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with ADHD
By James Kagan, MD  Attention Deficit Hyperactivity Disorder, or ADHD, is the most common neuropsychiatric disorder of childhood and, therefore, a common disorder among foster children. It is an inherited deficiency affecting the area of the brain located behind the forehead. This area is responsible for what are called "executive functions," and it requires an adequate amount of the chemical dopamine to do its job. When there isn't enough, executive functions are impaired, and symptoms of ADHD appear. What are these executive functions? What are the resultant symptoms of ADHD? The Executive Functions are the Ability to:
1. Get organized and stay organized.
2. Make a plan and stick to it.
3. Prioritize the various items in the plan.
4. Manage time, such as being aware of the passing of time, being on time and incorporating a timeline into the plan.
5. Resist procrastination and get down to work.
6. Resist distractions and stay on track.
7. Track one's progress and modify the plan or the goal as time passes.
8. Complete the plan on time. The Symptoms of ADHD Therefore are:
1. Disorganization
2. Poor planning
3. Poor prioritization
4. Poor time management or the absence of the concept and importance of time
5. Procrastination
6. Distractibility
7. Poor tracking of progress
8. Poor task completion
9. Many children with ADHD are also overly active with constant fidgeting and squirming. They are easily bored and frustrated, and can be argumentative and noncompliant. One of the most frequently asked questions about ADHD is, "That sounds like all kids at times - how can you tell if they have ADHD?" It's a legitimate question, particularly for foster children who have often suffered some degree of neglect, abuse and inconsistent parenting. The answer is, if the symptoms are present for so much time or are so severe that they interfere with the child's functioning at home, school and with peers, then ADHD is probably present. However, other psychiatric conditions such as depression, bipolar disorder, anxiety disorders and substance abuse can mimic the symptoms of ADHD and must be ruled in or out by a thorough evaluation. So, what can you, the foster parent, do to help your foster child improve his or her functioning at home, school and with peers if ADHD is present? The first thing you can do is become educated about the disorder. Check out the library for books on ADHD. Get online, and surf the Internet for reputable Web pages like those of the American Academy of Pediatrics, the National Institute of Mental Health, and Attention Deficit Disorder Advocacy Group. See if there are local ADHD parent support groups in your area. Talk with your child's physician, health clinic or mental health clinic. Speak with your child's school psychologist to find out if your child qualifies for a 504 Plan or Individual Education Plan, which can offer special modifications to improve learning. Next you can implement some relatively simple modifications to your usual parenting plan:
1. Make sure that you are dealing with ADHD and not some other disorder. This requires a professional evaluation by a physician familiar with the disorder, a psychologist or a psychiatrist.
2. Ask your child what will help. Chances are he or she has been struggling with symptoms long enough to have some good ideas of what works and what doesn't.
3. Provide additional structure in the form of lists, reminders, rewards and schedules.
4. Make frequent eye contact - this helps to ensure that your child is listening when you are speaking.
5. Take charge, set limits and boundaries, be consistent, act promptly and, above all, be calm, soft-spoken and reassuring rather than reactive and punitive.
6. Encourage your child to take the initiative to ask for a "time-out" when things feel too stressful.
7. Break down large tasks into smaller ones that are more manageable.
8. Be playful, fun and unconventional, but avoid over-stimulation.
9. Make expectations explicit.
10. Provide a lot of opportunities for strenuous physical exercise. What About Medications?
This issue often raises concerns, some perfectly justified, others based on fear or irresponsible fear mongering. The truth is that responsible medication management has been a mainstay in the treatment of ADHD for more than 40 years. When the disorder is properly diagnosed and medications are properly prescribed and administered, the results are generally quite gratifying to the child and parents. Medication treatment is aimed specifically at the biochemical problem, or the dopamine deficiency. Effective medications raise dopamine levels close to normal, resulting in decreased symptoms. The medications most often used are the amphetamines Ritalin and Dexedrine and the newer nonamphetamine medication Strattera. Because the amphetamines are potentially abusable substances, there has long been concern about their safety. As a result, a number of studies over many years have evaluated this concern, and the overwhelming opinion of experts in the field is that if they are appropriately prescribed and administered for ADHD, they are some of the safest medications used in children. ADHD is a common disorder in foster children. It may result in significant impairment of functioning at home, school and in social settings. Education about the disorder is key to providing appropriate help for the child with the disorder, and help is available in many forms, including educational, behavioral modification techniques and appropriate medication management. ABOUT THE AUTHOR: James Kagan, MD, is a pediatrician turned psychiatrist practicing in Fort Collins, Colo. He has cared for a large number of foster and adopted children during his more than 30 years of clinical practice. He currently works with children and adults in his private practice and adolescents in a local residential treatment facility. |
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