Sorting out the reasons for an ADHD diagnosis is, in the opinion of the Lucy Daniels Center clinicians, a complex task. There are times that the most important factor resulting in the ADHD symptoms is a genetic one, but that is in our opinion not always the case by any means. From our perspective and that of many professionals who share this perspective, the determination that a child "has ADHD" does not help answer the question: What are the reasons that my child has ADHD. We will explain some of the many factors that can result in a child being excessively inattentive (Attention Deficit Disorder), or excessively inattentive, impulsive and overactive (Attention Deficit Hyperactivity Disorder) so that parents can understand just how complicated this issue really is.
ADHD often has a physiological basis: People vary with regard to countless human features. Some possess a sense of direction like a homing pigeon; others become lost the minuet they turn a corner. (Fortunately, we have not yet labeled the more directionally challenged among us with a psychiatric disorder!) Children also vary with regard to their natural ability to pay attention, concentrate and control their activity and expression of impulses - traits associated with ADHD. This ability is affected by children's genetic inheritance, but agents that children are exposed to in their prenatal or early life can also influence it. Children who have extreme difficulties paying attention and controlling impulses and activity on the basis of their biological hard wiring have ADHD on a physiological basis.
Professionals have very different opinions regarding how many of the children whose symptoms and behaviors meet the criteria for ADHD fit into this physiological category. The opinion of Lucy Daniels Center mental health clinicians, based upon our understanding of the research and clinical evidence, is: There is some degree of physiological basis or tendency for ADHD in the majority of children with ADHD symptoms but, also in the majority of cases, other factors are making an equal or greater contribution to the symptoms.
Children develop the capacity to pay attention and control impulses: Every parent knows that much more than just genetics goes into being attentive and controlling movement and impulses. A major feature of parents' and teachers' job descriptions is helping children build increasing capacities in these areas. Think for a moment about a meal with an 18-month-old. Parents spend very little time eating because they're busy helping their child pay attention and control his activity and impulses.
The capacities to pay attention and control activity and impulse don't just grow like our pancreas. They are psychological capacities that must be created and molded. They are emotional capacities. Therefore - and here is the crucial point - anything and everything that can affect children's emotional development may affect children's development of the particular emotional capacities to pay attention and control activity and impulse.
Emotional factors also play a role in ADHD: The relationship between emotional development and the capacity to control oneself in various ways (inwardly through paying attention, outwardly through controlling activity and impulse) is indeed complex. Most people have noticed that their ability to pay attention and concentrate is diminished when they are worried, feeling blue or embarrassed? Children struggling with excessive painful emotions therefore often have difficulties with these capacities to control themselves inwardly or outwardly. Since children can respond to any painful internal emotion with ADHD symptoms, the reasons for ADHD symptoms are unique for each child. There are many different reasons and combination of reasons that a child might feel anxious, depressed, embarrassed or ashamed, or guilty.
Each diagnosis is unique; every treatment plan should be individualized: It is important to understand the various factors that have resulted in the unique diagnosis of ADHD for a child. The appropriate treatment(s) for ADHD symptoms can involve a number of methods used by mental health clinicians. It all depends upon what exactly needs to be treated.
The question of medication inevitably comes up when a child meets ADHD criteria. In our opinion, medication has its place in the proper treatment program for some children, but by no means all children.
In almost all situations, medication should be used as part of a comprehensive approach. Such an approach should be individualized on the basis of the understandings achieved in the assessment and might include components such as parent counseling, psychotherapy for the child, family therapy, group work to help with peer relationships, guidance and consultation with the school, and special educational assistance with learning difficulties.
Even children whose symptoms are primarily or exclusively on a physiological basis deserve a comprehensive approach to their symptoms. Although nature has not treated them kindly in the areas involving control of their attention, motor activity or impulsivity, children with physiological ADHD can develop controls in the same way that other children do. These children and their parents just need extra help, because these children are going to have to work extra hard to develop these abilities. Medication, although useful, does not help children grow. It provides an externalized control, a scaffolding from the outside, that is generally only partially effective and may not be nearly enough as the years go on.
We all become what we are for many reasons. ADHD is not an illness like diabetes; it is a part of a child's personality. Parents should keep in mind that a child's ADHD behaviors are likely the result of many factors. With professional support and a multi-faceted treatment program, parents will be on the right road to helping their child develop the capacities that he or she will need for a successful and rewarding life.
To download a PDF of this article, click here.