ADHD: Is Your Kid Just a Little Extra or Something More?

In this episode of MomDoc Talk, host and pediatrician Kristen Cook explores ADHD in children. She explains how to recognize ADHD symptoms, the importance of thorough medical evaluation, and evidence-based treatment options, including medication and behavioral strategies. Kristen also discusses how schools can support children with ADHD through IEPs and 504 plans, and debunks common myths about diet and hyperactivity. She offers practical advice for parents on managing ADHD at home and encourages advocacy and understanding, emphasizing that with the right support, children with ADHD can thrive.

What you’ll learn:

• Overview of Attention Deficit Hyperactivity Disorder (ADHD) in children
• Importance of proper medical evaluation for ADHD
• Treatment options for ADHD, including medication and behavioral strategies
• Role of schools in supporting children with ADHD through IEPs and 504 plans
• Common myths about ADHD related to diet (red dye, gluten, sugar)
• Developmentally appropriate behavior in toddlers and preschoolers
• Symptoms of inattentive and hyperactive/impulsive ADHD
• Process of diagnosing ADHD and ruling out other conditions
• Lifestyle management strategies for children with ADHD
• Advocacy for children with ADHD in educational settings

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Podcast Disclaimer

The information presented in this podcast is for educational and informational purposes only. It is not a substitution for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider for medical concerns. All of the opinions are of Dr. Kristen Cook and do not reflect the opinions of her employer nor the hospitals she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.

