Reprinted with permission from Forum Communications and author Danielle Teigen
Years ago when Jane Indergaard’s son was in second grade, she and her husband began noticing some behavioral and academic issues, but they weren’t sure what to do. His teacher suggested he be tested for Attention-deficit/hyperactivity disorder (ADHD).
“We were totally blindsided (by his diagnosis),” she recalled. “At the time, there just wasn’t a lot of information available or interest in it.”
Indergaard found resources to turn to and a treatment plan that made sense for her son, but then years later, Indergaard – a former critical care trauma nurse who made the first life flight from then-St. Luke’s Hospital in Fargo – became a professor at Concordia who eventually began teaching others about ADHD.
She's also the leader of the Red River Valley Satellite of Children and Adults with Attention Deficit Disorder (CHADD); the group recently started hosting events again last month, which was ADHD Awareness Month.
What’s the biggest misconception about ADHD that you’d like to set the record straight on?
ADHD is real. It is medically classified as a neurodevelopmental condition because it is brain-based. This means there are known biological differences (in structure, function, and chemistry) of the brains of people with ADHD, resulting in alterations that lead to under arousal of areas affecting self-regulation.
As a result, ADHD involves varying degrees of impairment with self-regulation of attention, impulses, activity levels, emotions, and is associated with executive function deficits.
While there is a wide range of symptoms and presentation, ADHD is classified into three types:
1. Predominantly Inattentive - difficulties with initiating, sustaining, and shifting focused attention and with filtering distractions
2. Predominantly Hyperactive Impulsive – difficulties in regulating activity levels and impulses
3. Combined Type - the person has significant features of both previous types.
ADHD is also a life-span disorder meaning it can and commonly persists into and through adulthood and if left untreated, it can cause significant issues, physically, professionally, and socially.
We also typically see ADHD diagnosed with other conditions, like anxiety, depression, and learning disabilities. In fact, only 30% of the time is a person diagnosed with only ADHD. So, a thorough assessment and the placement of a management (treatment) program is critical.
If a parent has concerns that their child may have ADHD, what do you recommend they do?
Start with your primary care provider and ask for an assessment, which involves a physical exam and detailed history (clinical interview) to determine if your child’s (or an adult’s) symptoms fit the diagnostic criteria and if so, how much they impact day-to-day function. There is no single test for diagnosing ADHD.
A physical exam is necessary because the symptoms could be related to something else, like a thyroid or sleep disorder. A thorough history (often used with behavioral checklists to document parent and teacher observations of behaviors) will help a provider establish a symptom profile or and the degree of what is known as clinically significant impairment, meaning symptoms are not an occasional nuisance or problem rather, they create marked challenges, impairment and distress in day-to-day life and prevail across the day, week or month in more than one setting.
People may be referred on to a psychologist, psychiatrist, or neurologist but you can always start with your primary care provider when seeking assessment for ADHD.
Can you talk about the issue regarding hidden signs of ADHD in girls and women?
ADHD in girls and women can present differently than in males. Often, girls present with inattentive type symptoms, which may go unnoticed. If hyperactive, their behaviors may be more hyperverbal or relational, rather than the classic picture of “bouncing off the walls”.
We also know that girls are better at masking their symptoms through behaviors such as perfectionism, people-pleasing, and overcompensation. They may look like everything is fine on the outside, but they are the ones who are “white-knuckling” it through their day, which is exhausting. They tend to internalize the stress, shame, and pressure, resulting in increased levels of anxiety and depression.
These female-associated factors can mean that the diagnosis of ADHD is missed. As a result, it is known that girls and women with ADHD are more frequently undiagnosed, misdiagnosed or diagnosed much later than males.
This gives more time for the stress-related issues with ADHD to take their toll, putting girls and women at higher risk for other mental health disorders (anxiety and depression), as well as self-harm or self-medication behaviors.
Is ADHD more prevalent now than it was in the past?
No. We just have much better awareness and diagnostic criteria now thanks to pioneers in ADHD research like Dr. Russell Barkley and Dr. Stephen Faraone. Research such as theirs helped refine the diagnostic criteria, so we are picking up on symptoms and issues better than we have in the past, although more work needs to be done.
Estimates are that almost 10% of the childhood population in the US has been diagnosed with ADHD, and Barkley highlights the significant problems associated with not being properly diagnosed or treated; he equates it to a public health issue because of evidence supporting potential long-term effects such as lost income, increases in substance use disorders and instability in completing education, holding down jobs, relationships and more.
While not everyone with ADHD will experience these outcomes, left untreated, ADHD can have a significant impact on one’s quality of life and achievement of goals. It is not a mere nuisance disorder. The good news is, treatment works and with appropriate medication, various evidence-based therapies, support, and structure, folks can thrive and achieve success while living with ADHD.
What is the best treatment option for ADHD?
Treatment for ADHD involves what we call a three-prong approach. These include: medications, therapy, and accommodations.
Medications help because they increase arousal levels in the affected brain. Taking stimulant medication for ADHD is not giving someone an advantage for performance; medications simply normalize the arousal levels to that of a neurotypical brain. We call that “leveling the playing field” so that affected individuals are able to function and perform to their unique ability.
When my son was diagnosed, the medical providers wanted to medicate him and initially, I didn’t want that. Once we realized how much better he could function on a daily basis with medication, we pursued that treatment plan.
It’s a personal choice whether to medicate a child with ADHD, but very important for parents to educate themselves first. These medications have been studied since the 1930s, they are safe, and they are 70-90% effective. That said, each child is different, and getting the medication right may involve some trial and error regarding the dosage as well as the right timing for the medication being delivered. They work well but getting them right can take time. When managed effectively by a knowledgeable provider, these medications provide optimal effects with the least amount of side effects.
Therapy can help individuals with ADHD (and their family members) manage emotions, process associated trauma, stress, and self-esteem issues, as well as develop important skills and strategies to improve problem areas in executive functioning.
ADHD Coaching, Parent Training, and school accommodations are all non-medical approaches that, when combined with effective medication treatment, help in day-to-day management and foster success in school, work and relationships.
What local resources can parents and educators turn to?
CHADD was started in the 1980s by a group of Florida parents, as a way to provide education and advocacy for their children with ADHD. It has grown into a leading national organization with a clearing house of best practices and evidence-based information, and over 200 local chapters.
Friend and local educator Stephanie Kautzman and I launched the Red River Valley CHADD in 2009. We’ve provided conferences, presentations, support groups, teacher and parent training over the years. Red River Valley CHADD is run solely by volunteers. A few years back we put the chapter’s activities on hold to attend to family and work responsibilities. We’ve started up again and will continue to provide monthly programming throughout the year.
We want people to know there is hope and help for ADHD and you can thrive with the right treatment and management plan in place. We are all becoming better educated about ADHD all the time, so no one needs to be afraid of a diagnosis.
Do not struggle alone – there are wonderful resources and treatment providers throughout our community who can help you negotiate the challenges whether you are a parent, grandparent, teacher, spouse or individual with ADHD. To quote ADHD author Ned Hallowell, “There is power in community and connection”. If you think you or a loved one may have ADHD, get diagnosed and get diagnosed now. If you have ADHD get treatment and get treatment now.
For more information about Red River Valley CHADD, visit https://www.chadd.net/chapter/336 or find them on Facebook as CHADD Red River Valley. November’s session topic will be “ADHD and Executive Function: What Gives?” Interested participants should check Facebook and the website for programming updates or reach out to the organization at redrivervalley@chadd.org.
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