Helpful therapies vary, but diagnosis is key.
When Brenda Mann started teaching kindergarten in West Bloomfield more than 20 years ago, she noticed that a distinct group of children had trouble following simple directions and adapting to the daily routines, while the majority of kids seemed to adjust quickly and easily.
“There were a lot of self-control issues, and most of these kids came from lovely families; many had siblings who did not have these problems,” she said.
Mann started doing her own research and realized many of these students fit the description of a condition called Attention Deficit Hyperactivity Disorder or ADHD.
ADHD is a common condition that affects the “executive functions” of the brain, which include organization, time management, focus,and the ability to prioritize tasks and activities.
Children with the disorder are often seen as disobedient, disruptive, restless and forgetful. While the ADHD child is usually at least as smart or smarter than his peers, his grades are often lower because he is unable to focus in class and often forgets to turn in homework or study for a test.
A 2011 study by the Centers for Disease Control and Prevention (CDC) found 5.2 million, or 8.4 percent of children ages 3-17 in the U.S., had been diagnosed with ADHD — 12 percent of all boys and 4.7 percent of all girls.
Because the condition carries over into adulthood, men and women with ADHD are frequently late, harried and disorganized. Those who may be labeled absent-minded, ditzy or scatterbrained may actually have ADHD that has gone undiagnosed since childhood.
Mann eventually left the teaching field to become a parent educator, coach, consultant and advocate for children and families struggling with ADHD and its ramifications. Through her practice, Academic and Behavior Consultants in Sylvan Lake, Mann helps parents develop strategies and navigate through the maze of issues involved in raising a child with ADHD.
The Missing H
While ADHD is the commonly used term, many children are missing the “H” factor: They have the attention problems but not the hyperactivity component. For this reason, the number of children, especially girls, who have ADHD may actually be higher than the CDC study showed because girls often lack the hyperactivity component, which makes the condition harder to diagnose.
Mann said those kids who are not hyperactive often fall under the radar at school because they do not misbehave or disrupt the classroom.
“These kids are the hardest to treat because they often slip through the cracks,” Mann said. “They may be considered lazy, but they’re not singled out because they’re causing trouble in the classroom.”
Mann and other experts agree it is essential to get an accurate diagnosis before an effective treatment plan can be developed. However, this is often easier said than done.
“It’s not something you can take a blood test for,” Mann said. “There are a lot of disorders with self-regulation issues that look like ADHD, such as Asperger’s Syndrome, anxiety and depression.
“Anxiety and depression can look like defiance,” said Mann, adding that other disorders, such as bipolar and even Tourette’s syndrome, can be present along with ADHD. Behavior problems or inattentiveness also can be caused by conditions such as allergies or lack of sleep. “I always advise parents to see a trained psychiatrist to rule out other things.”
While there are varying opinions about medicating children with ADHD, most health care professionals agree that a thorough medical evaluation should be done before any medicine is prescribed.
ADHD medications can fall into two basic categories: stimulants, such as Ritalin and Adderall, and non-stimulants, such as Stattera.
Dr. Randy Dean, a Bloomfield Hills-based psychiatrist, said she evaluates children based on a variety of factors, which include medical history along with observations of parents, teachers, tutors and caregivers.
“It is a clinical diagnosis based on a constellation of symptoms that pervade most areas of life and have been present since early childhood,” she said.
When it is determined that medication is warranted and the parents are in agreement, Dean said she prescribes it as part of a multi-modal treatment plan that includes other components such as therapy, coaching, tutoring and behavioral plans.
Melissa A., a Birmingham parent who asked to remain anonymous, tried a variety of prescription drugs to help her 10-year-old son, Max (not his real name), who was diagnosed with ADHD and anxiety five years ago. She also tried over-the-counter supplements and special diets, but the results were inconsistent and hard to track.
“There is no magic pill,” she said. “There is a lot of stress, heartache and a constant learning process.”
