When Kids Are Distractible or “Hyper”

When Kids Are Distractible or “Hyper”

“Our preschooler’s teacher has been hinting that he might be ‘hyperactive.’ She says it’s hard for him to sit still, he talks a lot without raising his hand, and he’s distracted by any little thing. At home, I have to constantly remind him to do things; he says he just forgets. He can play Nintendo for hours, but if he is supposed to practice his letters with me, it seems like it is torture for him to sit in the chair. Everyone is distractible, restless, or impulsive some of the time. And for a preschooler in particular, it’s normal to be sometimes forgetful, lost in the clouds, wild, jumpy, disinterested in routines, super-playful, silly, or fidgety. The question is, are these behaviors a problem for the child or for people around him or her?”

Perspectives on ADHD

One way to think about this topic is to imagine kids – or adults – on a spectrum in terms of three personal attributes: distractibility, restlessness, and impulsivity. As distractibility, restlessness, and impulsivity increase, around the 80th percentile – in the upper fifth or so of the population – we’d start to think about a child being “spirited.” As the intensity of these three characteristics increases further, at around the 95th percentile we’d start thinking about a child having Attention Deficit/Hyperactivity Disorder (ADHD).

The topic of ADHD is fairly controversial these days. There’s no controversy about the fact that individuals range on a spectrum of distractibility, restlessness, and impulsivity. What is controversial is what that spectrum means – and what to do about it.

In our view, there are plusses and minuses to just about any kind of temperament. We think of ADHD as a normal variation in human temperament, and that humans evolved to have a variety of temperaments in represented in the hunter-gatherer groups that our ancestors lived in for millions of years. Groups whose members had only cautious, conservative temperaments would not explore and take risks as much as they should – while groups with only spirited/ADHD members would not be as prudent and planful as they should be. The groups that would have the best odds of survival – and passing on their genes – would be the ones with a mix, a synergy of temperamental types.

So, in a sense, ADHD is normal. That six-year-old boy running around the playground, getting into a million things, full of spirit and passion, bored with schoolwork, driving his parents and teachers crazy . . . .would be on the fast track to becoming a mighty hunter or explorer – and admired and successful within his tribe – a hundred thousand years ago. But today, he’s sitting in the principal’s office because he just can’t hold it together to sit quietly at a desk for six hours a day.

In short, the “disorder” of ADHD is really a disorder of fit between perfectly normal – albeit inattentive, looking-for-action, intense, easily upset, on the move, impulsive, delightful, make-you-pull-your-hair-out – children and an environment that places historically unprecedented demands on young people (and grown-ups, too) to concentrate, sit still, and absorb streams of abstract material. These modern environments are recent, in the evolutionary time scale, and humans have not had time to adapt.

Some feel that ADHD has been long under-diagnosed. Others feel that children’s inability to pay attention, focus on their work, and control their bodies and impulses is usually due to psychological issues, including lax parenting. All kinds of secondary issues can get mixed up in the question of whether a child has ADHD: school district politics, fears of stigmatizing a child, moralistic views of child development, social agendas about “good old-fashioned parental discipline,” etc. We suggest focusing on the facts (what a concept), getting a good assessment (see below), and working on practical issues.

Bottom-line: ADHD is a concern, but it can be taken care of (see our next column). Unlike progressively worsening conditions like multiple sclerosis, ADHD usually gets better over the course of an individual’s development and often disappears entirely by adulthood.

Some Facts about ADHD

Fundamentally, ADHD involves weaknesses in regulation (of attention, activity, and desires). In a sense, someone with ADHD is like a big car with bicycle brakes. If the car is moving slowly or uphill, things work OK. If the car is moving quickly and/or the road is downhill, there’s a problem.

There are three types of ADHD

  • (A) Inattentive, distractible, hyperfocused, daydreamy: inconsistency in attention
  • (B) Impulsive, restless, hyperactive
  • Combined (A and B)

ADHD can vary in intensity from mild to moderate to severe. It can appear inconsistently, and in some settings more than others. It can change during a child’s development.

