Sophia had always been a creative child. She loves drawing, telling stories and making things. When she was 7 years old she wrote and illustrated a story about a dog named Max, whose tail wouldn’t wag, so he went to a powerful wizard, but even the wizard couldn’t help him.
She had an informal diagnosis of Attention Deficit Disorder (ADD) from her school psychologist at age 6 after teachers suggested she be evaluated, her mother, Rose Caiola, said. Although Sophia, now 13, isn’t hyperactive, she has a hard time focusing for long periods of time.
Caiola went to six different specialists, and looked at various alternatives to medication, such as group cognitive therapy and neurofeedback. The first is a group approach to a semi-structured therapy where patient and therapist examine the factors that led up to the problems they’re having and consider how their interactions with friends, family and other important figures in their life contribute to these issues. Neurofeedback is a real-time display of brain activity to teach people self-regulation of their brain functions.
She hired tutors and stayed in communication with her daughters’ teachers to check on her progress in class.
“Some can be forthcoming and just say, ‘You know what? We think your child has ADD.’ or they say, ‘There’s something wrong, and maybe we should have the child looked at,’ or ‘She has anxiety,’ or something,” Caiola said. “With parents, the first thought is ‘Oh my god,’ there is something wrong with my child. The second one is there is some embarrassment and shame … thinking, ‘What did I do? How did I mess up?’”
Diagnosing ADHD
Attention deficit hyperactivity disorder, or ADHD, is defined by the National Institute for Mental Health as a common childhood disorder that can continue through adolescence and adulthood. The symptoms included hyperactivity and a struggle to stay focused and control behavior. People can be predominantly hyperactive and impulsive, predominantly inattentive or have a combination of hyperactive-impulsive and inattentive behavior. In most cases, there is a combination.
Although students such as Sophia don’t have hyperactivity problems, ADHD is now the word used to describe all kids who fall under that umbrella, instead of ADD, which remains the more culturally popular term.
Students with ADHD have problems focusing for long periods of time, which can lead to stereotypes and assumptions about their abilities — namely that they’re lazy, rebellious or even unintelligent. Although they have problems focusing, students with ADHD can have self-discipline and even thrive academically, but it’s important that teachers put certain support systems in place and understand the nature of ADHD. Often, students with ADHD do better in college than high school, but first they need to get through the obstacles that present themselves in their secondary education years.
According to the Center for Disease Control’s 2009–10 data on children aged 4 to 17, 11 percent of children have ADHD, which accounts for 6.4 million children. It can be costly too, with the annual average direct cost for each ADHD patient coming to $1,574 compared to the CDC’s $541 for matched controls. The annual average payment plus indirect costs per family member was $2,728 for non-ADHD family members. The issue of how to teach and treat children, as well as adults, won’t go away any time soon. The CDC reported that two million more children in the U.S. have been diagnosed and one million more were taking medication for it over an eight-year period.
The gold standard for officially diagnosing a child is to do a two-hour assessment using a battery of tests and then do a clinical interview, which focuses on all the parts of their lives where their ADHD has caused problems. They would also consider information from outside sources such as parents and teachers and other people in the child’s life. There is also a more involved test which can cost thousands of dollars and takes all day, which would look beyond ADHD and other learning disorders and examine neurological function.
Children and adults with ADHD may go undiagnosed for several reasons. For adults, their symptoms may look like the symptoms of depression and are thus left untreated, especially in adulthood, because it has long been believed that it was only a disorder for children and young people. It can also go undiagnosed in girls because of how the symptoms can show up differently in girls than boys. Girls, may be quieter in class or afraid to ask help and draw attention to themselves, which can delay their getting help. According to the CDC, 13.2 percent of boys are diagnosed compared to 5.6 percent of girls.
Schuyler Cunningham, director of the DC Center for Neurocognitive Excellence, said the understanding of ADHD and how to diagnose it is rapidly changing. The Diagnostic and Statistical Manual of Mental Disorders changed the way it describes an ADHD in adults in its 2013 edition, though its evolution has been a long one. The idea of “mental restlessness” had been around since the late 1700s and was more clearly explained in the early 1900s, but it wasn’t until the 1970s that the definition of ADHD included more symptoms such as inattentiveness and distractibility. In the 1980s, the DSM changed ADD to ADHD and in the 1990s, there was more development on subtypes of ADHD. It no longer reads that only children are diagnosed with the disorder and describes how it can affect people later in their lives. It also mentions that people can have mild, moderate, or severe ADHD.
“Up to 50 percent of people with ADHD can have an anxiety disorder and around 30 percent can have major depression. Because there’s also a fair amount of people within the general population who have anxiety and depression that is clinically diagnosable that may have attention problems, but that doesn’t mean they have ADHD,” Cunningham said. “So if you give them a stimulant medication, yes, that will help any person focus.”
For those who do have ADHD, Cunningham helps them create an achievable plan during high school and into college. Students with ADHD are often treated as unmotivated — or even unintelligent — by their teachers and told that positive thinking will help them get through it, Cunningham said, but that’s the wrong message to give someone with ADHD. There’s also a tendency to think if a student is successful in one area, they should be able to be high performing students across the board.
