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Why ADHD Is on the Rise?
Statistics show that more children are being diagnosed with ADHD each year. Why? Read about possible explanations in Everyday Health’s exclusive expert roundtable discussion.
Everyday Health: Why are so many more children being diagnosed with ADHD now than in the past?
Steven Richfield, PsyD (parentcoachcards.com)
Child psychologist, Plymouth Meeting, Pa.; author of The Parent Coach: A New Approach to Parenting in Today’s Society
There is far greater awareness now of the signs and symptoms of ADHD because of in-service training for teachers and more enlightened parents. The emotional, educational, and social costs of undiagnosed ADHD are perhaps the biggest reasons that so many more kids are referred for evaluation. The lack of identification [of an ADHD diagnosis], proper educational planning, and treatment can be devastating for a child’s future.
Jacquelyn F. Gamino, PhD (brainhealth.utdallas.edu)
Research scientist, Center for BrainHealth, University of Texas, Dallas
The measures we currently have to diagnose ADHD are more sensitive than they used to be. Think about common ailments such as heart disease. Current medical practices make it much easier to detect and treat; the same is true of ADHD. We also know more about ADHD than before, so we can understand and recognize some of the symptoms more readily.
F. Allen Walker, MD (louisvilleadhd.com)
Board-certified psychiatrist, Louisville, Ky.
Many schools and teachers are not able to keep up with the different learning styles of students. Learning through imagination and creative curiosity (which I find inherent in kids with ADHD) is disappearing in many schools. At home, kids are allowed to spend too much time in sedentary activities and engaged in “screen time” (whether televisions, computers, or video games); in addition, many parents do not understand the importance of maintaining consistent boundaries. I feel everyone experiences symptoms of ADHD to varying degrees at some point during his or her life, and the current fast-paced culture seems to propagate the ADHD phenomenon.
L. Eugene Arnold, MD, MEd (psychmed.osu.edu)
Child & adolescent psychiatrist; professor emeritus of psychiatry, Ohio State University, Columbus
The main reasons are that the disorder is better recognized and that modern stress and the lack of structured discipline bring out the symptoms. But more cases of ADHD may result from things like environmental pollutants, a decrease in nutritional balance (because of food processing, fast foods, and additives), a lack of exercise, and the epigenetic consequences of early developmental experiences and exposures. Also, improved obstetrical care is saving more vulnerable birth-traumatized babies who in the past would have died. The downside of better recognition is the possible misdiagnosis of some who have other problems.
Common Theories About the Causes of ADHD
A variety of theories about the causes of ADHD have been proposed, including problem pregnancies and food additives. Discover what experts have to say about these theories.
Everyday Health: Why are there so many theories about the causes of ADHD? What are the most common?
Patricia O. Quinn, MD (addvance.com)
Developmental pediatrician; director, National Center for Girls and Women With ADHD, Washington, D.C.
ADHD is a brain-based condition and the result of problems with the transmitters that help relay messages in certain areas of the brain. But there may be several reasons that these brain areas are not functioning properly. ADHD tends to run in families, and several genetic variations have been found in different people. However, there does not seem to be one gene that is affected in all people with ADHD. We also know that an insult to the brain, either during development or later in life, can result in symptoms of ADHD. Many things can insult the brain, including infections (meningitis, encephalitis), toxins (low levels of lead or pesticides), poor nutrition (anemia, malnutrition); and problems during pregnancy (bleeding or maternal smoking) or after birth (prematurity).
Lawrence Diller, MD (docdiller.com)
Behavioral and developmental pediatrician and clinical therapist, Walnut Creek, Calif.; assistant clinical professor, University of California, San Francisco; author ofThe Last Normal Child, Running on Ritalin, and Should I Medicate My Child? (will be published in May 2011)
There are no biological tests or markers for ADHD. Because there are neither medical nor definitive psychometric tests, the causes of ADHD are open to varying interpretation. The ADHD diagnosis is a potential political football when it comes to etiology [causes]. The most widely held belief is that ADHD is genetic and biochemical — a disorder of the brain. However, that doesn’t mean that environment doesn’t play a role with regard to the expression and/or management of the problem behaviors of ADHD.