Common estimates are that approximately 5 to 10 percent of children have ADHD. This means that a typical class will have one to four children with ADHD. Boys are diagnosed with ADHD more than girls, although girls are probably underdiagnosed because their type of ADHD is often more daydreamy and less problematic for parents and teachers. ADHD often persists into adulthood, particularly inattention and impulsiveness.

ADHD is biologically based and studies have revealed a genetic link. It is not a character defect or personality flaw or motivated effort to drive parents and teachers crazy! A child’s environment can help or aggravate ADHD, but not create it.

There are many positive aspects typically associated with ADHD. These include high energy and enthusiasm, and above average intelligence, intuition, and creativity. People with ADHD are often lively and likable individuals. They are typically results-oriented, with a bottom-line focus.

Unfortunately, there are often aspects of ADHD that are problematic for children, parents, and teachers:

  • Inaccurate (often negative) opinions of self, others, and situations. Fix on one aspect of something, losing the big picture. Often misread social cues.
  • Forgetfulness. Poor organization. Rush through tasks. Procrastination and poor follow-through.
  • Want immediate rewards. Low tolerance of frustration or boredom. Impatient.
  • Intense kids who like high intensity situations. Get aroused (“hyped”) real easily; “hair-trigger gas pedals.”
  • Emotions on the surface. Easily hurt. Unstable moods. Background sense of unease, insecurity, or worry.

Other concerns are frequently associated with ADHD and are often the focus of parents and teachers. They include behavior problems, low self-esteem, underachievement at school, problems with peers, and risky behavior. These issues can mask underlying ADHD. Painfully, children with ADHD are often the target of physical and emotional abuse by parents and caregivers.

Children with ADHD can be termed “stupid,” “retarded,” “lazy,” or “flaky.” They can become the target and presumed culprit for family discord or classroom problems. A stressful and upsetting BIG STRUGGLE often revolves around a child with ADHD. It is important to allow the person with ADHD to step out of the “problem role.” The reactions of others can unwittingly maintain ADHD behaviors.

In a recent popular book about ADHD, Driven to Distraction, the author commented: “The picture of a young child who starts out well and then gradually sees his school performance tail off while teachers grow increasingly moralistic in their explanations should always suggest the possibility of ADHD.”

Assessment

The first step when ADHD is suspected should be assessment by a licensed psychotherapist and/or physician. School districts can sometimes help. A good assessment involves consultations with teachers and parents, review of school records, and observation of the child in natural settings. The most reliable diagnostic tool is the individual’s history. There is no single “test” for ADHD. ADHD should never be ruled out on the basis of testing or doctor’s office visits alone!

Sometimes other issues are primary and produce ADHD-like symptoms. Psychological issues include anxiety, depression, significant separation from parents, and family discord. Biological issues include intense allergies, chronic infections, seizure disorders, and hyperthyroidism. These other possibilities should always be ruled out through investigation by the applicable licensed professional.

ADHD and learning difficulties are statistically associated and can mask and exacerbate each other. If diagnosis is still unclear after assessment, address the ADHD and then see what learning disabilities remain; ADHD is the more general factor.

Care of ADHD

In our next column I will describe the care of ADHD. We use the word “care” instead of “treatment” because it is important to remember that there is a whole person suffering a condition not of his or her choosing.

In sum, we recommend four key elements in the care of ADHD

  • Education and understanding
  • Community and support
  • Holistic physical interventions
  • Psychological interventions within the child and at home and school

Please note that we have not mentioned Ritalin, which many people consider equivalent to a diagnosis of ADHD. Sometimes a fifth element — medication — may sometimes be called for in the care of a child, but only after the first four elements above have been thoroughly explored.

This is an article adapted from the book Mother Nurture by Rick Hanson, Ph.D., Jan Hanson, M.S. and Ricki Pollycove, M.D.

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Dr. Ramani Durvasula is a licensed clinical psychologist, author, and expert on the impact of toxic narcissism. She is a Professor of Psychology at California State University, Los Angeles, and also a Visiting Professor at the University of Johannesburg.

The focus of Dr. Ramani’s clinical, academic, and consultative work is the etiology and impact of narcissism and high-conflict, entitled, antagonistic personality styles on human relationships, mental health, and societal expectations. She has spoken on these issues to clinicians, educators, and researchers around the world.