“People say, ‘Oh you just need to put your mind to it and work harder or you just need to motivate yourself,’” Cunningham said. “I don’t really like positive thinking because if you have someone with ADHD and you just say ‘Why don’t you think positive thoughts?’ it’s basically a setup for shame. Because I should be able to do this, and I can’t do this, so there’s something wrong with me.”
Robert Rigby has worked with students with learning disorders at Fairfax County public schools. He also works as a high school Latin teacher. It can be challenging for teachers to both give attention and be gentle with students with ADHD because they’re trying to teach a variety of students with different learning styles, which can fray a teacher’s nerves.
“Teaching is hard too and you get impatient. Labeling is a product of impatience, and you have a crowded classroom and there’s too much pressure to make every student succeed. We’re rating teachers and judging teachers on how well those kids do to the test,” Rigby said. “We’re told to accommodate and we’re told to differentiate instruction, but we have standardized tests we need to prepare kids for. There’s pressure for kids to succeed so teachers have less time and opportunity for accommodations and patience and different ways of teaching.”
Why college is often an easier for people with ADHD
Rigby said a typical school setting, in which students sit in a desk all day without much time to move around can be difficult for anyone, but especially children with ADHD. He said high schools could help students more by offering more electives and paring down the required high school curricula.
“It’s not an ideal environment for someone who changes their attention to tasks, and school can be very alien for ADHD kids. I think college is a better environment,” Rigby said. “There is more freedom to choose what to study and more freedom on how to study, whereas in a high school class, you’re in class for an hour and a half, and you have all these teacher-directed hours, whereas in college, learning is more self-paced and self-directed. For kids with ADHD, not being interested is a real barrier to being engaged.”
Even in college, however, students with ADHD have certain challenges. They may struggle with taking certain required classes, for example, and need a plan on how to tackle that work.
“For example, do they want to get an A in an engineering a class they’re not that interested in? That may not be as possible as calculus or something. And to get clear realistic goals, like maybe your goal of getting straight As in everything isn’t realistic. Maybe you focus your time on one semester where you do these required courses and get academic support and all that. And plenty of my ADHD clients are highly successful and high functioning,” Cunningham said.
Cunningham said students can work with professors and their academic support department to create a plan that will help them learn the material and cope with inattention issues as they come up, whether they’re in their undergraduate years or graduate school. For example, some students with ADHD have a difficult time reading for a long period of time.
“Sometimes, people tell me they can’t deal with graduate work, so they don’t read anything and they go to class and get the slides from the professor’s lecture and the paper is based on how the professor has presented the material,” Cunningham said. “It make be too much for them in the timeframe they have to go through the syllabus, read the original document, create their own interpretation, integrate the interpretation of the professor with their interpretation and write their paper, so they would work around that and still achieve the goal they were looking to achieve — writing a good paper — and read the material when they have more time on their own.”
Despite some of the challenges that may still arise in college — disinterest, inability to focus for a long period of time — Rigby said that he keeps in touch with his former students with ADHD and has found that they can really succeed.
“I find a lot of kids who really struggled in middle school and high school sitting in a room with 30 or 35 people go to college and really thrive. …. ADHD kids can have self-discipline,” Rigby said.
College also allows more flexibility in certain rules on tests. For example, some students with ADHD really benefit from listening to music while they take tests, but a lot of teachers don’t allow students to listen to music because they think they may actually be listening to recorded answers or guidance for the test. Rigby allows students to listen to music on the tests he writes, but he can’t allow the same for standardized tests, where there are concerns that students will cheat if they are allowed to possess phones or iPods.
That isn’t to say that these problems of inattention or hyperactivity go away in college, however. For adults with ADHD, an office space can be a return to some of the challenges they faced in a high school classroom.
“Being in a chaotic classroom can be unsettling. In a professional setting, the open office space is a big deal and is seen as a huge innovation for everyone, to sit around this big table and talk to each other, but for someone with ADHD, that could be the worst,” Cunningham said.
Parenting a child with ADHD
Rose Caiola is optimistic about Sophia’s future. She has kept her interest in art and loves science. After all of those visits with different specialists, Caiola had a difficult time telling teachers and specialists that she didn’t want to medicate her daughter.
“No one wanted to hold my hand through it. They just said, ‘You need to give her medication and at the end of your search to help her, they told me, you’ll come back and give it to her,’ and I said that’s fine but I need to do the legwork whether it’s on the hamster wheel or not, and figure out what is best for her,” Caiola said.
After much research, she decided to ask her daughter’s opinion during the fourth grade. She took medication, but realized it wasn’t for her after eight months of not sleeping well, feeling anxiety and losing her appetite. She switched medication a couple times but nothing worked. Since then, Sophia has support systems in place, such as extra help from teachers, which has helped keep her on track academically.
In Sophia’s story, Max feels lonely and goes to the woods to contemplate his fate. The wizard returned and put Max in a time machine to the future, where finally he was cured and could play with other dogs.
For Sophia, and many other students with ADHD, time and access to support can help them cope with their challenges.
“Years later, she has not only excelled but has had some of the best years of her life,” her mother said.