ADHD

The text of this article was taken from an email interview with Dr. Pfeiffer for Bayousphere, a publication from the University of Houston – Clear Lake.

If a parent suspects his or her child might have ADHD, what tips do you have to help parents navigate the treatment maze?
Good question! We now know that ADHD has an early onset. In many cases, children with ADHD exhibit significant behavior-control problems as early as infancy. However, we also know that many young children display some of the symptoms of ADHD without meeting the full diagnostic criteria for the disorder. One study found 40% of 4-year-olds rated by parents and preschool teachers as displaying frequent symptoms of ADHD!

A parent who is concerned that his child might have ADHD should contact his child’s pediatrician and his child’s teacher. Both! Many pediatricians are now trained in developmental pediatrics and able to assist in making a diagnosis. However, for a diagnosis to be made, the ADHD-related behaviors must be observed in at least two different settings. In other words, it is not enough that a parent reports ADHD symptoms. The teacher must also be observing signs of high activity level, poor attention (particularly to group activities), impulsive behavior, and even, in some instances, aggressive behaviors.

A school psychologist can play a helpful role in assisting in the diagnosis. School psychologists are knowledgable in the use of rating scales that have been developed to quantify the behavioral characteristics of ADHD. These questionnaires are fairly accurate – they have what we call high test sensitivity and high test specificity.

It is important to remember that the child with ADHD must display ADHD symptoms across settings. This is known as the ‘cross-situational’ expression of the disorder ADHD. If a bright or gifted child only evidences ADHD-like symptoms in the classroom, but not in other settings, then the reason for the ADHD-like behaviors might be based on boredom and lack of intellectual stimulation.

How do you determine whether a child is gifted, ADHD or both? (The “symptoms” are very similar.)
I am not sure that I agree with the premise that the symptoms of giftedness and ADHD are very similar. Some gifted children appear to be overly excitable, driven to perfection, nonconforming, and strong-willed. I have frequently seen this in my private practice working with gifted children. And there is research to support this view. However, these are not the same “symptoms” as ADHD. ADHD-symptoms include inattentiveness, hyperactivity and impulsiveness, disorganization, difficulty waiting your turn, and being fidgety. These are not defining characteristics of a gifted child.

Are there tips and tricks you suggest for parents to try when the standard dos and don’ts are not working for a child with ADHD?
Behavioral interventions are very helpful; these are important tools in the parenting toolbox for any parent with a child with ADHD. Behavioral interventions are effective in the classroom and effective in the home (and on the playground and in other settings!). Token reinforcement procedures – involving the use of tokens or points based on positive behaviors – have been shown to be helpful with children with ADHD, particularly young children. In my consulting work, I have found it important for the parents and the school to be “on the same page” in terms of whatever behavioral plan is developed for the child with ADHD. This means that the parent and teacher need to understand the behavioral program, be consistent across settings, and dialogue on how it is working in each settings. Adjustments to behavioral programs are almost always the rule! Every child and every setting is different.

An exciting behavioral strategy gaining increasing popularity with children with ADHD is self-management. Self-management techniques usually include both behavioral principles and cognitive-based strategies. Many school psychologists are savvy in the use of self-management interventions and are available to consult with parents and teachers. Parents need to be prepared to experiment with different interventions – I advise parents that heavy dosages of patience, persistence, and optimism are invaluable in working with a child with ADHD! Each child is unique, and each child requires an intervention that is tailored or customized to their unique needs. In almost every gifted child with ADHD that I have consulted with, multiple interventions prove to be particularly beneficial.

If you could pick one thing that you wanted all parents dealing with a gifted child with ADHD to know, what would it be?
Children with ADHD, including gifted children with ADHD, face a number of real challenges. Parents need to understand that, in a great many instances, the symptoms of ADHD can be reduced and even fully held in check with a proper intervention program. However, professionals now believe that, in most cases, it is a lifelong disorder.

For further reading on twice-exceptionality check out these resources from the SENG website:
Gifted Students with Attention Deficits: Fact and/or Fiction? Or, Can We See the Forest for the Trees?

Attention deficit disorders and gifted students: What do we really know?

Before referring a gifted child for ADD/ADHD evaluation

The SENG Recommended Reading List Counseling, Multiple Exceptionality, and Psychological Issuessection.

The Misdiagnosis and Dual Diagnoses of Gifted Children and Adults

Steven Pfeiffer is a Professor in the Psychological Services in Education program in the Department of Educational Psychology and Learning Systems at Florida State University, and a practicing psychologist. He was recently elected to the SENG Board, and his term begins in January.

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