She is the author of Should I Stay or Should I Go: Surviving a Relationship With a Narcissist, and Don't You Know Who I Am? How to Stay Sane in an Era of Narcissism, Entitlement, and Incivility. Her work has been featured at SxSW, TEDx, and on a wide range of media platforms including Red Table Talk, the Today Show, Oxygen, Investigation Discovery, and Bravo, and she is a featured expert on the digital media mental health platform MedCircle. Dr. Durvasula’s research on personality disorders has been funded by the National Institutes of Health and she is a Consulting Editor of the scientific journal Behavioral Medicine.

Dr. Stephen Porges is a Distinguished University Scientist at Indiana University, Professor of Psychiatry at the University of North Carolina, and Professor Emeritus at both the University of Illinois at Chicago and the University of Maryland. He is a former president of the Society for Psychophysiological Research and has been president of the Federation of Behavioral, Psychological, and Cognitive Sciences, which represents approximately twenty-thousand biobehavioral scientists. He’s led a number of other organizations and received a wide variety of professional awards.

In 1994 he proposed the Polyvagal Theory, a theory that links the evolution of the mammalian autonomic nervous system to social behavior and emphasizes the importance of physiological states in the expression of behavioral problems and psychiatric disorders. The theory is leading to innovative treatments based on insights into the mechanisms mediating symptoms observed in several behavioral, psychiatric, and physical disorders, and has had a major impact on the field of psychology.

Dr. Porges has published more than 300 peer-reviewed papers across a wide array of disciplines. He’s also the author of several books including The Polyvagal Theory: Neurophysiological foundations of Emotions, Attachment, Communication, and Self-regulation.

Dr. Bruce Perry is the Principal of the Neurosequential Network, Senior Fellow of The ChildTrauma Academy, and a Professor (Adjunct) in the Departments of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine at Northwestern University in Chicago and the School of Allied Health at La Trobe University in Melbourne, Australia. From 1993 to 2001 he was the Thomas S. Trammell Research Professor of Psychiatry at Baylor College of Medicine and chief of psychiatry at Texas Children's Hospital.

He’s one of the world’s leading experts on the impact of trauma in childhood, and his work on the impact of abuse, neglect, and trauma on the developing brain has impacted clinical practice, programs, and policy across the world. His work has been instrumental in describing how traumatic events in childhood change the biology of the brain.

Dr. Perry's most recent book, What Happened to You? Conversations on Trauma, Resilience, and Healing, co-authored with Oprah Winfrey, was released earlier this year. Dr. Perry is also the author, with Maia Szalavitz, of The Boy Who Was Raised As A Dog, a bestselling book based on his work with maltreated children, and Born For Love: Why Empathy is Essential and Endangered. Additionally, he’s authored more than 300 journal articles and book chapters and has been the recipient of a variety of professional awards.

Dr. Allison Briscoe-Smith is a child clinical psychologist who specializes in trauma and issues of race. She earned her undergraduate degree from Harvard and then received her Ph.D. in clinical psychology from the University of California, Berkeley. She performed postdoctoral work at the University of California San Francisco/San Francisco General Hospital. She has combined her love of teaching and advocacy by serving as a professor and by directing mental health programs for children experiencing trauma, homelessness, or foster care.

Dr. Briscoe-Smith is also a senior fellow of Berkeley’s Greater Good Science Center and is both a professor and the Director of Diversity, Equity, and Inclusion at the Wright Institute. She provides consultation and training to nonprofits and schools on how to support trauma-informed practices and cultural accountability.

Sharon Salzberg is a world-renowned teacher and New York Times bestselling author. She is widely considered one of the most influential individuals in bringing mindfulness practices to the West, and co-founded the Insight Meditation Society in Barre, Massachusetts alongside Jack Kornfield and Joseph Goldstein. Sharon has been a student of Dipa Ma, Anagarika Munindra, and Sayadaw U Pandita alongside other masters.

Sharon has authored 10 books, and is the host of the fantastic Metta Hour podcast. She was a contributing editor of Oprah’s O Magazine, had her work featured in Time and on NPR, and contributed to panels alongside the Dalai Lama.

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