Erin N. King (schoolpsychologistfiles.com)
Nationally certified school psychologist, Virginia
Any disorder that does not have a known cause is open to a number of theories. People naturally want to know why, or want to feel as if it can be prevented in the future. Heredity is the most commonly accepted cause.
Eric Beam, PhD (Ask Dr. Eric)
Supervisor for school psychologists and speech language pathologists, Los Angeles County School District; Board of directors, California Association of School Psychologists
We’ve come a long way, but we still have a lot to learn. There are a lot of unconnected dots. This allows for a lot of theories to exist, and a lot of theoretical purists to act more like cultists than scientists. However, in time, the more that we learn and understand about ADHD collectively, the more the theories start to converge and overlap.
Barry Lessin, MEd [barrylessin.com]
Licensed psychologist and certified addictions counselor, Fort Washington, Pa.
Common theories of causation revolve around genetic (heritability), neurological (specific brain dysfunction — for example, of the frontal lobe), environmental (prenatal issues, diet, and so forth), and social factors. Also, because of the business aspect in the health care industry, competing interests exist among various disciplines/business sectors that provide treatment for ADHD and have a vested interest in their products and approaches.
Is ADHD Treatment Really Necessary for Children?
The decision to start children on drugs to treat ADHD can be tough for parents. Experts discuss the pros and cons of ADHD medication for children.
Everyday Health: How do you explain the value of treatment to resistant parents? For example, a parent might say, “I survived my childhood with ADHD — and I was never diagnosed or treated. Why does my child need ADHD treatment?”
Patricia O. Quinn, MD (addvance.com): When most people with true ADHD reflect on their childhood and adult years, they can appreciate the pain and suffering or lost opportunities in their lives. Most parents want what is best for their child, especially if their child is at a disadvantage or not able to live up to his or her potential because of a short attention span, distractibility, or disorganization. We have a fast-paced learning environment, and if a child is not paying attention, he or she misses out on a lot of skills (both academic and social). I always remind parents that they will never know how well their child can do (and how much easier life will be) until they undergo a trial period with an approved ADHD treatment.
Lawrence Diller, MD (docdiller.com): No parents I’ve ever met were initially enthusiastic with the notion of their children taking a psychiatric medication. Most parents are more open to considering a medication intervention after trying interventions other than drugs — like behavioral modification plans and educational interventions (effective parent/teacher strategies). Parents must consider the choice between using an effective, relatively safe medical intervention and an increasingly restrictive, potentially stigmatizing life for their child.
Eric Beam, PhD (Ask Dr. Eric): My personality is very bottom-line oriented, so I do better with these parents than the more touchy-feely practitioners. I don’t push for ADHD treatment; I push for results and for a plan that is calculated to improve outcomes. If parents ask me about medication, I will not share many opinions or answer many direct questions. However, I may help facilitate their ability to construct a set of questions to ask the appropriate medical practitioner. In the end, it’s not my decision.
Barry Lessin, MEd (barrylessin.com): Once I educate parents by giving balanced, quality information about what we now know — and don’t know — about ADHD and its successful treatment, the more willing they are to embrace treatment options. I work with the family to identify the child’s existing strengths and resources and to develop some behavioral strategies, built on these strengths, for them to use to improve the child’s condition. When parents are given hope and offered effective strategies for dealing with ADHD, they are usually more willing to enter into treatment.
The Challenges of ADHD at School
Children with ADHD need support at home and at school for proper treatment of the condition. How much help can parents really expect from teachers and administrators?
Everyday Health: What role does a child’s school play in helping him or her with ADHD?
