Child Mental Health for Pediatric Clinicians

53. Early signs of ADHD with Lauren and Ashley

• Elise Fallucco • Episode 53

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Understanding ADHD from a Parent's Perspective

In This episode of Child Mental Health for Pediatric Clinicians, we begin a new series, 'Child Mental Health Talks with Parents,' featuring advocates Ashley and Lauren, who share their experiences raising children with ADHD. They discuss the creation of a Mental Health and Neurodiversity PTA committee, early signs of ADHD in their children, and practical insights for clinicians. Listen in to understand how morning routines and psychoeducational testing can aid in assessing ADHD, and stay tuned for more on masking and self-esteem in the next episode.

00:00 Introduction and Welcome

01:33 Starting the Mental Health and Neurodiversity PTA Committee

03:40 Recognizing ADHD in Children

05:25 Executive Function Challenges

09:28 Gender Differences in ADHD

Check out our website PsychEd4Peds.com for more resources.
Follow us on Instagram @psyched4peds

Dr. Elise Fallucco:

welcome back to Child Mental Health for Pediatric clinicians, the podcast formerly known as Psyched for peds. I'm your host, Dr. Elise Lucco, child psychiatrist, and mom. Today we're introducing a new series for the podcast called Child Mental Health Talks with Parents In today's inaugural edition of Child Mental Health talks to Parents, we're gonna meet with some parents of kids with A DHD to take a deeper dive and learn insights into what it is like raising kids with A DHD and learn from their experiences about how we as clinicians can do an even better job of caring for kids. I am really excited to introduce two parents who are advocates for neurodiversity, and between the two of them have four kids with A DHD. They've also used some of their own personal experience as parents to give back to the community by starting a mental health and neurodiversity committee at their local elementary school. They're gonna tell us a little bit about their journey and share the early signs and clues that made them wonder about A DHD. And I'm so excited because through this discussion, we as clinicians can learn about what are the questions that are best to ask, and the signs specifically to look for in a child that may have a DHD. Without further ado, welcome Ashley and Lauren.

Lauren:

Hi.

Ashley:

Hi.

Dr. Elise Fallucco:

So happy to have you guys. Really excited about our conversation coming up. Let's start by talking about the mental health and Neurodiversity PTA committee that you guys started. Lauren, I know you're the one who came up with this. Tell us a little bit about what you guys do, and what motivated you to start it. First of all, thank you for having us. We're so excited to be here and talk about this important topic.

Lauren:

So I started the Mental health and Neurodiversity PTA committee because as a parent of two neurodivergent kids, I was. Kind of feeling like on an island a little bit. So we had them diagnosed and it's like, here's your diagnosis. Go off into the world and good luck. Good luck. Get your 5 0 4 plan. So what's a 5 0 4 plan? I was just feeling like alone in the advocacy piece. And so I knew as I would talk to like other parents, I'm not the only one here that's going through this trying to support my children. I knew there were other kids who had autism and A DHD and I wanted to create a community. So I decided to start this PTA committee to create that community of parents and to support other parents around me and support the teachers as well.

Dr. Elise Fallucco:

Lauren, that's such a great idea. Ashley, can you tell us about some of the ways your mental health neurodiversity group supports parents, students, and teachers?

Ashley:

We do a lot of really great events throughout the year to be able to provide that support. So we have a book club where we talk and discuss books and we do a movie night at school where we invite the whole entire school to come watch a movie. So last year we did inside Out two where we got the message across about anxiety to kids in a fun way. And we have a support group for parents and we meet once a month and it's just a really great to engage with one another.

Dr. Elise Fallucco:

How amazing that you, both of you are taking a need that you internally have and giving back to the community and creating this amazing support system and service to help other parents and other kids and the entire school better understand and support Neurodiverse kids. And the inside out too movie thing. Screening sounds so much fun.

Ashley:

It was fun.

Dr. Elise Fallucco:

So from a parent perspective, can you guys tell us a little bit about the clues that you noticed in your children that made you wonder about a DHD?