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Transcript

0:32

Hi friends. Welcome back to mom doc talk with Doctor Kristen Cook. I'm your host, a pediatrician, parenting advisor, and most importantly, a mom who understands the joys and struggles of raising strong willed kids. My mission is to help you parent the child that you have, not the one that you want, and to make that journey more peaceful and effective. Today, I'm diving into a topic that touches countless families ADHD, which is an abbreviation for Attention Deficit Hyperactivity Disorder. In this episode, I'm going to talk about what ADHD actually looks like in kids, how to get a proper medical evaluation, what treatment options are supported by science, how schools can step in with IEPs and 504 plans to support your child. We'll also tackle some of the myths like red dye, gluten and sugar because unfortunately, there's so much misinformation out there. Before I get started, I want to discuss developmentally appropriate behavior. Toddlers and preschoolers have a very limited attention span. In fact, a two year old can maintain focus for a maximum of six minutes, though they are prone to being distracted by sounds or movement around them. Inattention is common in this age group, and it happens to be developmentally appropriate. Toddlers and preschoolers are also very active. They have trouble sitting still even to eat dinner. So while you may be tempted to get your three year old evaluated for ADHD, I encourage you to wait just a few more years. While hyperactivity and inattention in toddlers and preschoolers can be frustrating for parents, it's actually normal behavior. Yet one does inattentive, hyperactive, or impulsive behavior become a problem? For me, it's when it starts to negatively affect functioning, typically in the school setting, I'm getting ahead of myself. Let's start with the basics. Attention deficit hyperactivity disorder is a neurodevelopmental disorder, which means that it influences the brain and can lead to impairments in cognitive and emotional functioning. It's not a result of poor parenting, too much screen time, or kids just being lazy. A child with ADHD struggles with inattention, hyperactivity, impulsivity, and maybe one, two, or all three of these symptoms. The classification of attention deficit hyperactivity disorder has changed over time and the terminology has evolved. There is no longer a diagnostic distinction between aid or attention deficit disorder and ADHD. All variations are diagnosed as ADHD, with a modifier suggesting inattentive type, hyperactive type, or combined inattentive and hyperactive type. That's the fancy medical terminology to indicate that a child is primarily struggling with inattention, hyperactivity, or both. Let's talk about the symptoms of ADHD with respect to inattention. These kids are forgetful, easily distracted, may lose things, constantly have trouble finishing tasks, or daydream a lot. They need frequent redirection and they struggle to complete tasks without reminders. Let's move on to hyperactive and impulsive symptoms. These kids are constantly moving, fidgeting, blurting out answers, or talking too much. They frequently get up out of their seat, interrupt other people, or cannot wait their turn. Importantly, the symptoms of hyperactivity, inattention, and impulsivity need to be present in two or more settings, such as at home and at school. In addition, those symptoms must interfere with daily life, not just be occasional behavior. For example, a child with ADHD may have a decline in academic performance, or they may be at risk for injury during a sporting event because they cannot focus on the coach's instructions. So how do you know if your child really has ADHD and not just high energy or normal forgetfulness? It's important to mention that the symptoms of ADHD develop before at the age of 12 years old. If your 17 year old suddenly seems to struggle with inattention but had no issues prior to this, it's not ADHD. Something else is going on. It is so important to figure out the actual issue rather than assuming ADHD is to blame. Let's say that you have an eight year old child who struggles with inattention and hyperactivity. He routinely gets out of his seat during math and science class. He needs frequent redirection and cannot complete multi-step tasks without frequent reminders. He is unintentionally disruptive and distracts other students from doing their work. This is a child that would benefit from an evaluation for attention deficit hyperactivity disorder. It's important for parents to understand that there's a process that a medical provider should go through before diagnosing ADHD. That medical provider should never simply monitor a child for a few minutes and determine if they have ADHD or not. An appropriate evaluation process usually includes parent and teacher questionnaires. Tools like scientifically validated screenings such as the Vanderbilt or Conner's rating scales. It's also important to perform a medical history and a physical exam in order to rule out things like thyroid issues, sleep disorders, or vision and hearing problems that may mimic the symptoms of attention deficit hyperactivity disorder. In my medical practice, I rely on completed Vanderbilt forms from parents as well as from teachers to guide my diagnostic approach. I also complete a thorough physical examination, and I have my staff do a vision and hearing screening. While Vanderbilt forms and Conner's rating scales are helpful. It's important to understand that the results of those screening tools are not sufficient to diagnose ADHD. Parent and physician input and evaluation is critical. Why? Because the outcome is immense. This diagnosis can follow a child into adulthood. I cannot tell you how many letters I have written for a patient in support of their abilities to perform successfully in their job, despite a past diagnosis of ADHD. Moving on. Once a child is diagnosed with ADHD, what next? Ideally, the gold standard in the management of this condition is a multimodal approach, meaning medication and behavioral strategies. I want to be clear. There is no cure for attention deficit hyperactivity disorder. Management involves treating the symptoms of inattention, hyperactivity, and impulsivity. In an ideal world, behavioral therapy would be available to every child that has a diagnosis of ADHD. Behavioral therapy provides parent training and behavior management strategies like positive reinforcement, consistent routines, and setting clear expectations. It also helps older kids to build organizational and coping skills. Yet in many communities, especially those that are underserved. Behavioral therapy is not readily available. The most effective medication management of ADHD symptoms are a group of medications classified as stimulants. There are many stimulant medications available, but the most common are methylphenidate, with brand names including Ritalin, Concerta, and vocal in. And amphetamines, with brand names including Adderall and Vivian's. These medications have been around for decades, and they are also very effective. They work by increasing dopamine and norepinephrine in the brain, which improves attention and impulse control. One of the benefits of stimulant medication is that the effects wear off in 4 to 8 hours, which is why they don't have to be given every single day, though daily administration is perfectly safe. I have plenty of families in my medical practice that only give their child a stimulant medication on school days. A lot of parents are worried about their children becoming addicted to these medications, and that's a very valid concern. Addiction is the result of the misuse of stimulant medication, since most parents are in charge of their child's medication administration. The risk of addiction in children is low. There are also non stimulant medication options available, though they don't tend to work as well as the stimulants do. Examples are Tera or guanosine. Adjunctive management of ADHD includes lifestyle management. This includes making sure that a child with attention deficit hyperactivity disorder receives adequate sleep. They have structured routines and engage in regular physical activity. It can also be helpful to limit distractions during homework, like turning off notifications or creating a quiet study space for many kids. Attention deficit hyperactivity disorder impacts their learning enough that they qualify for school based supports. One such support is called a 504 plan. A 504 plan provides accommodation so that the child has equal access to learning. Examples include extra time for tests, preferential seating near the teacher and not being excluded from recess for failing to complete an assignment. If ADHD significantly impacts academic performance, a child may qualify for special education services through an IEP or Individualized Education Plan. Examples for an IEP include specialized instruction and executive function skills, support from a resource teacher, and behavioral interventions. Parents, don't be afraid to advocate for your child. ADHD is recognized as a disability under federal law, and schools are required to provide reasonable support. A lot of parents are interested in trying to find all natural treatments for ADHD that do not involve medication. I completely understand this desire, and I truly believe that involved parents want the absolute best for their child. While I am supportive of parents, I need to ground people in the science. Ants. Let's start with red dye. Some small studies have suggested that certain artificial food dyes may worsen hyperactivity in a minority of children, but the large scale research shows that this is not the case. At best, red dye may trigger in a small group of sensitive kids. My recommendation if you are concerned that red dye is exacerbating your child's ADHD symptoms, try to eliminate it from their diet for a week. Make sure not to change anything else in their diet. If you notice a decrease in symptoms, avoiding red dye may be a good solution for your child. Now for gluten. Gluten is a protein found in certain grains such as rye, wheat, and barley. Unless your child has celiac disease, there's no evidence that gluten causes ADHD symptoms, nor does it worsen the symptoms of ADHD. And again, if you're concerned about the effects of gluten, eliminate it from your child's diet for a week and see what happens. Finally, let's talk about sugar. This is the classic myth. My kid is bouncing off the walls because of sugar. Multiple studies have shown no consistent link between sugar intake and hyperactivity. The excitement of birthday parties or holidays is the real culprit, not the cake. Bottom line there is no special diet that cures ADHD nor manages the symptoms. A healthy, balanced diet with limited processed food supports all children. Parents often ask me, what can I do at home to make life easier? Here are a few practical strategies. First of all, create structure. Kids with ADHD thrive on predictability. Use calendars, visual schedules, and consistent routines. Next, break tasks down. Instead of telling your child clean your room, give them step by step directions such as I'd like you to pick up the clothes on the floor, then put the toys away. In addition, provide positive reinforcement. Catch them doing well and praise them immediately. The brains of children with attention deficit hyperactivity disorder respond well to frequent small doses of encouragement. Finally, collaborate with teachers. Keep open the lines of communication so strategies are consistent at home and at school. And most importantly, remember that ADHD is not your child being bad, lazy, or defiant. Their brain is wired differently and with the right support they can absolutely thrive. So let's wrap up. ADHD is a common medical condition and it can be managed very effectively with the right tools. We've covered symptoms, proper medical evaluation, treatment options, social accommodations and debunked some of the myths around food and behavior. If you're listening and wondering if your child might have ADHD, my encouragement is this request a medical evaluation? Trust science. Trust your instincts as a parent, and don't be afraid to advocate for your child. Thank you for spending this time with me today. If you found the episode helpful, please share it with a friend who might need to hear it. And if you want more information about how to parent the child you have, not the child that you imagined. Head over to my website, Kristen Cook md.com and download a free chapter of my upcoming parenting book, Parenting Redefined. I'm Doctor Kristen Cook and I'll see you next time on Mom Dog Talk.