Lawrence Diller, MD (docdiller.com): Coordination among a child’s family, doctor, and school is critical in any treatment plan. All potential ADHD children should have a minimum screening for learning or processing problems. Sometimes simply addressing these issues with small-group instruction can sufficiently highlightthe problem behaviors. Similarly, placement in the front of the class and behavior modification interventions — like a daily report card that rewards a child for getting to, sticking with, and completing a task — can reduce the need for medication or lower the necessary daily dose. Finally, feedback from the teacher is critical in determining the most effective daily dosage when using a medication intervention.
Eric Beam, PhD (Ask Dr. Eric): The school’s role is to teach well. First and foremost, students with ADHD need excellent teachers. They need to be engaged in learning, door-to-door and bell-to-bell. They need a structured external environment that offers the right combination of support and challenge. They need to be engaged through a variety of methods and modalities. In addition, students with ADHD often need to receive explicit instruction in certain skills that students are usually just expected to “pick up” along the way — social skills, study skills, time management and organization, and so on. Energy and concentration are precious commodities, and children only have so much that they can deliver in a given day. We need to be wise and strategic because concentration is even more limited when dealing with ADHD.
Barry Lessin, MEd (barrylessin.com): Effective treatment for ADHD is more likely when we take a comprehensive approach. A child’s academic world can be very different from the home environment. Success in school, then, is often contingent on coordinating treatment approaches and working with the school directly to develop an appropriate educational program for the child. The likelihood that a child will improve is greater when the school, family, and therapist are on the same page.
Patricia O. Quinn, MD (addvance.com): Schools and teachers play a critical role in both diagnosis and treatment. The first symptoms of ADHD usually appear or cause difficulty in the school environment. Teachers need to be knowledgeable about ADHD and aware of how symptoms show up in the school setting. They also need to be willing to refer a child for appropriate evaluation. Schools can help a child with ADHD by making the classroom feel safe; teaching organization, planning, and memory skills; and assisting the child in developing social skills. Teachers should avoid public shaming or criticism for not doing work, talking too much, or not turning in homework. Instead, they should design programs to help children with ADHD develop these skills.
Frank Barnhill, MD (drhuggiebear.com)
Board-certified family physician, Gaffney, S.C.
Teachers and the entire school experience must be supportive of the changes needed for effective therapy, whether drug therapy or behavioral therapy, in order for it to help the child reach his or her potential.
Alternative Treatments for ADHD
Which nondrug strategies work best for children with ADHD? Get expert advice on alternative treatments.
Everyday Health: Which nondrug strategies work best for children with ADHD?
Will Meek, PhD (willmeekphd.com)
Counseling psychologist; staff psychologist and director of Counseling Services at Washington State University, Vancouver; adjunct professor, Portland State University, Portland, Ore.
There are two essential components to successful nondrug treatment of ADHD. The first is self-regulation, which focuses on tolerance and the healthy expression of emotions, as well as impulse control. Mindfulness and exercise programs are two areas of note for building these skills. The second is the development of compensatory strategies for the way the ADHD brain works.
Stephanie Sarkis, PhD (stephaniesarkis.com)
Counselor, coach, Boca Raton, Fla.; author of Your Money: A Guide to Personal Finance for Adults With Attention Deficit Disorder (2009) and Adult ADHD: A Guide for the Newly Diagnosed (May 2011)
Counseling is an effective strategy, although studies show that medication and counseling are more effective together than either treatment alone.
Rory Stern, PsyD (thetruthbehindadhd.com)
Child and parenting coach, North Andover, Mass.
Nondrug strategies, or alternative treatments, are quite appealing in the world of ADD/ADHD treatment. But not all of the alternative/nondrug strategies are as sexy as they sound. Many of these alternative treatments require a lot more effort, persistence, dedication, commitment, devotion, and accountability than a prescription pill. That said, I am a huge supporter of implementing nondrug strategies, and I believe these are critical components of effective treatment (even necessary, particularly when medications are being used). The best nondrug strategies for children start with a strong foundation from the parents and family. I always encourage parents to see ADD and ADHD as a difference in brain wiring and not as a disorder or illness. With this approach in mind, we can then build on some of the more active nondrug strategies, including social skills training, study skills training, test-taking strategies, relationship strategies, working-memory training, positive sleep routine, and healthy diet and exercise routine.