Ashley:

Sure. So I have two children. I have a girl and a boy. And for our boy, we really noticed something was different with his hyperactivity. So he's always running around. He can do sports and play with friends all day, and he is never, ever tired. Even at bedtime. He can't sit still at dinner. He's always bopping up and down and around. So he requires a lot of movement. For our daughter, it was a lot different because she doesn't have that hyperactivity piece. For her it was a lot more about executive functioning. So I could tell that she would struggle with simple routines. Even as a seven or 8-year-old, she knew she would have to get dressed every morning, but she couldn't do it by herself. Like she needed constant reminders. She needed me to help her pick out her outfit. She could not clean her room by herself. It just was an overwhelming task. And so I would have to always go into the room with her and help break it down by, category, Hey, let's do all of your books first and let's do all of your toys. Okay, now let's put away your clothes. So she just can't, to this day, she still can't do that by herself. And then she's, you know, she's disorganized. Her room is like a complete disaster, which I know a lot of kids have messy rooms, but she just really thrives in the chaos. And she will forget things. She'll lose things. She's really talkative with others, which is a great quality to have. But it does also result in a lot of interrupting of people. And that can be tough for her too. So it's a lot of that impulse control as well.

Dr. Elise Fallucco:

Wow. And going back to the executive function part and just to review, for everybody who's listening, executive functioning, what we're really talking about is higher level abilities to problem solve, to take a multi-step task or project and break it down and also be able to make changes on the fly, if you're interrupted between step two and step three to know how to reset and and then of course to control your impulses. And so you're talking about how your daughter would have trouble getting dressed in the morning or cleaning her room. you can imagine if you struggle with executive functioning and mom says, clean your room, you're like, that's completely overwhelming. There's books on the floor and there's clothes over there and I don't even know what that means. And where do you begin?

Ashley:

Exactly.

Dr. Elise Fallucco:

And I imagine as a parent it can be really frustrating and it would be hard to understand. They're not trying to be defiant, they're not trying to be difficult or overly emotional. It truly is completely overwhelming.

Ashley:

Exactly. Like I can tell that it wasn't just something she didn't want to do. It was something that she genuinely could not do herself. And I think one other thing I'll mention too is our school routine in the days which. Be so difficult, right? Every morning we do the same exact thing. You get up, you get dressed, you have breakfast, you brush your teeth, you get your shoes, and we leave. And no matter how often we did that, she still couldn't get it down by herself. So now as a fourth grader, she needs those constant reminders, okay, it's time to go do this now. Or send her upstairs, please go brush your teeth. And then 10 minutes later I yell up to the stairs, you know the stairs to her, and I'll be like, Hey, did you brush your teeth? It's time to leave her school. And she's like, oh no, sorry, I got distracted. I'm reading a book. And so that was also a really big sign for us.

Dr. Elise Fallucco:

I love how you're fleshing this out. Like one of the questions that we ask as clinicians when we're trying to suss out a DHD is does your child have trouble with multi-step commands? If you ask them to do two things in a row or three things in a row, can they do all three of those things or do they get sidetracked? And what a great example you're giving of. Like the classic example of the morning routine that has a bunch of repeated five or six steps. The other thing that makes me think about is how visual reminders can be so helpful. Making those silly little charts that say morning routine and there's a little picture of a toothbrush, to remind you, you first brush your teeth and the next thing is put your shoes on or, whichever the order is.

Ashley:

Yeah. And we've actually, interestingly enough, come up with a variation of that tool because we had tried that in the past for her and it still didn't work. But only recently did we come up with the same type of tool, but there's more tactile and interaction with it. It's almost like a little flip chart. And she'll have the tab or brush teeth and she has to move it from one side to the other side. And that's actually helped a lot more. And so that's not something I would've thought of but even just making that small tweak has helped her brain. Understand

Lauren:

We have a similar thing where my kids love to write with expo markers, so we have a laminated version of that chart on our refrigerator. And one thing I will say too about, as a parent of a child with A DHD, and as somebody with a DHD myself, it's this constant need to come up with a system that might work for a month or two months and then you find it doesn't work anymore. And now I have to come up with a new system. So there's your sign. If you're wondering if your child has a DHD. Do you change systems a lot?

Dr. Elise Fallucco:

Yes, that also makes me think about parenting in general. I'm like, you're never able to catch up. Oh no. Something will work for a little bit and then something new is thrown in your general direction and there you are again. For sure so Ashley, you've talked about a lot about the executive function issues with your daughter that made you wonder hmm, this possibly could be a DHD Lauren, what's your experience? What were some of the early clues or signs that made you wonder about A DHD and your kids?

