Attention-deficit/hyperactivity disorder, or ADHD for short, is one of the most common childhood neurodevelopment disorders. Child Psychologist, Dr Renee Simons, of Edgewood Paediatric Services, tells us more about the condition and how parents can get their child the help and support they need.
Royal Gazette: Is it more common to hear about children being diagnosed with ADHD today? If so, why?
Dr Renee Simons: I’m not sure if ADHD is more commonly diagnosed today, however, I do think there’s more acceptance of the diagnosis and more people seeking treatment and support. In recent years, some local insurance companies have provided increased coverage for ADHD. Additionally, what I’ve found is that the stigma around mental health and other childhood conditions is generally decreasing. In the past, people were more private about such conditions, but parents today are more aware of the different challenges children face and are more likely to seek support. Since the start of the pandemic, there has been an increased focus and discussion around mental health, so I think people are becoming more open. The thing about ADHD is that it’s a neurodevelopment disorder meaning there are brain differences and markers that you can see from a medical perspective, so it can’t just be dismissed or denied.
RG: What are the main signs that indicate a child may have ADHD?
DRS: The symptoms depend on which type of ADHD a child has. There is one type called Predominantly Hyperactive-Impulsive Presentation. That’s where you see children with a lot of hyperactivity and movement. They might fidget, talk a lot or be constantly doing things. You may see a child who is impulsive and who has more accidents and injuries than others. Older teens and adults may experience feelings of restlessness, but it may not be as apparent to an observer.
Another type of ADHD is called Predominantly Inattentive Presentation, which tends to be harder to notice. In this case, individuals may find it difficult to organise or finish a task. They struggle to pay attention to details, and find it hard to follow instructions or conversations. The person may be easily distracted, struggle to focus and be prone to daydreaming a lot.
Then there are also some people who have Combined Presentation, which is when symptoms of both types of ADHD are equally present in the person.
RG: If you suspect your child has ADHD, what steps should a parent take?
DRS: If you think your child has ADHD, the first step would be to discuss it with your child’s paediatrician. There is a questionnaire a doctor can lead the parent through to see if their child meets the criteria for ADHD. The doctor can also provide recommendations if a further, more detailed evaluation is needed by a psychologist.
Parents can also self-refer to psychologists in Bermuda or go to Child and Adolescent Services, which have a multidisciplinary team which can assist in the diagnosis. In order to get a formal ADHD diagnosis, doctors should take into account the parent, teacher and child’s perspective, if the child is old enough to weigh in.
One piece of advice I would give to parents when going through the diagnosis process is to be transparent with their doctor about any other emotional challenges the child may have experienced. Sometimes ADHD can be misdiagnosed because the symptoms mimic those seen in children with anxiety or those who have experienced trauma.
RG: What are the main treatment options available?
DRS: It’s important to remember that treatment doesn’t equal a cure. ADHD is something that needs to be managed rather than fixed, particularly because as kids get older their symptoms and presentation of the disorder changes, so their treatment also needs to change. The most common treatment for ADHD includes behaviour therapy and medication. According to the American Academy of Paediatrics, children age six and older are recommended to have both. Those under six should just have behaviour therapy.
There are also things that can be done in the classroom to support learning such as providing alternative seating, for example a yoga ball or a wobble seat; or preferential seating like allowing the child to sit at the front of the class or away from windows or doors, which can be distracting. Additional accommodations for students with ADHD may include providing extra time on exams. Parents can also help with setting up the child’s home environment to be more organised and supportive of their needs.
RG: How do parents you see normally feel while going through this process with their children?
DRS: Most parents I work with have seen the signs and aren’t really worried when they get an ADHD diagnosis. They are often relieved and may say: ‘Okay, so this answers my questions,’ and they can decide what to do next. Sometimes however, parents can be resistant to receiving a diagnosis. In these cases I try to encourage them to at least try the accommodations or treatment and then determine if there was any benefit for their child.
Sometimes it’s helpful to provide psycho-education so we can advise parents on what the diagnosis means and how our current knowledge can help support the child as they progress through school and life.
RG: Outside medicine, are there any other support channels available in Bermuda?
DRS: For younger kids there’s behavioural therapy, which involves the child and parents meeting with a psychologist and developing a treatment plan to support them in the areas they are having trouble in. Children can also participate in a social skills development group. Other more unexpected activities include martial arts, which can help kids with ADHD develop impulse control skills and improve focus.
As kids get older and progress to middle and high school they might benefit from meeting with an executive functioning coach, who teaches organisational strategies and study skills. The great news is we have all these options available in Bermuda – both in the private and public sector.
For more information, visit www.drreneesimons.com.