Lara Honos-Webb, PhD (visionarysoul.com)
Clinical psychologist, Walnut Creek, Calif.; author of The Gift of Adult ADD andListening to Depression: How Understanding Your Pain Can Heal Your Life
One of the best strategies for a child with ADHD is to focus on the gifts the child already has. When you help children define themselves by their strengths rather than their weaknesses, they can gain confidence and the motivation for patching up the weaknesses of distraction and impulsiveness. Parents can often make small changes that will create big improvements in their child. A simple example is for parents to build emotional intelligence in their child by helping the child label and then let go of intense emotions. So, for example, if a child is picking on a sibling, a parent can say, “It’s okay to be mad at your sister, but it’s not okay to tease.” In this way the child learns to label and handle emotions rather than act them out impulsively.
Rhonda Pawlan, MS (coachmerhonda.com)
ADHD and life coach, Northbrook, Ill.
Because every child is unique, different strategies work better for different children. In general, though, some things that work well include routines (morning, bedtime, homework) and structure to help keep a child on task. The use of timers to remind the child to pay attention is also helpful, as are brightly decorated whiteboards to list tasks.
Linda Aber (lindaaber.com)
Certified Theraplay group specialist; certified family life educator; owner, Tac Tics Resource Services, Montreal, Quebec
Whether parents choose to use medication or not, the following practices benefit all children:
- Connection: The messages sent by parents need to encourage, support, and guide children as they traverse their developmental years. There is no stronger indicator of a child’s success than a parent who believes in him or her.
- Diet: It is very important to provide children with a diet of whole foods — avoiding junk food, sugar, additives, and dyes. A recent study in the medical journal The Lancet showed that additives can increase hyperactivity, so check labels on the foods you purchase. Many physicians recommend giving a daily fatty-acid supplement in the form of fish oil.
- Sleep: Studies reveal that many children with ADHD do not get enough sleep — this diminishes mental performance at school, creating behavioral problems in class.
- Exercise: Parents and teachers must never deny children participation in sports nor keep them in during recess. Many physicians agree that daily exercise continues to be a cornerstone of ADHD treatment.
- Structure: Establishing consistent rules and schedules both at home and at school helps children manage their daily tasks and activities and lowers their level of anxiety.
Jodi Sleeper-Triplett (jstcoach.com)
ADHD coach, Herndon, Va.; author of Empowering Youth With ADHD
The success rate of any strategy varies by factors such as age, commitment to the process, and level of hyperactivity or distractibility, and coexisting problems like learning disabilities, anxiety, depression, and OCD.
- ADHD coaching can address many of the challenges faced by young people with ADHD and may focus on supporting the young person in areas such as improving time management and organizational skills and establishing routines and good habits.
- Younger children who are not quite ready (emotionally or cognitively) for coaching can benefit from behavior therapy, also known as behavior modification. This therapy addresses specific problem behaviors at home, at school, and in social situations by structuring time, setting reasonable and clear limits, establishing predictability and routines, and increasing positive attention.
- Neurofeedback, a type of biofeedback, uses brain exercises to train the brain to reduce impulsivity and increase focus and attentiveness. The treatment is painless and has been shown in some studies to have lasting effects.
- Exercise increases energy and circulation and improves mood, enhancing the ability of children and adults with ADHD to focus. Deep breathing is a valuable tool in conjunction with exercise or as a stand-alone practice throughout the day. Children who stop to stretch and take a few deep breaths before transitioning to a new activity or task report a better sense of focus and well-being.
Can Bad Parenting Cause ADHD?