After determining the stimulant drugs were more effective, it took a process of trial and error to find the right dosage. Because Max could not swallow pills at the time, his mother would crush the tablets and sprinkle them on yogurt. Max got the best results from a low dose of Adderall XR, a time-release stimulant medication, combined with the anti-depressant Zoloft to address his anxiety. He also sees a therapist and an academic tutor.
“As a parent, you have a huge responsibility to make everything work,” she said.
Because parents play such a critical part in creating and managing the child’s home life, Mann believes parent education should be the first priority for families dealing with ADHD.
“If parents change the environment properly, the child will be more successful,” she said, adding that new routines and strategies should be research-based. “The best behavior plans, at home and in school, are consistent, positive and repetitive.”
Because there is a hereditary component to ADHD, many parents have the condition themselves, making it difficult to stay organized and maintain consistency at home. Keeping accurate records about medication, school progress and behavior plans also is a challenge.
In addition to providing individual coaching, Mann offers “Parenting Boot Camp” classes that educate parents about the disorder and provide strategies to improve behavior and foster teamwork and communication between home and school.
Mann encourages parents to be proactive when it comes to dealing with their children’s school.
“The [educational] system is not well versed in ADHD,” she said. “Don’t wait to hear from the school; communicate with them first. Send a letter before the first day, and set up a meeting as soon as possible. Never assume.”
Mann said that punishment usually does not work because ADHD is a neurobiological disorder, and those who have it cannot usually control its effects without the right kind of support. Many of these children develop low self-esteem because they are reprimanded so frequently.
“These kids get in trouble constantly because they can’t stay in line or they lose things,” Mann said. “Part of their disability is a lack of organization. You can’t punish them for it.”
She recommends meeting with teachers and other school personnel to suggest some simple strategies that can be worked into the regular school routine without drawing attention to the child with ADHD.
“A lot of teachers want to help, but don’t know what to do because they haven’t been trained,” she said.
Because restlessness is often a factor, teachers can find positive ways to let a child stand up and move around, such as returning books to the media center or passing out supplies. For a child who repeatedly forgets to turn in his homework, appointing him “homework collector” may resolve the problem.
In addition to ADHD, Max has a learning disability called dyscalculia, which makes it difficult to memorize facts. Because he needed more specialized support than the public school was providing, Melissa A. enrolled him in Eton Academy, a private school in Birmingham that specializes in students who have ADHD and other learning disabilities.
“There are only six kids in a class, and they put together an individualized program for each student,” she said. “It would be wonderful if all schools could take that approach.”
Cristene Hall grew up with ADHD, so she thought she could help her 10-year-old son, Jakeb Bradburn, when he started showing signs of the disorder.
“He kept getting in trouble in school,” said Hall. “He refused to stay in his seat on the bus, he wasn’t following directions and his grades were Cs and Ds.”
When Hall took her son for testing, the results were as she had suspected: Jakeb was diagnosed with ADHD. She met with school personnel before Jakeb entered fourth grade to develop a plan under Section 504 of the 1973 Rehabilitation Act, which ensures that any child who has a disability identified under the law receives the accommodations necessary for academic success.
“I thought I would start seeing a difference,” Hall said. “Then came my breaking point. He was suspended three times during the first month. I was doing everything the school told me to do, everything the doctors told me to do. I had hit the wall; I was frustrated, crying. I didn’t know what to do.”
At the suggestion of a school social worker, the Melvindale mother turned to Mann for help, who reassured her there were options to help Jakeb manage his behavior and improve his performance in school. Mann facilitated a meeting at the school, working with the staff to design a behavior plan that worked with Jakeb’s ADHD, rather than against it.
“He’s only gotten in trouble once, and his grades are As and Bs,” Hall said. “He’s starting to see he has responsibility and to be accountable. I see him maturing.”
Hall also enrolled in Mann’s parenting program, where she learned effective strategies to use with Jakeb at home.
Some of the tools include detailed checklists for morning, after school and bedtime, with visual reminders about daily tasks such as brushing his teeth, hanging up his coat and emptying his backpack. Hall said the checklist is more effective than the constant verbal reminders she used in the past.
