don’t wear sunscreen, I will get severely sunburned. I tell families that ADHD medication works similarly – we’re adding extra protection or support in an environment that isn’t conducive to how our body or brain is built.”
There is another side to the coin with ADHD. “These kids have superpowers,” said Geiger-Simpson, which can include:
- Being creative, inventive, out-of-the-box thinkers
- Hyper-focusing on subjects/projects/topics that are of interest to them
- Having the ability to adapt quickly to changing environments
The bottom line, according to Geiger-Simpson, is that ADHD can and does create significant challenges and problems for children and adolescents, especially when it goes untreated. “So, while I focus on the strengths of the individual and talk about their ‘superpowers’ – ensuring that the child and family have the resources and appropriate treatment to manage the challenges is paramount.” she said.
More information about ADHD:
ADHD resources for caregivers:
- Taking Charge of ADHD: The Complete Authoritative Guide for Parents (Revised Edition) by Russell A. Barkley, PhD
- Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood by Edward M. Hallowell & John Ratey
- Putting on the Brakes by Patricia Quinn & Judith Stern
- Raising Your Spirited Child, by Mary Sheedy Kurcinka
- The Whole-brain Child by Daniel J. Siegel