Experts agree that parenting plays a role in ADHD — but whether lack of discipline or lax parenting may cause the condition is still subject to debate.
Everyday Health: Can too little discipline or lax parenting cause ADHD? Why or why not?
Will Meek, PhD (willmeekphd.com): Part of what makes the picture of ADHD so confusing is that we still do not have an agreed-upon idea of what it is, or enough research to understand what causes it. Most people agree that there is some biological component that may express itself regardless of environment, while others propose that it is a vulnerability that surfaces based on things such as too much TV or permissive parenting. My personal view is that ADHD does have a strong genetic component and that lax parenting either exacerbates ADHD or causes behavior that looks similar to ADHD.
Stephanie Sarkis, PhD (stephaniesarkis.com): ADHD is a genetic and biological disorder. More than 10 genes have been identified as being linked to ADHD. There is nothing a parent can do to cause ADHD. Children with ADHD benefit from structure and positive reinforcement, so pay attention to what your child is doing well.
Rory Stern, PsyD (thetruthbehindadhd.com): Bad parenting, lack of discipline, and lax parenting cannot and do not cause ADD/ADHD. However, that does not mean such parenting styles do not contribute to the severity of the ADD or ADHD that appears in the child. That said, many people believe that children with ADD or ADHD need more discipline. This is simply not accurate. Rather, children with ADD or ADHD need a specific style of discipline that works with them and their biological differences rather than against them. Too many people want the child to change in ways that are not chemically, biologically, or neurologically possible. It’s the old forcing-a-square-peg-in-a round-hole debate. On the contrary, these children can be quite successful, but mentors and parents need to fully understand what they are up against.
Rhonda Pawlan, MS (coachmerhonda.com): Parenting does not cause ADHD. This is a neurobiological disorder, often inherited from a parent. However, parents who learn how to use effective strategies can help their child with ADHD fare better in the world.
Linda Aber (lindaaber.com): Symptoms of ADHD like distractibility, hyperactivity, impulsivity, inattention, disorganization, and forgetfulness are not the result of lax parenting. ADHD is a neurological, biochemical brain condition, a heritable trait that is influenced by genetics. The same genes also promote positive qualities, such as creativity, sensitivity, high energy, imagination, and persistence, as well as thinking that can be characterized as being “out of the box.” These strengths are the hidden gems that parents need to point out daily and celebrate with their children.
Jodi Sleeper-Triplett (jstcoach.com): Children and teens with ADHD benefit from added structure and daily routines, which can be difficult for some parents to implement. But lack of structure and discipline or lax parenting does not cause ADHD. Studies have shown that parenting style has no correlation with ADHD. There is some evidence, however, that having an ADHD child affects the quality of parental care. In one study, the quality of parenting improved after the child was treated with stimulant medication, which reflects the not surprising conclusion that raising an ADHD child is a challenge.
TV, Video Games, and ADHD
Too much screen time has been shown to affect a child’s behavior, but can it cause ADHD symptoms? Find out what experts have to say.
Everyday Health: Does watching too much television or playing video games cause ADHD symptoms?
Stephanie Sarkis (stephaniesarkis.com): ADHD is a genetic and biological disorder and is really an issue with motivation, not attention. Symptoms of ADHD can include inattention and hyperfocusing. That is why a child seems to be “inside” the TV or video game. When you need your child’s attention, instead of asking him or her repeatedly to turn off the TV, just go over and shut it off.
Robert F. De Maria, DC, NHD (druglessdoctor.com)
Author of Dr. Bob’s Series, including Guide to Stop ADHD in 18 Days
A study from the American Academy of Pediatrics shows that toddlers who watch videos may develop ADHD later in life. Children need to be outside playing, and not always in organized sports, but learning social skills with a pick-up game of kick ball or baseball or going fishing or riding a bike. Activity promotes life. Inactivity sabotages and stagnates optimal function of all cells in the body.