“It reminds me every single day that I have to do everything,” said Jakeb, who is “really happy” about the improvement in his grades.
Hall uses another system involving pennies and marbles to reward Jakeb for good behavior during the school day.
“As a parent, you’ve just got to stay on it,” Hall said. “Stick with your instincts. Parents know their kids. Look for answers, talk to people.”
More than 60 percent of children with ADHD also have sensory processing disorders, according to Michelle Mintz of Inner Connections in West Bloomfield. Mintz, who is an occupational therapist, provides a variety of services using sensory input techniques that help the brain build new neural pathways. Some of the signs that a child has sensory processing issues include sensitivity to touch or sounds.
“These are the kids who can’t tolerate noisy environments, or who are bothered by the tags inside their clothing,” she said.
The treatment Mintz provides helps children with problems such as attention deficits, poor handwriting or other fine motor skills and coordination.
“A lot of them don’t have a sense of where their bodies are in space,” said Mintz. “I look at the whole kid, the whole picture, to determine what kind of therapy is best.”
She uses a variety of techniques, sometimes in combination, that include integrated listening systems, balance and movement exercises, and craniosacral therapy, which works with the tissue and fluids surrounding the central nervous system to help create balance and improve performance.
Dr. Eric Mintz of Gentle Touch Family Chiropractic in West Bloomfield uses a neurofeedback system called BrainCore Therapy to treat children and adults with ADHD and other disorders. According to Mintz, who is Michelle’s husband, research shows those with ADHD had higher than average levels of delta and theta brainwaves, which are normally associated with sleep. Some of the outward manifestations of this include lack of attention and hyperactivity.
“By helping the brain through BrainCore Therapy to retrain dysregulated brainwave patterns, we can transform an unhealthy brainwave imbalance into a normal, healthy, organized pattern,” Mintz said. “The best thing is that it’s non-invasive and no drugs are utilized.”
While BrainCore Therapy is a proprietary system, other local practitioners offer neurofeedback-based treatment for the purpose of brain wave regulation. One such psychologist is Michael Morris of Novi, who uses interactive light therapy to relieve symptoms of ADHD, anxiety, depression and other conditions.
Mintz said that, in some cases, BrainCore Therapy can minimize and sometimes replace the need for medication. “I’ve seen children go from getting C’s and D’s in school to A’s and B’s, sleeping better, improving behavior, handling stress better, no longer forgetting things,” he said. “Most often what I hear from patients is an overall improvement in ability to focus and pay attention.”
As a fourth-grader in Lake Orion, Jacob Lasher was experiencing a decrease in grades and an increase in confrontational behavior, hyperactivity and insomnia. While researching treatment options for his son’s ADHD, his father, Anthony Lasher, came across information about neurofeedback and BrainCore Therapy. Although he was skeptical at first, Lahser decided to give it a try. After 20 sessions over a 10-week period, Jacob began to exhibit significant improvement in several areas.
“Jacob’s insomnia began to disappear … no longer was I finding a restless, exhausted, frustrated child each morning,” said Lahser, who received feedback from several adults who noticed that his son appeared visibly calmer and more focused. “Finally, at the conclusion of his fourth-grade school year, Jacob brought home a report card of straight A’s in academics and significant improvements in behavior-related markings.”
Music is another tool that can be used to improve concentration in children with ADHD. A research study at Brigham Young University found that when a group of kids ages 7-17 with ADHD listened to three 40-minute recordings of classical music a week, their brain waves moved to higher levels that allowed them to focus more on tasks while they listened.
For very young children, giving directions in a rhythmic sing-song manner can help improve attention because rhythm is perceived differently by the brain.
Martial arts, such as karate, have been shown to help children with ADHD by promoting self-discipline and improving physical dexterity and confidence.
At Mann’s suggestion, Cristene Hall signed Jakeb up for karate lessons, which she says have helped develop his coordination as well as his self-esteem.
“A lot of people look at it [ADHD] as an excuse for a ‘bad kid,’ but I think he’ll do better than I did as a child,” Hall said.
By Ronelle Grier, Contributing Writer