Lauren:

So interestingly, I think mine is like the exact opposite experience. And so we talk about gender differences and stuff. I have a boy and a girl, so my boy is older and he has autism, and A DHD. So he is extremely creative and at the same time really struggles with organization and a lot of the struggles that Ashley's daughter would struggle with, like cleaning up and prioritizing tasks. So all those executive functions it really struggles with those. It really came down to his profile once we got tested and we were looking at that and he was very bright. With the visual spatial reasoning but his working memory and processing speed was a lot lower. And so having that differential was a red flag of maybe there's something going on here.

Dr. Elise Fallucco:

So to recap, in your son, you noticed that he had problems with organization, problems with executive function and prioritizing things, and then when you had him do a full IQ test, what you noticed was relative areas of weakness in processing speed index, as well as in the working memory index and these symptoms together with other problems with hyperactivity and impulsivity and inattention. Are the common pattern that we see in kids with a DHD. So tell us about what were clues that you noticed in your daughter that she might have a DHD?

Lauren:

So for my daughter it was a little bit. A little bit confusing because she couldn't sit still like a typical A DHD symptom, something that you think of, like hyperactivity. When she was watching a show, she'd be bouncing around and liked a lot of that proprioceptive input. We also had sensory issues with getting dressed and interrupting others constantly because she thinks she's going to forget what's in her head, and so she has to get it out now or else it's gone forever. One thing that I noticed with her too, and this was something that I was just really confused about, was word recall. So she'd be talking about something and she's trying to get the thought out before she forgets the whole thought, but she can't come up with the word that she's thinking of. So a lot of times she'd say the thing or over there,

Dr. Elise Fallucco:

Her mind is moving very rapidly. Yes. And she's thinking about a lot of things and she doesn't wanna stop and take the time particularly to remember this weird word that she doesn't use very often. So she just. Insert something else and keeps on going.

Lauren:

So we took her to have an evaluation.. So we thought we'd have her tested so she had that same sort of spiky profile that my son had very high in a lot of areas. And then working memory processing speed was lower.

Dr. Elise Fallucco:

And so for her, the working memory issue manifested as kind of trouble remembering the word In your brain. Yes.

Lauren:

Yeah, exactly. It's oh, that's unimportant details over there. Yes. Yeah. I don't have time for that. Let me get my thought out. Yes. Because the big picture for her, she can very much see the big picture and things, but details for her, she's just not into the details.

Dr. Elise Fallucco:

Yes. And I would say that phenotype is very classic of a DHD. Certainly not all kids with a DHD, but a lot of people with a DH, ADHD are incredibly creative and can think outside of the box and can have this amazing big picture. And then when you sit down and you say, I'm gonna need you to take me from step one to step 571 and make sure the i's are dotted and the T's are crossed, like people with a DHD are just like that, you have no patience for that. That's incredibly boring. Yeah. And it's much, your brain is oriented towards. S creativity and big vision and all of these incredible gifts. And it is boring to go from step one to step 571. So

Lauren:

Yeah, a hundred percent.

Dr. Elise Fallucco:

And we're gonna take a pause right now and recap some of what we've learned from Ashley and Lauren. So as clinicians, things that we can look for and questions we can ask when we're assessing someone for A DHD. Number one, ask about the morning routine. And does the child have trouble following multi-step commands? When you ask them to do multiple things in a row, can they easily get distracted? Or feel overwhelmed. Second of all, for kids who have had the benefit already of having some type of psychoeducational testing, take a look at their full scale IQ and at the various subsections, and you might see what Lauren called a spiky profile, where there are elevated scores in a lot of the subsections, but particularly or relatively lower scores in working memory and processing speed. Our plan is to continue the conversation next episode with Ashley and Lauren, and learn from the perspective of parents about masking among kids with a DHD and the toll that that takes on self-esteem and energy. Finally, Ashley and Lauren will tell us about what are the things that they wish that everybody knew about A DHD. Thanks so much for listening in. If you liked this episode, please share it with a friend and click the plus button to follow us on Apple and Spotify. Thanks for listening to Child Mental Health for Pediatric Clinicians. See you next time.