Lara Honos-Webb, PhD (visionarysoul.com): Research has shown a correlation between the amount of time spent watching TV and a diagnosis of ADHD. It is unlikely that TV watching causes ADHD, but it does cause many problems, including passivity, negative cognitive affects, and decreased sensitivity to violence. Parents should limit TV for these reasons. The correlation may reflect the fact that because ADHD kids are more difficult to manage, parents let them watch more TV or play more video games.
Rhonda Pawlan, MS (coachmerhonda.com): Absolutely not! Perhaps some people think there’s a connection because when a child with ADHD is watching TV or playing video games, he or she will hyperfocus and have difficulty stopping to do more important things, such as homework.
Linda Aber (lindaaber.com): Neither of these causes ADHD, yet it’s imperative that a child not become a couch potato or video potato. A lack of exercise is bad for the brain, and self-isolation causes social discord. Parents need to set strict time limits for computer and TV use. Children acquire skills such as reciprocity, turn taking, empathy, compromising, and negotiating from peer socialization. They need to acquire a “we” rather than a “me” mentality.
The ADHD-Diet Link
Pesticides, preservatives, and other food additives have been linked to ADHD in children. Find out about the connection between a poor diet and ADHD symptoms.
Everyday Health: What role does diet play in ADHD behavior?
Will Meek, PhD (willmeekphd.com): We do not know exactly how this works yet. However, it doesn’t take a psychologist to point out that food with low nutritional value and high sugar content can alter mood and attention. It certainly never hurts to be eating a well-balanced, healthy diet, rich in vegetables and lean meats.
Robert F. De Maria, DC, NHD (druglessdoctor.com): The body is dependent on whole-food nutrients and proper oils and fats. When improper foods are eaten — like trans fats, for example — the brain cannot send signals to the rest of the body effectively. This affects mood, behavior, and physical health. Eating poor-quality food is like putting low-octane gas in a car that needs premium.
Rory Stern, PsyD (thetruthbehindadhd.com): There’s not enough evidence that pesticides, preservatives, or other additives cause the condition; yet diet is an important factor in ADD/ADHD behavior. Sugar provides a very quick burst of energy and often leads to a crash soon after. For children with ADHD, this can be devastating, given the already complex variables and differences in the manner in which their brains operate and function with tasks of daily living. Because of this, a healthy diet can provide an excellent “alternative” or nondrug approach to managing ADHD symptoms. This is why we often suggest that a child start the day with protein (good sugars) instead of candy and junk food (bad sugars) to provide fuel to the brain and body.
Lara Honos-Webb, PhD (visionarysoul.com): While no research has found that a bad diet causes ADHD, a child who does not eat healthy food will have difficulty concentrating and staying in control of his or her behavior. Obvious problems are not eating breakfast, eating too much sugar or caffeine or too little protein, and other nutritional deficiencies.
Linda Aber (lindaaber.com): Some studies have found that behavior improved when food coloring and common allergens like corn, milk, eggs, wheat, soy, oranges, and peanuts were removed from the diet. It is wise to resist the intake of sugar from candy, soft drinks and fruit drinks, and frozen desserts — such foods may also contain preservatives and dyes. A diet of whole foods — along with fruits, vegetables, and omega- 3 fatty acids, found in salmon, trout, sardines, and fish oil capsules — plays a role in cognition and behavior.
Jodi Sleeper-Triplett (jstcoach.com): A healthy diet rich in protein, complex carbohydrates, and omega-3 fatty acids helps children and adults with ADHD increase focus and sustain attention. It’s been reported that a high-protein breakfast helps ADHD medication work more effectively throughout the day, which is very helpful for school-age children. Too much sugar and caffeine, and too many food additives or artificial ingredients, will zap energy and decrease a child’s ability to focus and perform effectively. Many children and teens experience a decreased appetite because of stimulant medication, so breakfast is essential. In addition, packing small, tasty, high-protein snacks instead of a full lunch will help with children’s focus throughout the day and keep them healthy.